COVID-19 disrupted the whole world at the beginning of 2020 and was recognized as a pandemic by the World Health Organization on March 11, 2020. It impacted the economy, social life, and education and overwhelmed the health-care systems around the world with a flood of patients including many deaths. The uncertainty of the disease affected the psychological well-being, social, and working life of millions of people across the world. Evidence suggests that people who are kept in isolation and quarantine experience significant levels of anxiety, anger, confusion, and stress. Fear of the unknown nature of the virus and the outcome of infection can lead to mental disorders. The situation is occurring in Malaysia as well and is similarly alarming.
Studies have also shown that the academic world is a highly stressful occupation. Reports from the UK, China, and India all show that a large proportion of academic and related staff found their work stressful. According to the United Nations Educational, Scientific, and Cultural Organization, the pandemic has interrupted the learning of more than one billion students in 129 countries around the world. The lockdown has caused lecturers to stress from having to adapt to provide online classes in record time. This stress has often been accompanied by symptoms of anxiety, depression, and sleep disturbance as a consequence of the increased workload and work from home.
A few studies pertaining to the prevalence of depression, stress, and anxiety have been conducted among lecturers in Malaysian medical universities. Such research is timely and important. Hence, this study aims to extend the existing literature by evaluating the impacts of the COVID-19 pandemic and the subsequent lockdowns on the sociopsychological well-being and anxiety among Malaysian medical university lecturers, during this pandemic using few tools that measure mental health and correlate the findings of these different tools.
A cross-sectional study was conducted among the faculty members in International Medical University (IMU) in Malaysia from July 26, 2021, to October 26, 2021. All faculty members working at the university were asked to participate. A randomized controlled trial method was used in selecting the respondents. A research randomizer, a computer-based special tool to generate sets of random numbers, was used in this study so as to ensure that all academicians who were eligible for the study had an equal probability of being selected. The randomization of the participants will take place after recruiting the subjects through convenient sampling. The inclusion criteria include Malaysia medical university lecturers who are competent in English language, experiencing none to severe stress, anxiety, or depression based on Depression, Anxiety, and Stress Scale (DASS)-21 score and those who are not IMU faculty members, nonEnglish competent, and experiencing extremely severe stress, anxiety, or depression based on DASS-21 score were excluded from the study.
To determine the sample size needed for the study, a sample size calculator obtained from OpenEpi© was used. Permission to carry out the study was obtained from the Research Ethics Committee of IMU. We have followed CONSORT guidelines for our study design. The study will be conducted by adhering to the Declaration of Helsinki.
The participants were e-mailed the preintervention questionnaires in Microsoft Forms through their university e-mail or WhatsApp. They were asked to complete questionnaires on their sociodemographic and work details, DASS-21, Satisfaction with Life Scale (SWLS), and Brief Resilience Scale (BRS). Self-administered preintervention questionnaires were distributed directly to the respondents through e-mail or WhatsApp. To maximize the response rate, a written notice and verbal reminder by phone were made to the nonrespondents 2 weeks after the initial distribution of the questionnaires.
Qualitative study will be assessed based on participants’ feedback on their user experience. This will be included in the postintervention questionnaire.
This study recruited 70 academic faculty members from all IMU campuses across Bukit Jalil, Seremban, Batu Pahat, and Kluang. They were reached through e-mails and Microsoft Teams. A webinar on mental health resilience was carried out by the ThoughtFull team and the research team as a platform to introduce our research project and to recruit participants. Faculty members who were interested in taking part in the project were required to complete a Google Form that included the DASS-21, SWLS, and BRS.
The metrics used in the questionnaire are DASS-21, SWLS, and BRS. The questionnaire was carried out in English since it is a widely spoken language in Malaysia and the language of choice used as a medium to communicate at IMU.
The Depression, Anxiety, and Stress Scale-21 items
It is a self-report scale to measure anxiety, depression, and stress. Each of the main scales contains seven subscales which sum up to 21 subscales. The sum scores for each scale (anxiety, depression, and stress) were categorized into normal, mild, moderate, severe, and extremely severe based on Lovibond and Lovibond severity ratings. There are some terms which we thought that needed further understanding was described within brackets (in the questionnaires) according to Macmillan dictionary as an alternate explanation.
The Satisfaction with Life Scale
It is a five-item scale with each using a seven-point Likert-type scale. The sum scores on each item were categorized into extremely satisfied (31–35), satisfied (26–30), slightly satisfied (21–25), neutral (20), slightly dissatisfied (15–19), dissatisfied (10–14), and extremely dissatisfied (5–9).
The Brief Resilience Scale
Each item has a five-point Likert-type scale. The score of the six items was totaled up and divided by the number of questions answered. The score was interpreted based on the recommended range which is low resilience (1.00–2.99), normal resilience (3.00–4.30), and high resilience (4.31–5.00).
We carried out a pilot study of the questionnaire among the research team and academic staff who were not included in the study population to make sure if the questions were understood well and met the correct perception. Most of the participants understood the context well and were able to answer the questionnaires within 5 min.
The collected data were exported from Microsoft Form in Google Sheets and analyzed using the IBM Statistical Package for the Social Sciences (SPSS) Version 126.96.36.199 (190) (IBM Corp, Armonk, NY).
Descriptive statistics were calculated for the sociodemographic factors of the participants. Pearson Chi-square for qualitative variables was used to study the association between the three instruments (DASS-21, SWLS, and BRS) and participants’ sociodemographic factors. For each outcome, P values were considered significant if the values were <0.05.
