Safety and Health at Work

Occupational Safety and Health Research Institute, Korea Occupational Safety and Health Agency (산업안전보건연구원)
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Influencing Factors of High PTSD Among Medical Staff During COVID-19: Evidences From Both Meta-analysis and Subgroup Analysis

  • Qi, Guojia (Department of Epidemiology and Health Statistics, School of Public Health, Zunyi Medical University) ;
  • Yuan, Ping (Department of Epidemiology and Health Statistics, School of Public Health, Zunyi Medical University) ;
  • Qi, Miao (Department of Epidemiology and Health Statistics, School of Public Health, Zunyi Medical University) ;
  • Hu, Xiuli (Department of Epidemiology and Health Statistics, School of Public Health, Zunyi Medical University) ;
  • Shi, Shangpeng (Department of Quality Management, The Third Affiliated Hospital of Zunyi Medical University (The First People's Hospital of Zunyi)) ;
  • Shi, Xiuquan (Department of Epidemiology and Health Statistics, School of Public Health, Zunyi Medical University)
  • Received : 2022.03.27
  • Accepted : 2022.06.16
  • Published : 2022.09.30
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Abstract

Background: PTSD (Post-traumatic stress disorder, PTSD) had a great impact on health care workers during the COVID-19 (Corona Virus Disease 2019, COVID-19). Better knowledge of the prevalence of PTSD and its risk factors is a major public health problem. This study was conducted to assess the prevalence and important risk factors of PTSD among medical staff during the COVID-19. Methods: The databases were searched for studies published during the COVID-19, and a PRISMA (preferred reporting items for systematic review and meta-analysis) compliant systematic review (PROSPERO-CRD 42021278970) was carried out to identify articles from multiple databases reporting the prevalence of PTSD outcomes among medical staff. Proportion random effect analysis, I2 statistic, quality assessment, subgroup analysis, and sensitivity analysis were carried out. Results: A total of 28 cross-sectional studies and the PTSD results of doctors and nurses were summarized from 14 and 27 studies: the prevalences were 31% (95% CI [confidence interval, CI]: 21%-40%) and 38% (95% CI: 30%-45%) in doctors and nurses, respectively. The results also showed seven risks (p < 0.05): long working hours, isolation wards, COVID-19 symptoms, nurses, women, fear of infection, and pre-existing mental illness. Two factors were of borderline significance: higher professional titles and married. Conclusion: Health care workers have a higher prevalence of PTSD during COVID-19. Health departments should provide targeted preventive measures for medical staff away from PTSD.

Keywords

Acknowledgement

We thank the multiple databases for providing many data to our study. This work was supported by the National Natural Science Foundation of China (Grant No. 82060602, PI: Xiuquan Shi); the Science and Technology Support Program of Guizhou province (Grant No. Qiankehe Zhicheng [2020]4Y171; PI: Xiuquan Shi); and the Science and Technology Support Program of Zunyi City (HZ [2020]5; PI: Shangpeng Shi). The funders had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.

