Psychological impact of managing COVID-19 patients among doctors: A pre- and post-survey study


  • Amber Tahir, MBBS, FCPS-I (Psychiatry)
  • Anaam Bugti, MBBS, FCPS-I (Psychiatry)
  • Ayesha Sarwat, MBBS, MCPS (Psychiatry), FCPS (Psychiatry)
  • Azizullah Khan Dhiloo, MBBS, FCPS (Medicine), FCPS (Infectious Diseases)
  • Mahnoor Yousif Shaikh, MBBS


anxiety, COVID-19 pandemic, depres¬sion, healthcare providers, severe acute respiratory syndrome coronavirus 2, stress, post-traumatic stress


Objective: In any struggling healthcare system, it is always the frontline workers—doctors, nurses, and paramedical staff – that are affected first. This study aimed to assess the psychological impact—anxiety, stress, depression, and post-traumatic stress disorder (PTSD) —among doctors working in COVID-19 wards and the underlying triggers in a public hospital in Karachi.

Methods: Pre- and post-survey methodologies were adopted. Post-graduate trainees working in COVID-19 isolation facilities from April till September 2020 were interviewed before starting their one-month rotation and after completing it. The psychological impact was assessed using two standard instruments—Depression Anxiety and Stress 21 (DASS-21) and the Impact of Event Scale-Revised (IES-R). Data were entered and analyzed through SPSS version 22.0.

Results: For 100 doctors, the mean score for stress, anxiety, stress, and depression on DASS-21 and PTSD on IES-R significantly increased after the rotation (p < 0.01). The mean score of depression and IES-R was higher in younger (<28 years) doctors (p ≤ 0.05). Married doctors scored higher on anxiety and IES-R (p ≤ 0.05). Doctors who were not willfully performing their duties scored worse on all measures of DASS-21 and IES-R (p < 0.01). Doctors facing family resist­ance scored significantly higher on stress, anxiety, and IES-R (p < 0.01).

Conclusion: Working in COVID-19 facilities is imparting a negative impact on the psychological health of doctors. Healthcare administration should be aware of this psychological distress and should introduce mental health aid at administrative levels to prevent a mental health epidemic among care providers.

Author Biographies

Amber Tahir, MBBS, FCPS-I (Psychiatry)

Resident Psychiatrist, Department of Psychiatry, Dow University of Health Sciences, Karachi, Karachi City, Sindh, Pakistan

Anaam Bugti, MBBS, FCPS-I (Psychiatry)

Resident Psychiatrist, Department of Psychiatry, Dow University of Health Sciences, Karachi, Karachi City, Sindh, Pakistan

Ayesha Sarwat, MBBS, MCPS (Psychiatry), FCPS (Psychiatry)

Associate Professor, Department of Psychiatry, Dow University of Health Sciences, Karachi, Karachi City, Sindh, Pakistan

Azizullah Khan Dhiloo, MBBS, FCPS (Medicine), FCPS (Infectious Diseases)

Assistant Professor, Department of Infectious Diseases, Dow University of Health Sciences, Karachi, Karachi City, Sindh, Pakistan

Mahnoor Yousif Shaikh, MBBS

Dow Medical College, Dow University of Health Sciences, Karachi, Karachi City, Sindh, Pakistan


World Health Organization: Rolling updates on corona virus disease (COVID-19). Available at Accessed May 14, 2020.

World Health Organization: WHO extends support to Pakistan as it confirms its first two cases of COVID-19. 2020. Available from: Accessed May 14, 2020.

Government of Pakistan: COVID-19 Health Advisory Platform by Ministry of National Health Services Regulations and Coordination. 2020. Available at Accessed December 14, 2020.

Hassan A, Mahmood K, Bukhsh HA: Healthcare system of Pakistan. Int J Adv Res Publ. 2017; 1: 170-173. Available at

Bhatti MW: Pakistan has lost 42 doctors among 58 healthcare providers to COVID-19. The News. 2020. Available at Accessed December 14, 2020.

Rana W, Mukhtar S, Mukhtar S: Mental health of medical workers in Pakistan during the pandemic COVID-19 outbreak. Asian J Psychiatr. 2020; 51: 102080. DOI:10.1016/j.ajp.2020.102080.

Lovibond SH, Lovibond PF: Manual for the Depression Anxiety & Stress Scales (2nd Ed.). Sydney: Psychology Foundation, 1995.

Christianson S, Marren J: The impact of event scale-revised (IES-R). Medsurg Nurs. 2012; 21(5): 321-322.

Lai J, Ma S, Wang Y, et al.: Factors associated with mental health outcomes among health care workers exposed to coronavirus disease 2019. JAMA Netw Open. 2020; 3(3): e203976. DOI:10.1001/ jamanetworkopen.2020.3976.

Liu S, Yang L, Zhang C, et al.: Online mental health services in China during the COVID-19 outbreak. Lancet Psychiatry. 2020; 7(4): e17-e18. DOI:10.1016/S2215-0366(20)30077-8.

Xiao H, Zhang Y, Kong D, et al.: The effects of social support on sleep quality of medical staff treating patients with coronavirus disease 2019 (COVID-19) in January and February 2020 in China. Med Sci Monit. 2020; 26: e923549. DOI:10.12659/ MSM.923549.

Wong TW, Yau JK, Chan CL, et al.: The psychological impact of severe acute respiratory syndrome outbreak on healthcare workers in emergency departments and how they cope. Eur J Emerg Med. 2005; 12(1): 13-18.

Pappa S, Ntella V, Giannakas T, et al.: Prevalence of depression, anxiety, and insomnia among healthcare workers during the COVID-19 pandemic: A systematic review and meta-analysis. Brain Behav Immun. 2020; 88: 901-907. DOI:10.1016/j.bbi.2020.05.026.

Rodríguez-Rey R, Garrido-Hernansaiz H, Bueno-Guerra N: Working in the times of COVID-19. Psychological impact of the pandemic in frontline workers in Spain. Int J Environ Res Public Health. 2020; 17(21): 8149. DOI:10.3390/ijerph17218149.

Wilson W, Raj JP, Rao S, et al.: Prevalence and predictors of stress, anxiety, and depression among healthcare workers managing COVID-19 pandemic in India: A nationwide observational study. Indian J Psychol Med. 2020; 42(4): 353-358. DOI:10.1177/0253717620933992.

Brooks SK, Webster RK, Smith LE, et al.: The psychological impact of quarantine and how to reduce it: Rapid review of the evidence. Lancet. 2020; 395(10227): 912-920. DOI:10.1016/S0140- 6736(20)30460-8.

Galbraith N, Boyda D, McFeeters D, et al.: The mental health of doctors during the COVID-19 pandemic. BJPsych Bull. 2020. DOI:10.1192/bjb.2020.44.


How to Cite

Tahir, MBBS, FCPS-I (Psychiatry), A., A. Bugti, MBBS, FCPS-I (Psychiatry), A. Sarwat, MBBS, MCPS (Psychiatry), FCPS (Psychiatry), A. K. Dhiloo, MBBS, FCPS (Medicine), FCPS (Infectious Diseases), and M. Y. Shaikh, MBBS. “Psychological Impact of Managing COVID-19 Patients Among Doctors: A Pre- and Post-Survey Study”. Journal of Emergency Management, vol. 19, no. 9, July 2021, pp. 91-97,