There were 70 IMU faculty members who responded to our questionnaires. Table 1 presents the sociodemographic characteristics of the respondents. The sample largely comprises females (60%), aged between 25 and 64 years old (85.7%), and married (82.9%). The nationality of the respondents is separated into two major categories which are Malaysian (54.3%) and others (45.7%).
The majority of our respondents have a high level of education with graduated masters (58.6%) and Ph.D (32.9%). In terms of income status, we categorize the respondents into B40 (<RM4849), M40 (RM4850-RM10959), and T20 (>RM10959) by following the income range set by the department of statistics, Malaysia in 2019.
The prevalence of depression, anxiety, and stress among faculty in IMU was measured using DASS-21, and the results are shown in Table 2. The majority of our participants are in prevalence of depression, anxiety, and stress was 32.9%, 42.8%, and 40%, respectively. Ten percent were either slightly dissatisfied or dissatisfied with life and 10% had high resilience.
There was no correlation between all the demographic factors we recorded for depression, anxiety, or stress. Younger adults below 65 years were significantly more satisfied with life (P = 0.03).
There were also differences regard resilience. Men were noted to have higher resilience compared to women and those above 65 years old were more resilient than younger adults. Individuals who were married also show higher resilience compared to the singles (P = 0.002).
We noted four similar studies among adults and academics regard DASS-21 scores [Table 3].
It is clear that there appears to be a wide variation of depression (10.9%–42.5%), anxiety (22.8%–67.8%), and stress (5%–70.7%) even if we consider studies only during the COVID pandemic [Table 4]. With that wide variation, we cannot say that is any difference when compared to the study in 2012 in the prepandemic era. If there is to be any difference noted, it is that stress is higher in the studies in the pandemic era but considering the variations noted this cannot be certain.
However, a study was done in Spain among university lecturers in 2020 also noted an increase of stress in the faculty members. Some of the important factors are changes in teaching methodology with reported difficulties related with the adaptation to the new system and technologies, poor class dynamics, and heavy workloads. The inability to hold practical classes, which is essential in medical education has been shown as a disadvantage. The lack of interaction between lecturers and students has also been revealed as one of the stress factors.
The study which noted the lowest rates of depression, anxiety, and stress which was conducted in Universiti Teknologi MARA (UITM) in 2020 was among academicians and nonacademicians. Academic face more challenges than nonacademicians, and medical educators perhaps more so as reported in study of a private medical college in Pakistan. A similar study in Iran also shows the high levels of stress among almost all faculty members in three different medical schools.
The study with the highest prevalence of depression, anxiety, and stress was conducted during the first phase of the COVID-19 pandemic Movement Control Order. It was cross-sectional across all 15 states in Malaysia conducted in 2020. This may indicate that in the early phase, depression, anxiety, and stress rose and have returned to lower levels with time in 2021.
The study conducted in Hospital Universiti Sains Malaysia and Universiti Kebangsaan Malaysia Medical Centre was among the university health-care workers in July 2020, about 5 months after the first Movement Control Order. The studies show that the prevalence of depression, anxiety, and stress is slightly lower compared to our study. The timing of our study, it should be noted, coincided with the wave of COVID-19 which cause the highest number of cases and death in Malaysia, beginning in May 2021.
In regards to the SWLS, our study showed that academic staff have a high level of life satisfaction evidenced by a mean score of 26.6 (SD=5.43) [Table 2]. The maximum sum score for SWLS is 35.A similar study was conducted by Universiti Teknologi MARA, Penang in 2005 noted a mean score of the Life Satisfaction score was 4.61 (SD=1.05) for academic staff and 4.82 (SD=1.03) non-academic staff. They analysed according to the likert scale 1-7 and the mean values suggested that the staff were moderately satisfied with their life. That study however, showed that the older age group had higher life satisfaction compared to the younger age group.
We found significant demographic factors for resilience. However, this should be further clarified by more studies focusing on the generation instead of age groups. Furthermore, our study showed that married couples have a higher resilience and this could be due to having consistent partner support and sense of security [Table 5].
Strength and limitation of the study
Our study had several strengths by providing baseline data on the threshold of the DASS-21 score among the faculty members in a medical university. DASS-21 is a widely used instrument, and these findings can be compared with other studies as we have done. It also records data as baseline for intervention which we intend to do following this. The timing of our study during a pandemic that has disrupted life and created new normal will be useful for future reference.
One limitation is that this study only involved one medical university and may not be generalized. Second, our studies did not look into the details of other stressors such as the working environment, job satisfaction, and family-related factors that would have contributed to the results. These factors are important and should be included in the future studies. Third, we have a small sample size which may have limited the reliability and variability of the study.
All in all, this study shows that the recent Movement Control Order (MCO) for COVID-19 has greatly affected the mental health of university lecturers. DASS-21 was used, and depression, stress, and anxiety were all prevalent among university lecturers. A satisfaction with life study conducted showed that age is a factor linked to satisfaction with life. The BRS study conducted also showed that age and gender were factors that affected resilience.
The findings we got from this study can assist the management of the university to form effective strategies in helping faculty to manage depression, anxiety, and stress and also increase their mental resilience. Satisfaction with life can also be looked into as this is also very important in these troubling times.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
Special thanks to ThoughtFull World Pte. Ltd. for supporting this study.
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