Volume 29, Issue 4 (Fall 2021)                   Avicenna J Nurs Midwifery Care 2021, 29(4): 340-348 | Back to browse issues page

Ethics code: IR.SHMU.REC.1399.081

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Ebrahimi H, Mirhosseini S, Basirinezhad M H, Shariati E. Prevalence of Post-Traumatic Stress Disorder (PTSD) following COVID-19 Epidemic in Health Workers of Shahroud University of Medical Sciences. Avicenna J Nurs Midwifery Care 2021; 29 (4) :340-348
URL: http://nmj.umsha.ac.ir/article-1-2341-en.html
1- Associate Professor of Nursing, Center for Health Related Social and Behavioral Sciences Research, Shahroud University of Medical Sciences, Shahroud, Iran
2- Nursing and Midwifery Care Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
3- Department of Epidemiology and Biostatistics, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
4- Imam Hossein Center for Education, Research and Treatment, Shahroud University of Medical Sciences, Shahroud, Iran , shariati.esmail@yahoo.com
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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.


Materials and Methods

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.



Based on the results, 85.5% of people were experienced PTSD. The regression determination coefficient (R2) was 15.1, so that men experienced 4.88 units of lower posttraumatic stress than women. People whose relatives died of COVID-19 experienced 7/04 unit higher PTSD than others.


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.

Conflicts of Interest

The authors declared no conflict of interest.


Type of Study: Original Research | Subject: Nursing
Received: 2021/06/7 | Accepted: 2021/11/29 | Published: 2021/12/21