References

  1. World Health Organization. Weekly operational update - 30 September; 2021 [cited 2021 sept. 30]. Available from: https://www.who.int/publications/m/item/.
  2. Civantos AM, Byrnes Y, Chang C, Prasad A, Chorath K, Poonia SK, Jenks CM, Bur AM, Thakkar P, Graboyes EM, Seth R, Trosman S, Wong A, Laitman BM, Harris BN, Shah J, Stubbs V, Choby G, Long Q, Rassekh CH, Thaler E, Rajasekaran K. Mental health among otolaryngology resident and attending physicians during the COVID-19 pandemic: national study. Head Neck 2020;42:1597-609. https://doi.org/10.1002/hed.26292
  3. Evanoff BA, Strickland JR, Dale AM, Hayibor L, Page E, Duncan JG, Kannampallil T, Gray DL. Work-related and personal factors associated with mental well-being during the COVID-19 response: survey of health care and other workers. J Med Internet Res 2020;22:e21366. https://doi.org/10.2196/21366
  4. Kang L, Ma S, Chen M, Yang J, Wang Y, Li R, Yao L, Bai H, Cai Z, Xiang Yang B, Hu S, Zhang K, Wang G, Ma C, Liu Z. Impact on mental health and perceptions of psychological care among medical and nursing staff in Wuhan during the 2019 novel coronavirus disease outbreak: a cross-sectional study. Brain Behav Immun 2020;87:11-7. https://doi.org/10.1016/j.bbi.2020.03.028
  5. Liu CY, Yang YZ, Zhang XM, Xu X, Dou QL, Zhang WW, Cheng ASK. The prevalence and influencing factors in anxiety in medical workers fighting COVID-19 in China: a cross-sectional survey. Epidemiol Infect 2020;148:-98.
  6. Abdulbari DB, Ventriglio A, ventriglio Antonio. Mental health and quality of life of frontline health care workers after one year of COVID-19 pandemic. Public Health Manage 2021;26:6-11.
  7. Lasheras I, Gracia-Garcia P, Lipnicki DM, Bueno-Notivol J, Lopez-Anton R, de la Camara C, Lobo A, Santabarbara J. Prevalence of anxiety in medical students during the COVID-19 pandemic: a rapid systematic review with meta-analysis. Int J Environ Res Public Health 2020;18:6603.
  8. Olaya B, Perez-Moreno M, Bueno-Notivol J, Gracia-Garcia P, Lasheras I, Santabarbara J. Prevalence of depression among healthcare workers during the COVID-19 outbreak: a systematic review and meta-analysis. J Clin Med 2021;15:3406.
  9. Santabarbara J, Bueno-Notivol J, Lipnicki DM, Olaya B, Perez-Moreno M, Gracia-Garcia P, Idoiaga-Mondragon N, Ozamiz-Etxebarria N. Prevalence of anxiety in health care professionals during the COVID-19 pandemic: a rapid systematic review (on published articles in Medline) with meta-analysis. Prog Neuro-Psychopharmacology Biol Psychiatry 2021;107:110244. https://doi.org/10.1016/j.pnpbp.2021.110244
  10. Shalev A, Liberzon I, Marmar C. Post-traumatic stress disorder. N Engl J Med 2017;376:2459-69. https://doi.org/10.1056/NEJMra1612499
  11. Azoulay E, Pochard F, Reignier J, Argaud L, Bruneel F, Courbon P, Cariou A, Klouche K, Labbe V, Barbier F, Guitton C, Demoule A, Kouatchet A, Guisset O, Jourdain M, Papazian L, Van Der Meersch G, Reuter D, Souppart V, RescheRigon M, Darmon M. Symptoms of mental health disorders in critical care physicians facing the second COVID-19 wave: a cross-sectional study. Chest 2021;160:944-55. https://doi.org/10.1016/j.chest.2021.05.023
  12. Jaksic N, Brajkovic L, Ivezic E, Topic R, Jakovljevic M. The role of personality traits in posttraumatic stress disorder (PTSD). Psychiatr Danub 2012;24:256-66.
  13. Conti C, Fontanesi L, Lanzara R, Rosa I, Doyle RL, Porcelli P. Burnout status of Italian healthcare workers during the first COVID-19 pandemic peak period. Healthcare (Basel) 2021;9:510.
  14. Gu Y, Zhu Y, Xu G. Factors associated with mental health outcomes among health care workers in the Fangcang shelter hospital in China. Int J Soc Psychiatry 2020:20764020975805.
  15. Guo WP, Min Q, Gu WW, Yu L, Xiao X, Yi WB, Li HL, Huang B, Li JL, Dai YJ, Xia J, Liu J, Li B, Zhou BH, Li M, Xu HX, Wang XB, Shi WY. Prevalence of mental health problems in frontline healthcare workers after the first outbreak of COVID-19 in China: a cross-sectional study. Health Qual Life Outcome 2021;19:103. https://doi.org/10.1186/s12955-021-01743-7
  16. Mattila E, Peltokoski J, Neva MH, Kaunonen M, Helminen M, Parkkila AK. COVID-19: anxiety among hospital staff and associated factors. Ann Med 2021;53:237-46. https://doi.org/10.1080/07853890.2020.1862905
  17. Zhang C, Yang L, Liu S, Ma S, Wang Y, Cai Z, Du H, Li R, Kang L, Su M, Zhang J, Liu Z, Zhang B. Survey of insomnia and related social psychological factors among medical staff involved in the 2019 novel coronavirus disease outbreak. Front Psychiatry 2020;11:306.
  18. Zhang Y, Xie S, Wang P, Wang G, Zhang L, Cao X, Wu W, Bian Y, Huang F, Luo N, Luo M, Xiao Q. Factors influencing mental health of medical workers during the COVID-19 outbreak. Front Public Health 2020;8:491. https://doi.org/10.3389/fpubh.2020.00491
  19. Zhou C, Shi L, Gao L, Liu W, Chen Z, Tong X, Xu W, Peng B, Zhao Y, Fan L. Determinate factors of mental health status in Chinese medical staff: a crosssectional study. Medicine (Baltimore) 2018;97:e0113. https://doi.org/10.1097/MD.0000000000010113
  20. Kim MS, Kim T, Lee D, Yook JH, Hong YC, Lee SY, Yoon JH, Kang MY. Mental disorders among workers in the healthcare industry: 2014 national health insurance data. Ann Occup Environ Med 2018;30:31. https://doi.org/10.1186/s40557-018-0244-x
  21. Tawfik DS, Scheid A, Profit J, Shanafelt T, Trockel M, Adair KC, Sexton JB, Ioannidis JPA. Evidence relating health care provider burnout and quality of care: a systematic review and meta-analysis. Ann Intern Med 2019;171:555-67. https://doi.org/10.7326/M19-1152
  22. Aymerich C. COVID-19 pandemic effects on health worker's mental health: systematic review and meta-analysis. Eur Psychiatry 2022;65:e10. https://doi.org/10.1192/j.eurpsy.2022.1
  23. Yunitri N. Global prevalence and associated risk factors of posttraumatic stress disorder during COVID-19 pandemic: a meta-analysis. Int J Nurs Stud 2022;126:104136. https://doi.org/10.1016/j.ijnurstu.2021.104136
  24. Li Y. Prevalence of depression, anxiety and post-traumatic stress disorder in health care workers during the COVID-19 pandemic: a systematic review and meta-analysis. PLoS One 2021;16:e0246454. https://doi.org/10.1371/journal.pone.0246454
  25. Sahebi A. The prevalence of post-traumatic stress disorder among health care workers during the COVID-19 pandemic: an umbrella review and metaanalysis. Front Psychiatry 2021;12:764738. https://doi.org/10.3389/fpsyt.2021.764738
  26. Willis DE. COVID-19 vaccine hesitancy: race/ethnicity, trust, and fear. Clin Transl Sci 2021;14:2200-7. https://doi.org/10.1111/cts.13077
  27. Foo PK. Patient and physician race and the allocation of time and patient engagement efforts to mental health discussions in primary care: an observational study of audiorecorded periodic health examinations. J Ambul Care Manage 2017;40:246-56. https://doi.org/10.1097/JAC.0000000000000176
  28. Parola V, Coelho A, Cardoso D, Sandgren A, Apostolo J. Prevalence of burnout in health professionals working in palliative care: a systematic review. JBI Database Syst Rev Implement Rep 2017;15:1905-33. https://doi.org/10.11124/JBISRIR-2016-003309
  29. Zeng X, Zhang Y, Kwong JS, Zhang C, Li S, Sun F, Niu Y, Du L. The methodological quality assessment tools for preclinical and clinical studies, systematic review and meta-analysis, and clinical practice guideline: a systematic review. J Evid Based Med 2015;8:2-10. https://doi.org/10.1111/jebm.12141
  30. Moon DJ, Han MA, Park J, Ryu SY. Post-traumatic stress and related factors among hospital nurses during the COVID-19 outbreak in korea. Psychiatr Q 2021:1-11.
  31. Marcomini I, Agus C, Milani L, e Sfogliarini R, Bona A, Castagna M. COVID-19 and post-traumatic stress disorder among nurses: a descriptive crosssectional study in a COVID hospital. Med Lav 2021;112:241-9.
  32. Fang L. Correlation analysis of anxiety, depression and post-traumatic stress disorder among first-line nurses fighting New Coronavirus pneumonia. J Clin Nurs 2020;19:14-7 [in chinese].
  33. Manman H, Ying Z, Congyan Y. Study on the influencing factors of posttraumatic stress disorder for nurses during COVID-19 epidemic. J Gannan Med Univ 2020;40:1107-11 [in chinese].
  34. Asnakew S. Prevalence of post-traumatic stress disorder on health professionals in the era of COVID-19 pandemic, Northwest Ethiopia, 2020: a multi-centered cross-sectional study. Plos One 2021;16.
  35. Havaei F, Ma A, Staempfli S, MacPhee M. Nurses' workplace conditions impacting their mental health during COVID-19: a cross-sectional survey study. Healthcare (Basel) 2021;9.
  36. Heesakkers H, Zegers M, van Mol MMC, van den Boogaard M. The impact of the first COVID-19 surge on the mental well-being of ICU nurses: a nationwide survey study. Intensive Crit Care Nurs 2021;65:1030-4.
  37. Lasalvia A, Bonetto C, Porru S, Carta A, Tardivo S, Bovo C, Ruggeri M, Amaddeo F. Psychological impact of COVID-19 pandemic on healthcare workers in a highly burdened area of north-east Italy. Epidemiol Psychiatr Sci 2020;30:e1.
  38. Li J, Zhou Y, Xu X, Peng Y, Liu Y. COVID-19 negatively impacts on psychological and somatic status in frontline nurses. J Affect Disord 2021;294:279-85. https://doi.org/10.1016/j.jad.2021.07.031
  39. Li X, Hou Y, Xu X. Factors associated with the psychological well-being among front-line nurses exposed to COVID-2019 in China: a predictive study. J Nurs Manag 2021;29:240-9. https://doi.org/10.1111/jonm.13146
  40. Marco CA, Larkin GL, Feeser VR, Marco CA, Larkin GL, Feeser VR, Monti JE, Vearrier L., ACEP Ethics Committee. Post-traumatic stress and stress disorders during the COVID pandemic: survey of emergency physicians 2020. J Am Coll Emerg Physicians Open 2020;6:1594-601.
  41. Wang Y, Ma S, Yang C, Cai Z, