Background:

Recently, we have been devastated by the coronavirus-2019 (COVID-19) pandemic. Globally, there is a huge fight against coronavirus by frontlines fighters and number of cases and mortality is growing number of areas, including Ethiopia(1). 

Most people infected with the COVID-19 virus will experience mild to moderate respiratory illness and recover without requiring special treatment.  Older people, and those with underlying medical problems like cardiovascular disease, diabetes, chronic respiratory disease, and cancer are more likely to develop serious illness(2).

Today's increased global mobility has exceedingly provoked new outbreaks causing the public to worry about becoming infected. Police officers have a higher risk of getting infected as one of frontline fighter involved directly or indirectly in the pandemic response(3). The occupation by itself is the most mentally challenging due to rotating shifts, threats of violence, and increased need for hypervigilance(4, 5).

Police services or military units charged with civil policing have to enforce and monitor these restrictions. These frontline fighters will have obligation to do over time and responsibly even during the time of pandemic with high risk of their life(6, 7). psychological problems, anxiety, depression, and sleep problem among police officers may be most commonly expected problems(3, 8).

Since the outbreak of the COVID-19 pandemic, many researchers have evaluated the physical and mental health issues among the health care workers (9-12), there is little systemic study involving the police personnel. During the current pandemic, police personnel are one of frontline fighters who is in added risk of getting infected as well as infecting own family members.

The main purpose of the study is to measure the prevalence and severity of anxiety, depression, sleep status, and coping among the police officers in Dessie town all who were in duty at the time of data collection.

Methods

This is a cross-sectional study among frontline police officers. Data were collected from June 20 and July 10, 2020 in Dessie town during the COVID-19 pandemic. We distributed self-report questionnaires to police officers who were in duty after informed consent was received from police officers.

Study participants

Participating police officers included all police officers of age greater than 18, who were on duty at the time of data collection in Dessie town.

Sample size determination and Sampling procedures

To determine the sample size, single population proportion formula was used to determine the sample size and a prevalence of 50% was taken as there was no earlier study done. Assuming 5% margin of error, 95% CI, and 10 % contingency for non-response rate; the final calculated sample was found to 423.

For sampling procedure we used convenience sampling since we can’t find exact number of police officers in Dessie town and we tried to include from all type of police officers who were on duty at the time of data collection.

Materials

The questionnaire consisted of socio-demographic characteristics, psychological tools. To screen depression we used the Patient Health Questionnaire (PHQ-9) which has 9-items and a total score ranging from 0 to 27. A total score will be classified as 0-4, 5-9, 10-14, 15-19, and 20-27 indicates minimal depression, mild depression, moderate depression, moderately severe depression, and severe depression respectively. It have been validated in Ethiopia with Amharic version with Cronbach’s alpha of 0.85(13).

To assess general anxiety we used Generalized Anxiety Disorder-7 (GAD-7), 7-point item questionnaire and each has a 4-point likert scale which ranges from 0-3. A total score ranges from 0-21 and Scores of 5-9, 10-14, and 15-21 represents cut points for mild, moderate, and severe anxiety, respectively(14).

To screen for insomnia we used Insomnia Severity Index (ISI) has 7- item questionnaire with a 5-point likert scale ranges from 0-4. A total score ranges from 0-28. Scores of 0–7, 8–14, 15–21, and 22–28 indicates  No clinically significant insomnia, Sub threshold insomnia, Clinical insomnia (moderate severity), and Clinical insomnia (severe)(15).

To screen coping status of participants we used Brief Resilient Coping Scale: it has 4-item and Scores of 4-13 points, 14-16 points, and 17-20 points are cut points for low resilient copers, Medium resilient copers, and High resilient copers(16).

Oslo Social Support Scale (Oslo-3):  used to screen the availability of social support. It is a 3 items questionnaire which ranges from scores 3-8 poor support, 9-11 moderate support 12-14 strong support(17).

