Due to the growing prevalence of COVID-19 in the world and the increasing workload of health care providers, health workers face many problems such as long working hours, being away from family, and worrying about themselves and their families, which can affect their health and consequently challenge their job performance. The aim of this study was to investigate the prevalence of Post-Traumatic Stress Disorder (PTSD) following the COVID-19 epidemic in health workers of Shahroud University of Medical Sciences, Iran.

 

In this descriptive cross-sectional study, 228 Shahroud University of Medical Sciences health workers were studied from July 22 to August 22, 2020. Participants included nursing, medical, radiology, and laboratory personnel. The Demographic Information Questionnaire and PTSD Checklist – Civilian version (PCL-C) was completed online. Descriptive statistics and the multivariate linear regression model were used to analyze the data.

The present study results showed that the prevalence of PTSD in the subjects was 85.5%. The study by Zhang et al. (2020) investigated the prevalence of posttraumatic stress disorder in health care workers in China during the COVID-19 outbreak. The prevalence of PTSD was reported at 20.87% among health care workers at Wuhan Central Hospital, about six months after the first local outbreak of COVID-19. The reason for the difference in the results can be due to the difference in the sample size and the cut-off point for determining the possible PTSD in the PCL-C questionnaire. Because in the present study, the cut-off point was 35, and in the mentioned study, the cut-off point was considered 50 [19]. In a study by Song et al. (2020), the results showed that the prevalence of PTSD was 9.1%. Possible reasons for the difference in the obtained findings can be attributed to the difference in prevalence, the number of disease peaks, and sample size [20].
The present study results showed that gender is an influential factor in the incidence of PTSD so that women are significantly more exposed to PTSD than men. In this regard, the results of a study by Tang et al. (2017) that aimed to investigate the prevalence of posttraumatic stress syndrome among health workers exposed to patients with avian influenza A, showed that among health workers and caregivers, women were more exposed than men [21]. Also, the results of the study of Lai et al. (2020), which was conducted to investigate the factors related to mental health in health workers at risk of COVID-19, showed that health care workers are at high risk of adverse mental health outcomes and 71.5% of participants experienced moderate to severe stress [22]. In general, epidemiological studies report a higher prevalence of stress-related disorders such as acute stress disorder (ASD) and PTSD in women than men after trauma exposure [23]. This finding can be attributed to gender differences in physiological and psychological responses to trauma, differences in assessment, interpretation, or experience of threat, and coping styles.
The results of the study showed that laboratory and radiology staff were at higher risk of PTSD than midwives. This finding can be explained by the fact that constant exposure to infected specimens in the laboratory environment has caused professionals in this profession to be so anxious for fear of dying, dying, or transmitting the disease to others that the potential risk of PTSD in them is significant and is more than midwives.
On the other hand, radiologists may be under a lot of stress because they are constantly dealing with patients suspected of having COVID-19 for radiological diagnostic tests, which ultimately leads to possible PTSD. In this regard, the results of the study of Huang et al. (2020), which aimed to investigate the factors affecting the anxiety of radiology staff in high exposure to COVID-19, show the level of anxiety of radiology staff exposed to patients with COVID-19 [24].
The results showed that people whose first- or second-degree relatives died of COVID-19 were more likely to develop PTSD. In this regard, it should be borne in mind that the death of a loved one may accelerate the symptoms of prolonged grief disorder (PGD), PTSD, and depression [25]. The results of studies show that the sudden and unexpected death of a loved one is a risk factor for several mental disorders, including PTSD, major depressive disorder, panic disorder, and disorders caused by alcohol abuse [26]. Because COVID-19 is a highly contagious disease, some people may experience severe damage to their families or communities. Due to the negative social, psychological, economic, and health consequences of this disease, many people may experience various forms of loss (for example, the loss of a loved one, loss of health, loss of property, job loss, loss of social relationships, and loss of security) that may complicate the grieving process and increase the risk of developing PTSD and chronic mental illness. On the other hand, COVID-19 has forced people to make significant changes in their lives, such as funerals and how to say goodbye to their deceased loved ones, which can lead to increased stress in them [27].
According to the results of the present study, the daily follow-up of news related to COVID-19 was directly and significantly related to the rate of PTSD. In line with this finding, the results of Arafa et al.'s (2020) study in Saudi Arabia showed that watching and studying COVID-19-related news in health care workers during the COVID-19 pandemic increases psychological distress (stress, anxiety, and depression) [28]. Also, the results of Mirhosseini et al.'s (2020) study, which aimed to investigate the role of hope in reducing community anxiety in Iran during the COVID-19 pandemic, showed that the higher the follow-up of COVID-19-related news in individuals, the higher the anxiety levels [29]. Other studies have also confirmed this finding [30, 31].
 
 

Given that a significant proportion of health workers experienced PTSD, senior treatment center managers must include more supportive measures to reduce PTSD in their work schedule.
 
 

This study results from a research project with the ethics code IR.SHMU.REC.1399.081 of Shahroud University of Medical Sciences. We would like to thank all the health workers of Imam Hossein (AS) Hospitals in Shahroud. We appreciate them who, despite all the many problems that existed in implementing this research, carefully and diligently helped us.
 
 

The authors declared no conflict of interest.