The results of an online study conducted by L V Prasad Eye Institute (LVPEI) in collaboration with the All India Ophthalmological Society (AIOS) and The George Institute for Global Health, India to evaluate the psychological impact of the COVID-19 crisis on trainees and practising ophthalmologists in India during lockdown demonstrated that a significantly high proportion of ophthalmologists were affected psychologically as they are at an increased risk of close contact with the patient’s eyes and face.

The findings of this study are in consonance with studies done globally on health workers which have shown that the mental health impact of COVID-19 is very high and it needs to be addressed immediately.   

COVID-19 outbreak has affected millions globally, both physically and mentally, causing psychological impact such as stress, anxiety, depression, insomnia, denial, anger and fear. Psychological implications can be attributed to direct or indirect effects of the illness on livelihood and living conditions. Asymptomatic transmission of the disease causes fear and anxiety. In addition, lack of personal protective equipment (PPE) and social discrimination increases the stress and anxiety levels among healthcare professionals.

Stigmatization of health care professionals during an epidemic is common. There is a need for personalized mental health care from psychologists and psychiatrists, especially for those with moderate/severe depression and/or suicidal/self-harm ideations. This study showed that even the health workers who are not in the forefront of COVID-19 care and at less risk of being affected are suffering mental health consequences due to multiple factors.  

Dr Rohit C Khanna, Epidemiologist and Director – rural eyecare services, L V Prasad Eye Institute said, “The national and state ophthalmology societies, health administration, and the government should be cognizant of the need to support the mental health of all the healthcare workers, and not only those in the frontline of the management of COVID-19 infection.”

Pointing out that mental health was a very challenging and unaddressed issue during COVID-19, Dr Pallab Maulik, Deputy Director, and Director of Research at The George Institute for Global Health, India, said “what we see in this study among a group of ophthalmologists is just the tip of the iceberg. Health care workers including doctors and nurses in general and other frontline health workers are facing huge mental health challenges during this pandemic and the stigmatisation just adds to their woes”.       

The survey was completed by 2,355 ophthalmologists and ophthalmologists-in-training in the age group of 25 to 82 years. Depression was significantly higher in younger ophthalmologists. It was also higher in non-practicing ophthalmologists, as also those who were considerably worried about their training or professional growth, and those with difficulty in meeting living expenses.

Overall, the results indicated that 765 (32.6%) had some degree of depression; mild: 504 (21.4%), moderate: 163 (6.9%) and severe: 101 (4.3%). Seventy-five (3.2%) ophthalmologist had suicidal/self-harm ideations during more than half of the period over the last two weeks. This was much higher than the 10% prevalence for common mental disorders reported from general population in India. The high level of depression could be due to a generalized pervading climate of uncertainty among the ophthalmologists, triggered by the limitations in training and job security; fear factor as COVID-19 can cause severe symptoms in a segment of infected individuals; limited knowledge and availability of personal protective equipment (PPE); lack of adequate care in hospitals; and a shortage of ventilators and intensive care unit beds if someone were to contract the disease. It could also arise out of a fear of carrying infection to the family members at home, including the elderly and sick. Finally, the entire situation has implications on the career in intermediate term, as the patient volume in most of the eye hospitals is expected to decrease significantly, thus impacting their financial sustainability and the quality of training.

The survey was done using Patient Health Questionnaire-9 (PHQ-9), a self-report measure used to assess the severity of depression over the prior two weeks. The survey was designed to understand the status of the mental health of ophthalmologists and possibly use the data to design policies and programs and provide useful solutions.  

The research was conducted primarily by Dr Rohit C Khanna, Dr Santosh G Honavar, Asha Latha Metla, Amritendu Bhattacharya, and Dr Pallab K. Maulik.