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Background  COVID-19 is a global pandemic and has become a major public health burden worldwide. With already fragile healthcare systems it can have long lasting effects in developing countries. Outbreaks especially a pandemic situation evokes fear related behaviors among healthcare professionals and there is always an increased risk of mental health disorders. Therefore, this study aims to determine knowledge and perception about this pandemic, prevalence and factors associated with anxiety/depression among frontline physicians of Pakistan.    Methods  Data were collected through an online survey released in the last week of March-2020. 389 frontline physicians from all four provinces and 65 cities of Pakistan participated. Survey questionnaire consisted of 4 parts including informed consent section, demographic section, knowledge and perception about COVID-19 pandemic and assessment of depression through World Health Organization Self-reporting questionnaire (SRQ-20). A score of 8 or above on SRQ-20 was used as cut-off to label the participant as depressed. Data was analyzed using SPSS version22.    Results  A 43% prevalence of anxiety/depression among frontline physicians of Pakistan was reported. Almost all the doctors had moderate to high knowledge score. Majority of participants marked N-95 mask as “essential” during aerosol generating procedures, assessing patients with respiratory symptoms, in COVID patient-care area, ER triage and direct care of COVID-19 patient. Only 12% of the doctors were fully satisfied with the provision of PPEs and almost 94% felt unprotected.  In multivariable model, assessing more than five COVID suspects/day (aOR = 2.73, 95% CI: 1.65–4.52), working 20 h/week or less (aOR = 2.11, 1.27–3.49), having children among household members (aOR = 1.58, 95% CI: 1.00–2.50) and moderate to low knowledge of the infection (aOR = 2.69, 95% CI: 1.68–4.31) were found to be independent predictors of anxiety/depression among physicians.    Conclusion  Anxiety/depression among more than a third of frontline doctors of Pakistan warrants the need to address mental health of doctors caring for patients during this pandemic; control modifiable factors associated with it and explore the effectiveness of interventions to promote psychological well-being of physicians.

COVID-19 pandemic- knowledge, perception, anxiety and depression among frontline doctors of Pakistan