Statistical data analyses

Continuous were summarized as mean values and standard deviation.  And categorical variables were summarized as frequency (percentage). Model assumptions were cheeked then univariate and multivariate linear regression analysis model was fitted to identify the relationship between socio-demographic factors and dependent variables (depression, anxiety, and sleep problems). Statistically significant differences were identified as a two-sided P-value <0.05.

Results
Demographic Characteristics

From all participants 385 participants were included in the final analysis, with a response rate of 91%. Of the total sample, most of the participants (84.2%) were male, and the mean age was 34 with 7.42 SD; This study all police officers reported as they or their family members have no history of being quarantine or being infected with COVID-19. Of the total number of respondents, 197(51.2) live alone, 156(40.5) live with family members, and 32(8.3) live in apartments. The Majority of police officers are single 266(69.1%) and 14(3.6%) are widowed/divorced. From all the participants 19(4.94%) have a history of chronic medical illness, either hypertension, diabetic mellitus, cardiac illness, or asthmatic illness (Table 1).

Table: 1 Socio-demographic data participants and binary linear regression analysis of depression, anxiety and sleep problem.

Prevalence of Depression, general Anxiety, Insomnia, and coping status of police officers

The prevalence of symptoms for psychological problems among the total sample was 28.9% (95% CI, 26.5%-30.2%) have depression, with 19.7% mild depression,7.3% moderate depression, 1.6% moderate-severe depression, and 0.3% severe depression. 30.2% (95% CI, 28.2%-33.0%) have anxiety, with 22.1% mild anxiety, 2.6%moderate anxiety, and 5.5% severe anxiety. 15.9% (95% CI, 13.5%-17.2%) for insomnia. Almost all participants have good knowledge of COVID-19 transmission and pandemic (Table: 2).

Table: 2 prevalence report of participants knowledge about COVID-19,  coping, depression,  general anxiety, and insomnia

Factors Associated with of Depression, general Anxiety, Insomnia, and coping status

In the multivariable analysis, being younger age, sex, marital status, having chronic diseases, coping, and social support were found to be associated with the of depression, general anxiety, and insomnia. Male gender and coping score of participates displayed a higher risk for depression, and general anxiety, and marital status for insomnia (Table: 3).

Table: 3 Multivariate analyses of factors related to depression, anxiety, and insomnia

Male Individuals showed 0.312, 0.865, and 0.035 times reduction in depressive, anxiety, and insomnia symptoms respectively, as compared with those female participants (B, -0.312 [p-value=0.001] for depression, 0.865 [p-value=0.004] for anxiety, 0.035 [p-value=0.05] for insomnia. Age of the participants were also significant predictor of depression and insomnia symptoms, (B, 0.132, p-value=0.002) and (B, 0.135, p-value=0.001), for depression and insomnia respectively. In addition, associations were identified between marital status and the three psychological health problems, depression, anxiety, and Insomnia. Being divorced/widowed increases depression symptoms by 1.256 (B, 1.256, p-value=0.002), and being single decrease anxiety symptoms by 0.213, p-value=0.008 but increases insomnia symptoms by 0.892, p-value=0.001.

Having one or more chronic medical illnesses, from hypertension, diabetic mellitus, cardiac illness, or asthma increases the three psychological health problems, by 1.235, p-value=0.001 for depression, by 0.825, p-value=0.004 for anxiety, and by 0.321, p-value=0.002 for insomnia.

Nevertheless, Social support and resilient coping score reduced the score of psychological health problems, depression, anxiety, and insomnia (Table: 2).

Discussion

As per to our knowledge this is the first study in Ethiopia, to assess the prevalence and factors associated with psychological health problems among the police officers during the COVID-19 pandemic. These findings provide a comprehensive profile of psychological status in the police officers during the COVID-19 outbreak and may contribute to developing mental health management and intervention strategies.

