Asian Journal of Healthy and Science p-ISSN: 2980-4302
e-ISSN: 2980-4310
Vol. 2 No. 8 August 2023
OVERVIEW OF THE CAUSES
OF ANXIETY FOR HEALTH WORKERS
IN HOSPITALS DURING THE COVID-19
PANDEMIC: SYSTEMATIC REVIEW
Noelio Auxilio Pedro Martins,
Levi Anatolia S. M. Exposto, Santiago
Jorge Pereira, Rogerio Fontes
Universidade da Paz, Dili, Timor-Leste
Email: noelmartins1997@gmail.com, bebretelevi@yahoo.com,
boruanan729@gmail.com, rogeriofontes643@gmail.com
Abstract
Health workers play an important role in handling
COVID-19 which has to deal with patients who continue to arrive, claiming many lives and
even uncertain when it ends, so they experience psychological problems
including anxiety. High anxiety can make
the body's resistance decrease as a result of the risk of contracting COVID-19. Knowing
the description of the causes of anxiety experienced by health workers
in hospitals during the COVID-19 pandemic. This research design is literature review with a systematic review approach. Secondary data sources in the form of articles
are taken from three data
bases (PubMed, ProQuest and Google Scholar). The
criteria for articles reviewed
are a publication period of 5-10 years, in Indonesian and English, original
articles and available in full text.
Articles that deserve
to be reviewed are 10 articles,
namely two in Indonesian and eight articles in English. The factors causing
anxiety of health workers are mostly social factors. The dominant biological factors causing anxiety are age and sex. The psychological factor causing anxiety is the frequency of suspected infection either health
workers themselves, family or colleagues.
Social factors causing anxiety are the availability of PPE, both social and hospital support and the position of
health workers in the workplace (frontline). The causes of anxiety in hospitals are biological factors,
psychological factors and social factors.
Therefore, health care workers improve their ability to provide services and work in accordance with established
operational standards so as to reduce anxiety
experienced.
Keywords: anxiety; health workers in hospitals; covid-19
pandemic
INTRODUCTION
Coronaviruses
are a large family of viruses that
cause deadly diseases. There are at
least two types of coronavirus that cause severe symptoms
such as Middle East Respiratory
Syndrome (MERS) and Severe
Acute Respiratory Syndrome (SARS).
The risk of death of SARS
cases is 10% death, MERS is 35%, while the coronavirus
is only 3% (Larassaty, 2020). The World Health
Organization (WHO) has officially declared the COVID-19
coronavirus a pandemic
(Sebayang, 2020). This disease has
disturbed the world because
of the rapid and cross-country increase in the number of cases. Total COVID-19 cases as of September 19, 2020, globally
confirmed 30.9 million cases with 960 thousand cases of death (CFR 3.10%). The highest
number of COVID-19
cases in the United States is 6.9 million cases with 203 thousand deaths
(CFR 2.93%). COVID-19
cases in Indonesia are 240,687 people with 9,448 deaths (CFR 3.93%) (Bramasta, 2020). The number of COVID-19
cases in Central Java Province was confirmed at 19,531 cases with 1,790
deaths (CFR 9.17%).
The data shows that the COVID-19 mortality
rate in Indonesia (3.93%), especially
Central Java Province
(9.17%), exceeds the world CFR (3.10%) (Tanggap
COVID-19 Prov Jateng, 2020). Patients positive for coronavirus (Covid-19) infection can have severe and burdensome symptoms
if they have comorbidities or comorbidities (Farid, 2020).
The patient died preceded by comorbidities and COVID-19 worsened
the body's resistance (Kemenkes, 2017). COVID-19 causes death in people with serious pneumonia (14%), in respiratory and multiorgan system failure
(5%). The fatal ratio of COVID-19
in patients with cardiovascular disease (eg ischemic heart disease, stroke, heart disease
due to high blood pressure) is 10.5%, the ratio of corona patients over the age of 80 years confirmed
to die is 14.8% (Ridhoi, 2020).
