The effect of the COVID-19 pandemic on the mental health of obstetrics and gynaecology trainees: a world-wide literature review

Figures & data

Table 1. Results: studies using validated questionnaires (n = 8).

Author	Sample size and population	Tools used	Key findings
Gunasekera et al. (2022) UK	177 O&G trainees	GAD-7 PHQ-9	(1) There were three times as many trainees (20.9%) with moderate to severe anxiety compared to the UK population estimates (7%). (2) Similarly trainees were twice as likely to have moderately severe and severe depression (9%) compared to the general UK population (4%). (3) Within the study population, median GAD 7 score was 7 (mild) and the median PHQ-9 was 6 (mild).
Prasad et al. (2021) India	96 O&G trainees	DASS-21 Stress DASS-21 Anxiety DASS-21 Depression K-10 ISI FCV-19S	(1) O&G residents within this study demonstrated significant levels of suffering from stress (66.7%), anxiety (68.7%) and depression (61.5%). This is in stark contrast to studies conducted in other medical health workers where the prevalence of stress, anxiety and depression were 9.5%, 19.5% and 17%, respectively. (2) According to K-10, 57.3% of residents showed features of distress. (3) The ISI highlighted that 65.6% of residents suffered from insomnia. (4) On the FCV-19 scale, the mean score was 18.79 ± 6.782 suggesting residents generally had a mild to moderate level of fear from COVID-19.
Zoorob et al. (2021) USA	179 (all specialty trainee doctors although O&G trainee specific metrics present)	RSWBI BRS	(1) 24% of O&G residents were deemed at risk (RSBWI ≥5) of burnout, medical errors and suicidal ideation. O&G residents reported significantly higher RSWBI scores. (2) 8.9% of O&G residents reported low resilience scores (BRS<3). (3) Females showed disproportionately lower scores in both tools compared to their male counterparts.
Piccolo et al. (2021) Italy	169* O&G HCPs (consultants, trainees, midwives grouped together)*	GHQ-12	(1) 51.5% of respondents had a GHQ-12 score of ≥3 (clinically significant psychological distress). (2) Females were twice more likely than men to have a GHQ-12 score of ≥3.
Al Zarooni et al. (2023) UAE	105* (all specialty HCPs) (O&G consultants & trainees grouped together)*	GAD-7 PHQ-9	(1) Compared to other specialties, O&G doctors reported the highest mean score for depression (21 ± 0) and anxiety (20 ± 0). (2) Moderate anxiety risk was mostly noted in O&G doctors (18.3%) when compared to other specialties.
Vafaei et al. (2020) Iran	130* O&G HCPs (trainees and Med students grouped together)*	PHQ-9 SF-36 (Mental)	(1) The mean PHQ-9 score for O&G Residents and medical students was 8.6 ± 6.8, which was higher than that for O&G Consultants (7.4 ± 5.7). (2) Incidence of depression negatively correlated to all domains of SF-36 (Mental) – Social functioning, energy/fatigue, limitations due to emotional problems and emotional well-being.
Harzif et al. (2022) Indonesia	169 O&G trainees	GAD-7 PHQ-9 PCL-C-17	(1) Although the results in this study showed a lower value than previous studies, particularly in the outcome of anxiety and depression, 31.3% of participants still reported decreasing morale during the pandemic. (2) Prevalence of psychological trauma with severe symptoms was mostly found in trainees at higher level of training.
Yaunin et al. (2021) Indonesia	448 (all specialty doctors of which 63 were O&G)	DASS-42 Stress DASS-42 Anxiety DASS-42 Depression	(1) With regards to the various DASS-42 subscales, 16.9% had clinically significant depression, 15.6% had clinically significant anxiety and 24.4% struggled with stress.

Table 2. Results: studies using non-validated questionnaires (n = 7).

Author	Sample size,n (population)	Tools used	Contribution to mental health stated	Key findings
Afridi et al. (2023) Pakistan	98	5-Point survey Multiple choice	Yes	(1) 51% of respondents claimed a significant negative impact on mental health and 42.9% said some negative impact on mental health (2) 86.7% were most fearful of infecting their families, and this was followed closely by the fear of isolation (37.8%), fear of being socially stigmatised (11.2%) and fear of death (11.2%). (3) 78% of trainees suffered due to inadequate opportunities for elective surgeries. (4) The largest challenge reported by 85% of trainees was the inability to practice social distancing in the workplace.
Bitonti et al. (2020) Italy	476	45-Point survey Multiple choice	Yes	(1) 96% of respondents reported a negative impact on their mood and 84% had fears about the future. (2) More than 50% reported anxiety relating to the pandemic and 79% felt that they suffered from an irreversible training compromise.
Duggan et al. (2022) UK	67	36-Point survey 5-Point Likert scale Free text comments	No	(1) 60.3% of respondents reported an ongoing negative impact on their mental health.
Gothwal et al. (2022) India	280	Survey point not stated Multiple choice Variable Likert scales	Yes	(1) 78.9% of trainees reported anxiety due to fear of contracting virusand due to discomfort of PPE. (2) 96.1% of trainees reported fear of COVID-19 transmission to family. (3) 82.8% reported a negative impact on their mood. (4) 87.1% expressed anxiety relating to their professional futures.
Mallick et al. (2021) UK	87	33-Point survey 3-Point Likert scale	No	(1) 77% of respondents reported a negative impact on their wellbeing.
Bahat et al. (2020) Turkey	253	79-Point survey Multiple choice	Yes	(1) 78.2% of trainees felt anxious when caring for COVID-19 patients and 64.8% reporting falling into ‘despair’ during the pandemic. (2) 74.4% of trainees were afraid of getting sick.
Wådell et al. (2022) Sweden	162	28-Point survey Multiple choice	Yes	(1) 44% of respondents had either slightly or very increased stress levels during the pandemic.