Main prevalence finding of current study shows  that 28.9% (95% CI, 26.5%-30.2%) have depression, with 19.7% mild depression,7.3% moderate depression, 1.6% moderate-severe depression, and 0.3% severe depression. 30.2% (95% CI, 28.2%-33.0%) have general anxiety, with 22.1% mild anxiety, 2.6%moderate anxiety, and 5.5% severe anxiety. And also 15.9% (95% CI, 13.5%-17.2%) had for insomnia.

Almost all participants have good knowledge of COVID-19 transmission and pandemic. Being younger age, sex, marital status, having chronic diseases, coping, and social support were found to be associated with depression, general anxiety, and insomnia. Male gender and coping score of participates displayed a higher risk for depression, and general anxiety, and marital status for insomnia.

The prevalence of depression in the present study is consistent with the study in china general population during COVID-19 pandemic, which indicated that nearly 34.4% of the respondents manifested depressive symptoms(18).

The Current result is lower than another online survey of china and Singapore during the pandemic of adolescent population(19, 20). The difference might be due to the population and tools used, that in china they include the adolescent population by online data collection, and in Singapore they used General health questionnaire and on people who come for a clinical visits.

The prevalence of symptoms of depression was higher than the previous national health survey done in 2012 before the pandemic in Ethiopia reported as 22.9%(21). These findings indicate that severe psychological distress occurs among police officers during the COVID-19 outbreak.

In the current study, some demographic factors found to associate with depression, general anxiety, and insomnia symptoms during the COVID-19 pandemic. age, female gender, having a chronic medical illness, low resilient coping score, and low social support were identified as risk factors for depression, general anxiety, and insomnia which is consistent with previous studies(18, 19, 22). But being married against previous literature found to be risk factors for anxiety; this might be due the worry about being a source for infection of COVID-19 for loved one and children.

Strengths

To the best of our knowledge, this is the first study that has systematically investigated the prevalence of and factors associated with psychological health problems (ie, symptoms of depression, general anxiety, and insomnia,) by standardized rating scales among the police officers during the COVID-19 pandemic in Ethiopia. Our findings may provide more helpful information for policymaking, recognition of high-risk populations, and framework design for police officers’ psychological crisis management.

Conclusions

This study found the prevalence of symptoms of psychological problems(depression, general anxiety, and insomnia, was 28.9% (95% CI, 26.5%-30.2%), 30.2% (95% CI, 28.2%-33.0%), and 15.9% (95% CI, 13.5%-17.2%)respectively)among police officers in Dessie town during the COVID-19 pandemic. females, advanced age, married(has family), having chronic medical illness, low coping and low social support were found significantly associated with psychological problems.

The  study shows  the importance of counseling for  general anxiety, depression, and insomnia  to  the  participants as means of effectively improving their psychological problems and ultimately  improving the quality of participants during this outbreak.

In addition to the general population exposed to the viral outbreak, police officers need serious attention and psychological counseling as they are one of frontline workers during the pandemic.

Declarations
Ethics Approval and Consent to Participate

The research was approved by the Institutional Review Board (IRB) from Wollo University College of medicine and health science before data collection. Permission was obtained from administrative bodies in Dessie town police organization and the willingness of the respondents also had been asked. Written informed consent were obtained from each participants. The respondents' right not to give information their privacy will be reassured and any information that they give will be kept confidentially. During data collection, the purpose of the study will be properly clarified to the respondents and the questions should be delivered in their own language. Those who score severe psychological problems (depression, anxiety, and insomnia) were advised to contact to mental health specialist (principal investigator).

Availability of Data and Materials

The datasets used and analyzed in this study are available from the corresponding author on reasonable request.

Funding

This research was supported by Wollo University. The funder has no role in the interpretation of findings and decision for publication.

Acknowledgments

We would like to thank Wollo University for valuable support, Dessie town police organization for facilitating the data collection process and study participants’ co-operation for data collection.

Consent for Publication

Not applicable

Competing Interests

The authors declare that there is no conflict of interest.

Author Contributions

MT, conceptualize and write the manuscript. MT, MN, HG, and MB have contributed to design, data collection tool preparation, writing proposal, and editing. The final manuscript was read by all authors and accepted.