Groups with a very high risk of exposure
to COVID-19 are health workers
who care for COVID-19
patients, especially health
workers (Hamdi, 2020).
Health
workers play an important role and are at the forefront of handling COVID-19. They must be ready to be placed in any condition and anywhere. Power health is required to provide extra services for patients at risk of exposure to COVID-19. The surge in cases has put health workers
under great pressure for a long time (Raharjo, 2020).
In addition, the workload of health workers
becomes irrational (Asmara, 2020). Health workers do extra emotional work and have to suppress
their own feelings. They have to deal with COVID-19 coronavirus patients
who continue to arrive,
claiming many lives
and even uncertain when it ends. This creates
psychological problems for health workers (Arif, 2020). Psychological problems
experienced include stigmatization, depression and anxiety (Chen, et.al., 2020).
Anxiety is indicated by the vague worry felt by a person with feelings of uncertainty
and helplessness (Stuart, 2014). The psychological response experienced by health workers to infectious disease
pandemics is increasing because it is caused
by feelings of anxiety about one's own health and the spread
of families. Panic
and fear are part of the
emotional aspect, while the mental or cognitive aspect is the emergence
of disturbances to attention, worry, irregularity in thinking, and feeling irregular,
so that from this Covid-19 incident, health workers feel depressed and worried
(Chen, et.al., 2020). Excessive anxiety can have a detrimental impact on the mind and body and can even cause physical
illness (Cutler, 2014). High anxiety can make
the body's resistance decrease, so health workers are at risk for contracting COVID-19 (Passarella, et.al,
2020). Excessive anxiety and not treated quickly
and well can have an adverse
effect on the quality of care (Liu,
et. al, 2020). Mental health
problems are also reported to affect the attention, understanding,
decision-making, and ability of
health workers (Kang, et. al, 2020). The
impact of anxiety experienced by
health workers in dealing with COVID-19 can be prevented by knowing early the cause of anxiety itself.
The
causes of anxiety experienced by a person include biological,
psychological
and social factors (Stuart,
2014; Kaplan dan Sadock,
2015). Social factors cause health workers,
especially health workers,
to experience anxiety, one of which
is due
to high job demands,
including long working
hours, the number of patients
increases, the more difficult
it is to get social support because of the stigma of society against
frontline workers (Inter-Agency
Standing Committee (IASC), 2020).
Many health workers have anxiety disorders, because they not only bear the workload,
high risk of
infection, and prolonged fatigue, thus leading to an increased risk of
infection, therefore, it is very necessary for health workers and policy makers to
pay attention to protection factors
and successful adaptation processes to the conditions of the Covid-19 pandemic for health workers (Taghizadeh,et.al, 2020). Factors
that also influence anxiety
in health workers
are biological and psychological factors.
Biological factors that cause anxiety in health workers include
self-protective equipment that limits movement, lack of information
about long-term exposure to infected
people (Inter-Agency Standing Committee (IASC), 2020). Psychological factors that cause health workers to experience anxiety include fear that frontline
workers will transmit Covid-19
to friends and family because of their field of work (Inter- Agency Standing
Committee (IASC),
2020).
RESEARCH METHODS
The research design that will be used in this study is literature review with a systematic review approach. The keywords in this literature review are "COVID Health Care Worker
Anxiety", "Coronavirus Health
Care Workers
Anxiety", COVID nurse anxiety",
"COVID Medical Workers Anxiety" and "COVID-19
Anxiety Healthcare Workers ". Secondary
data sources in the form of articles
or journals using data bases are
PubMed,
ProQuest and Google Scholar. Criteria for selected journals, one year journal publication period in 2020,
Indonesian and English, health workers in hospitals, Google scholar, PubMed, Proquest with plagiarism-free conditions, original research articles (not
research reviews) and available full text,
causes of anxiety experienced by health workers
in hospitals during
the COVID-19 pandemic.