Figure 1. World map showing countries of origin of the 15 articles on COVID-19 and mental health of O&G trainees. Closed circle depict studies using validated questionnaires (n = 8) while crosses indicate studies using non-validated questionnaires (n = 7).

Gunasekera, A., et al., 2022. Did the COVID-19 pandemic affect mental health, training progression and fertility planning of Obstetrics and Gynaecology trainees? A survey of London trainees. Journal of Obstetrics and Gynaecology Research, 48 (4), 1026–1032.

 PubMed Web of Science ®Google Scholar

Prasad, S., Mahato, C., and Magon, N., 2021. Psychological impact of COVID-19 on obstetrics and gynaecology residents in India. International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 10 (7), 2785–2794.

 Google Scholar

Zoorob, D., et al., 2021. Insight into resident burnout, mental wellness, and coping mechanisms early in the COVID-19 pandemic. PLOS One, 16 (4), e0250104.

 PubMed Web of Science ®Google Scholar

Piccolo, L.D., et al., 2021. The psychological impact of COVID-19 on healthcare providers in obstetrics: a cross-sectional survey study. Frontiers in Psychology, 12, 632999.

 PubMed Web of Science ®Google Scholar

Al Zarooni, A.A.R., et al., 2023. Impact of COVID-19 on depression and anxiety among healthcare professionals in Abu Dhabi. PLOS One, 18 (3), e0282198.

 PubMed Web of Science ®Google Scholar

Vafaei, H., et al., 2020. Obstetrics healthcare providers’ mental health and quality of life during COVID-19 pandemic: multicenter study from eight cities in Iran. Psychology Research and Behavior Management, 13, 563–571.

 PubMed Web of Science ®Google Scholar

Harzif, A.K., et al., 2022. Social factors influence on anxiety, depression level and psychological trauma of obstetrics and gynecology residents during COVID-19 pandemic. Heliyon, 8 (12), e12271.

 PubMed Web of Science ®Google Scholar

Yaunin, Y., et al., 2021. The mental health impact of the Coronavirus disease-19 pandemic on resident doctors at M. Jamil Hospital Padang, Indonesia. Open Access Macedonian Journal of Medical Sciences, 9 (T3), 330–334.

 Google Scholar

Afridi, F., et al., 2023. Personal, professional, and educational challenges faced by the postgraduate residents of gynecology and obstetrics in Peshawar during Covid-19 pandemic. Journal of Medical Sciences, 31 (1), 1–7.

 Google Scholar

Bitonti, G., et al., 2020. Being an obstetrics and gynaecology resident during the COVID-19: impact of the pandemic on the residency training program. European Journal of Obstetrics, Gynecology, and Reproductive Biology, 253, 48–51.

 PubMed Web of Science ®Google Scholar

Duggan, I., et al., 2022. The impact of COVID-19 on O&G trainees; where are we now? Facts, Views & Vision in ObGyn, 14 (1), 69–75.

 PubMed Web of Science ®Google Scholar

Gothwal, M., et al., 2022. Impact of COVID-19 pandemic on obstetrics and gynecology residency training program in India: a National Online Survey. Journal of Obstetrics and Gynaecology Research, 48 (7), 1955–1960.

 PubMed Web of Science ®Google Scholar

Mallick, R., et al., 2021. The impact of COVID-19 on obstetrics and gynaecology trainees; how do we move on? Facts, Views & Vision in ObGyn, 13 (1), 9–14.

 PubMed Web of Science ®Google Scholar

Bahat, P.Y., et al., 2020. Evaluating the effects of the COVID-19 pandemic on the physical and mental well-being of obstetricians and gynecologists in Turkey. International Journal of Gynaecology and Obstetrics, 151 (1), 67–73.

 PubMed Web of Science ®Google Scholar

Wådell, M., et al., 2022. Challenges imposed by the COVID-19 pandemic on the obstetrics and gynecology residency program: a mixed-methods Swedish survey in the COPE Staff Cohort Study. BMC Medical Education, 22 (1), 602.

 PubMed Web of Science ®Google Scholar

Data availability statement

The authors confirm that data supporting the findings of this study are available within the article.