Cross-sectional study to assess depression among healthcare workers in Lusaka, Zambia during the COVID-19 pandemic

Objectives We sought to assess depression among healthcare workers (HCWs) in the context of COVID-19 in Lusaka Province, Zambia. Design This cross-sectional study is nested within a larger study, the Person-Centred Public Health for HIV Treatment in Zambia (PCPH), a cluster-randomised trial to assess HIV care and outcomes. Setting The research was conducted in 24 government-run health facilities from 11 August to 15 October 2020 during the first wave of the COVID-19 pandemic in Lusaka, Zambia. Participants We used convenience sampling to recruit HCW participants who were previously enrolled in the PCPH study, had more than 6 months’ experience working at the facility and were voluntarily willing to participate. Primary outcome measures We implemented the well-validated 9-question Patient Health Questionnaire (PHQ-9) to assess HCW depression. We used mixed-effects, adjusted Poisson regression to estimate the marginal probability of HCWs experiencing depression that may warrant intervention (PHQ-9 score ≥5) by healthcare facility. Results We collected PHQ-9 survey responses from 713 professional and lay HCWs. Overall, 334 (46.8%, 95% CI 43.1%, 50.6%) HCWs recorded a PHQ-9 score ≥5, indicating the need for further assessment and potential intervention for depression. We identified significant heterogeneity across facilities and observed a greater proportion of HCWs with symptoms of depression in facilities providing COVID-19 testing and treatment services. Conclusions Depression may be a concern for a large proportion of HCWs in Zambia. Further work to understand the magnitude and aetiologies of depression among HCWs in the public sector is needed to design effective prevention and treatment interventions to meet the needs for mental health support and to minimise poor health outcomes.

Yıldırım, M., & Çiçek, İ. (2022) Optimism and pessimism mediate the association between parental coronavirus anxiety and depression among healthcare professionals in the era of COVID-19, Psychology, Health & Medicine, 27:9, 1898-1906, DOI: 10.1080/13548506.2021  Methods: what kind of analysis method did you used? Incorporate in the methods. Response: Thank you. We used descriptive analyses (e.g., frequency tables and bar charts), scatter plots of adjusted marginal probability, and mixed effects Poisson regression to estimate prevalence ratios for those with mild depression allowing random effects at the facility level and measured fixed effects for month of survey and clinic size category. These are included in the abstract and methods section. Results: "as well as preventative 16 interventions, to minimize the possibility of poor health outcomes" this phrase indicates the recommendations. Therefore, after conclude your results insert this phrase. Remove from the results. In addition, if you have any variable which are significant predictor for depression you can narrate it in the results. Response: We have made the revision according to the feedback provided. We do not however, have any additional variables which are significant predictor of depression such as sex, age, and type of cadre for Health Care Workers. These were not collected to protect the privacy of our study participants. We acknowledge this as a limitation to the study and it has been highlighted in the limitations sections. Conclusion: conclude your finding based on your results. Some words also need consistent" wellbeing or depression or mental health disorder or mental health problems" in all over your document. Response: We have revised the conclusion based on the feedback. We have also revised the text in the document and maintained the word depression for consistency and to be reflective of the tool (Patient Health Questionnaire -PHQ-9) that we used assess depression among Health Care Workers, in Lusaka, Zambia Introduction Citation line 41. Response: We have included the citation to the sentence in the introduction.
Methods: why poison regression? Did you assessed predictors? How did you see the profession of HCW? Frontline or not? Unit of HCW (ICU, OPD, ward)? What does mean lay HCW? Response: • We used Poisson regression because our data is count data and this model would is ideal for predicting the frequency of occurrence of eventin this case depression. • Assessing predictors: We looked at associations between facility and survey date. We did not collect individual-level demographics, including specific department or cadre (e.g., frontline/OPD) or link lay versus professional status to individual responses to protect privacy in this sensitive research topic. We note this as a limitation in our manuscript. We • We revised our study population section to better specify professional versus lay HCW roles: "The PCPH sample was comprised of both professional HCWs including nurses, pharmacists, midwives, medical doctors, radiographers, and lay HCWS including treatment supporters and general workers." Editor(s)' Comments to Author (if any): -Please revise the title of your manuscript to include the research question, study design and setting. This is the preferred format of the journal. Response: We have revised the title of the manuscript according to feedback provided. The revised title is "A cross sectional survey to assess depression among Health Care Workers in Lusaka, Zambia during the COVID 19 pandemic." -Please ensure that your abstract is formatted according to our Instructions for Authors: https://nam12.safelinks.protection.outlook.com/?url=http%3A%2F%2Fbmjopen.bmj.com% 2Fpages%2Fauthors%2F%23research&amp;data=05%7C01%7Cjmpry%40ucdavis.edu%7C43 5839f7c1064d389b4208dad16b7d4c%7Ca8046f6466c04f009046c8daf92ff62b%7C0%7C0%7 C638052556837102378%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV 2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C3000%7C%7C%7C&amp;sdata=v6pHxNAefX Djkv9NXGff1GtWLefVANGg9kAY%2BVqMZvw%3D&amp;reserved=0 Response: We have revised the outline of the abstract according to the guidelines provided.
-Please revise the 'Strengths and limitations of this study' section of your manuscript (after the abstract). This section should contain up to five short bullet points, no longer than one sentence each, that relate specifically to the methods. The novelty, aims, results or expected impact of the study should not be summarized here. Response: We have included the strengths and limitations of our manuscript according to the feedback. End itemized review response.

GENERAL COMMENTS
Congratulations for this valuable and impressive work.

GENERAL COMMENTS
I thank you for giving the chance to reviewing this paper." Dear authors of this manuscript, I have read your paper in detailed. I have observed several studies conducted in this area. Your paper missed the predictors that affect the depression in this population. Your references are also not updated. In addition, I have missed the new variables or concepts that your study added for the scientific worlds. Many thanks, again, for your positive assessment of the work.