Figure
1.
Article
Search Process
RESULT AND DISCUSSION
The results of the review article show that the factors causing
anxiety experienced by
health workers in hospitals during the COVID-19 pandemic are mostly
social factors. The results of the review article show that the biological
factors causing anxiety experienced by health
workers in hospitals during the COVID-19 pandemic are age, family status, gender,
marital status, personal
resilience, suspected signs
and symptoms. The results of the review article show that psychological
factors that cause anxiety
experienced by health workers in hospitals during the COVID-19 pandemic are patient honesty,
self-efficacy, frequency of suspected infection, frequency of suspected family
infection, frequency of suspected colleagues infected, vulnerability to emotions, conflicts with colleagues /
patients. The results of the review article show that social factors that cause anxiety experienced by health workers
in hospitals during the COVID-19
pandemic are the availability of PPE, knowledge,
types of labor professions, work status of health workers, types of hospitals,
positions at work (frontline), direct contact with the patient, hospital position, type of patient treated,
position at work, length of service, working
time/length of hours, social support,
organizational support (hospital), position at
work, behavior of people around.
The factors causing anxiety experienced
by health workers in hospitals during the
COVID-19 pandemic are mostly social factors. Social factors that cause anxiety in
health workers in hospitals during the COVID-19
pandemic include the availability of PPE, knowledge
(Fadli, et.al, 2020), Types of Health Worker Professions, Status of Health Workers (Yang et al.,
2020), type of hospital, position at
work (frontline)
(Lai, J., et.al, 2020), direct contact with the patient, hospital position
(Hubei), type of patient treated (Liu,
Yang, dan Zhang, 2020), Position at work (Rossi et al., 2020), Working period, working time / length of working hours
(Li et al., 2020), social support, organizational support (RS) (Labrague & De los Santos, 2020), posisi di tempat work, availability of PPE, behavior of people around (Huang et al., 2020), PM-3
(Zhao et al., 2020).
The biological factors that cause anxiety experienced by health workers
in hospitals
during the COVID-19 pandemic are most age, family status (Fadli, et.al, 2020),
gender (Lai, J., et.al, 2020), age, gender
(Rossi et al., 2020), gender, age, Marital status (Li et al., 2020),
Personal resilience (Labrague &
De los Santos, 2020), age, suspected signs and symptoms
(Huang et al., 2020) and age (Zhao et al., 2020). The
causes of anxiety experienced by a person include biological factors
(Stuart, 2014). Biological factors are more often
associated with genetic factors, because genetic factors have an important role in the
development of anxiety disorders. In addition,
a number of neurotransmitters and norepinephrine in the brain also play a role in anxiety disorders. The biological
contribution explains anxiety derived from family
genetic influences and the influence of neurotransmitters in the brain. The three main neurotransmitters associated
with anxiety are norepinephrine, serotonin and Gamma-Aminobutyric Acid (GABA). Biological factors include genetic
predisposition, irregurity
in neurotransmitter function, and abnormalities in brain pathways that
signal danger (Nevid,
2015).
One of the biological factors causing the most anxiety experienced by health workers
in hospitals during the COVID-19 pandemic is age. Age had an influence on anxiety (p = 0.030), with almost
all ages either =30 years (39.1%) or >30 years (26.1%) experiencing mild anxiety
(Fadli, et.al., 2020). Young age is the age when the
brain develops by cell division, the formation of new connections between
cells, and breaking connections that are not needed at the cellular
level. Brain development is very important to be able to perform its functions optimally, one of its functions is to control anxiety (Nevid, 2015).
The biological factor that causes anxiety experienced by health workers
in hospitals during the COVID-19 pandemic
is most gender.
Gender factors have an influence
on anxiety (p = 0.001), where male health workers who experience anxiety as many as 66 people (22.5%) while female as many as 299 people (31.0%) (Lai, J., et.al,
2020). Anxiety occurs more in women. Women have high levels of anxiety due to
excessive autonomic nerve reactions with increased sympathetic systems, increased norepinephrine, increased release of cotekalamine, and abnormal
serotonergic regulatory disorders
(Kaplan dan Sadock, 2012).
The psychological factor that causes
anxiety experienced by health workers in hospitals during the COVID-19 pandemic is
patient honesty (Fadli, et.al, 2020), efikasi diri
(Suhamdani, et.al, 2020) and the frequency of suspected infection,
the frequency of suspected family
infection, the frequency of suspected colleagues being infected (Yang et
al., 2020), susceptibility to emotions
(Huang et al., 2020) and conflicts with colleagues/patients (Zhao, et.al, 2020). The causes of anxiety
experienced by a person include psychological factors (Stuart,
2014). Viewed from the
aspect of psychoanalysis, anxiety can arise due to unconscious impulses
(for example: sex, aggression, and threats) that enter the conscious.
Ego debriefing mechanisms that are not entirely successful can also
generate floating anxiety. Shift reactions
can result in phobic reactions. Anxiety as an emotional
conflict that occurs between two elements of personality, namely the id
and the superego. The id
represents instinctual drives and
primitive impulses, while the superego
reflects conscience and is controlled
by cultural norms. The ego and I, mediate the demands of these two opposing elements, and the
function of anxiety is to remind the ego that
there is danger (Kaplan dan Sadock, 2015).
Social factors that cause anxiety in health workers in hospitals during
the COVID-19
pandemic include the availability of PPE, knowledge (Fadli,
et.al, 2020), Types
of Health Worker Professions, Status of Health Workers (Yang et al., 2020), type of hospital, position at work (frontline) (Lai, J., et.al, 2020), direct contact with the patient, hospital position (Hubei),
type of patient treated (Liu, Yang, dan Zhang, 2020),
Position at work (Rossi et al.,
2020), Working period, working time / length
of working hours (Li et al., 2020), social support,
organizational support (RS) (Labrague & De los
Santos, 2020), position at work, availability of PPE, behavior of people around (Huang et al., 2020), PM-3 (Zhao et al., 2020). The causes of
anxiety experienced by a person
include social factors (Stuart, 2014). Emotions can occur
due to frustration, pressure, conflict or circumstances that he thinks
are not liked by others who are
trying to pass judgment on his opinions. Anxiety arises from feelings of fear of disapproval and interpersonal
rejection. Anxiety is also associated with the
development of trauma, individuals with low self-esteem are
especially prone to severe anxiety
(Stuart, 2014). Social factors include
stimulation, reward or punishment, motivation, family, peers, stress, love, affection,
quality of interaction.
CONCLUSION
The factors causing anxiety experienced
by health workers in hospitals during the
COVID-19 pandemic are mostly social factors. The biological factors that cause anxiety experienced by health workers in
hospitals during the COVID-19 pandemic are
most age, and gender. The most dominant psychological factor causing anxiety experienced by health workers in hospitals during
the COVID-19 pandemic
is the frequency of suspected infection, both
health workers themselves, family and
colleagues. The most dominant social
factors causing anxiety experienced by health workers in hospitals during the COVID-19 pandemic are the availability
of PPE, both social and hospital support and the position of health workers in the
workplace (frontline).
Health workers should increase
compliance in the use of personal protective
equipment and establish good relationships with patients and colleagues
so that emotions can be controlled, physical immunity is maintained and mental in handling patients with COVID-19 so that health
workers' anxiety can be controlled. Health workers should improve spirituality in accordance
with their beliefs, improve the ability
to provide services and work in accordance with established operational standards so as to reduce anxiety experienced.
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Copyright holders:
Noelio Auxilio Pedro Martins, Levi Anatolia S. M. Exposto, Santiago
Jorge Pereira, Rogerio Fontes (2023)
First publication right:
AJHS - Asian Journal of Healthy and Science