1. Samarathunga W. Post-COVID19 Challenges and Way Forward for Sri Lanka Tourism. Available at SSRN 3581509. 2020. [DOI:10.2139/ssrn.3581509]
2. Organization WH. Mental health and psychosocial considerations during the COVID-19 outbreak, 18 March 2020. World Health Organization, 2020.
3. Adams JG, Walls RM. Supporting the health care workforce during the COVID-19 global epidemic. Jama. 2020;323(15):1439-40. [DOI:10.1001/jama.2020.3972] [PMID]
4. Canova V, Lederer Schläpfer H, Piso RJ, Droll A, Fenner L, Hoffmann T, et al. Transmission risk of SARS-CoV-2 to healthcare workers-observational results of a primary care hospital contact tracing. Swiss medical weekly. 2020;150(1718). [DOI:10.4414/smw.2020.20257] [PMID]
5. Torrens C, Campbell P, Hoskins G, Strachan H, Wells M, Cunningham M, et al. Barriers and facilitators to the implementation of the advanced nurse practitioner role in primary care settings: a scoping review. International Journal of Nursing Studies. 2020;104:103443. [DOI:10.1016/j.ijnurstu.2019.103443] [PMID]
6. Fiksenbaum L, Marjanovic Z, Greenglass ER, Coffey S. Emotional exhaustion and state anger in nurses who worked during the SARS outbreak: The role of perceived threat and organizational support. Canadian Journal of Community Mental Health. 2007;25(2):89-103. [DOI:10.7870/cjcmh-2006-0015]
7. da Silva FC, Neto ML. Psychiatric symptomatology associated with depression, anxiety, distress, and insomnia in health professionals working in patients affected by COVID-19: A systematic review with meta-analysis. Progress in Neuro-Psychopharmacology and Biological Psychiatry. 2021 Jan 10;104:110057. [DOI:10.1016/j.pnpbp.2020.110057] [PMID] [PMCID]
8. Spoorthy MS, Pratapa SK, Mahant S. Mental health problems faced by healthcare workers due to the COVID-19 pandemic-A review. Asian journal of psychiatry. 2020;51:102119. [DOI:10.1016/j.ajp.2020.102119] [PMID] [PMCID]
9. Siyu C, Xia M, Wen W, Cui L, Yang W, Liu S, et al. Mental health status and coping strategy of medical workers in China during The COVID-19 outbreak. medRxiv. 2020.
10. Alaqeel MK, Aljerian NA, AlNahdi MA, Almaini RY. Post-Traumatic Stress Disorder among Emergency Medical Services Personnel: A Cross-sectional Study. Asian Journal of Medical Sciences. 2019;10(4):28-31. [DOI:10.3126/ajms.v10i4.23990]
11. de Wijn AN, van der Doef MP. Patient-related stressful situations and stress-related outcomes in emergency nurses: A cross-sectional study on the role of work factors and recovery during leisure time: STRESSFUL SITUATIONS IN EMERGENCY NURSES. International Journal of Nursing Studies. 2020:103579. [DOI:10.1016/j.ijnurstu.2020.103579] [PMID]
12. Sheerin CM, Brick LA, Nugent NR, Amstadter AB. Genetic Studies of PTSD and Substance Use Disorders: Background, Developments, and Future Directions. Posttraumatic Stress and Substance Use Disorders: Routledge; 2019. p. 285-309. [DOI:10.4324/9781315442648-15]
13. Uphoff E, Robertson L, Cabieses B, Villalón FJ, Purgato M, Churchill R, et al. An overview of systematic reviews on mental health promotion, prevention, and treatment of common mental disorders for refugees, asylum seekers, and internally displaced persons. Cochrane Database of Systematic Reviews. 2020(9). [DOI:10.1002/14651858.CD013458.pub2] [PMID] [PMCID]
14. Hilton NZ, Ham E, Rodrigues NC, Kirsh B, Chapovalov O, Seto MC. Contribution of critical events and chronic stressors to PTSD symptoms among psychiatric workers. Psychiatric services. 2020;71(3):221-7. [DOI:10.1176/appi.ps.201900226] [PMID]
15. Safa M, Ismaili Dolabi Nejad Sh, Qasem Boroujerdi F, Hajizadeh F, Mirabzadeh Ardakani B. Evaluation of post-traumatic stress disorder in nursing staff involved in the care of patients with COVID-19 in Masih Daneshvari Hospital. Scientific Journal of the Medical System Organization of the Islamic Republic of Iran. 2021; 38 (1): 27-33
16. Weathers FW, Litz BT, Herman DS, Huska JA, Keane TM, editors. The PTSD Checklist (PCL): Reliability, validity, and diagnostic utility. annual convention of the international society for traumatic stress studies, San Antonio, TX; 1993: San Antonio, TX.
17. Ruggiero KJ, Del Ben K, Scotti JR, Rabalais AE. Psychometric properties of the PTSD Checklist-Civilian version. Journal of traumatic stress. 2003;16(5):495-502. [DOI:10.1023/A:1025714729117] [PMID]
18. Sadeghi M, Taghva A, Goudarzi N, Rah Nejat A. Validity and reliability of persian version of "post-traumatic stress disorder scale" in war veterans. Iranian Journal of War and Public Health. 2016;8(4):243-9.
19. Zhang H, Shi Y, Jing P, Zhan P, Fang Y, Wang F. Posttraumatic stress disorder symptoms in healthcare workers after the peak of the COVID-19 outbreak: A survey of a large tertiary care hospital in Wuhan. Psychiatry research. 2020;294:113541. [DOI:10.1016/j.psychres.2020.113541] [PMID] [PMCID]
20. Song X, Fu W, Liu X, Luo Z, Wang R, Zhou N, et al. Mental health status of medical staff in emergency departments during the Coronavirus disease 2019 epidemic in China. Brain, Behavior, and Immunity. 2020. [DOI:10.2139/ssrn.3605323]
21. Tang L, Pan L, Yuan L, Zha L. Prevalence and related factors of post-traumatic stress disorder among medical staff members exposed to H7N9 patients. International journal of nursing sciences. 2017;4(1):63-7. [DOI:10.1016/j.ijnss.2016.12.002] [PMID] [PMCID]
22. Lai J, Ma S, Wang Y, Cai Z, Hu J, Wei N, et al. Factors associated with mental health outcomes among health care workers exposed to coronavirus disease 2019. JAMA network open. 2020;3(3):e203976-e. [DOI:10.1001/jamanetworkopen.2020.3976] [PMID] [PMCID]
23. Cohen H, Yehuda R. Gender differences in animal models of posttraumatic stress disorder. Disease markers. 2011;30(2, 3):141-50. [DOI:10.1155/2011/734372] [PMID] [PMCID]
24. Huang L, Wang Y, Liu J, Ye P, Chen X, Xu H, et al. Factors influencing anxiety of health care workers in the radiology department with high exposure risk to COVID-19. Medical science monitor: international medical journal of experimental and clinical research. 2020;26:e926008-1. [DOI:10.12659/MSM.926008]
25. Boelen PA, Lenferink LI. Associations of Depressive Rumination and Positive Affect Regulation with Emotional Distress After the Death of a Loved One. Clinical Psychology & Psychotherapy. 2020. [DOI:10.1002/cpp.2482] [PMID] [PMCID]
26. Keyes KM, Pratt C, Galea S, McLaughlin KA, Koenen KC, Shear MK. The burden of loss: unexpected death of a loved one and psychiatric disorders across the life course in a national study. American Journal of Psychiatry. 2014;171(8):864-71. [DOI:10.1176/appi.ajp.2014.13081132] [PMID] [PMCID]
27. Boyraz G, Legros DN. Coronavirus Disease (COVID-19) and Traumatic Stress: Probable Risk Factors and Correlates of Posttraumatic Stress Disorder. Journal of Loss and Trauma. 2020:1-20. [DOI:10.1080/15325024.2020.1763556]
28. Arafa A, Mohammed Z, Mahmoud O, Elshazley M, Ewis A. Depressed, anxious, and stressed: What have healthcare workers on the frontlines in Egypt and Saudi Arabia experienced during the COVID-19 pandemic? Journal of affective disorders. 2020;278:365-71. [DOI:10.1016/j.jad.2020.09.080] [PMID] [PMCID]
29. Mirhosseini S, Dadgari A, Basirinezhad MH, Mohammadpourhodki R, Ebrahimi H. The Role of Hope to Alleviate Anxiety in COVID-19 Outbreak among Community Dwellers: An Online Cross-sectional Survey. Annals of the Academy of Medicine, Singapore. 2020;49(10):723-30. [DOI:10.47102/annals-acadmedsg.2020341]
30. Moghanibashi-Mansourieh A. Assessing the anxiety level of Iranian general population during COVID-19 outbreak. Asian journal of psychiatry. 2020:102076. [DOI:10.1016/j.ajp.2020.102076] [PMID] [PMCID]
31. Fullana MA, Hidalgo-Mazzei D, Vieta E, Radua J. Coping behaviors associated with decreased anxiety and depressive symptoms during the COVID-19 pandemic and lockdown. Journal of Affective Disorders. 2020;275:80-1. [DOI:10.1016/j.jad.2020.06.027] [PMID] [PMCID]

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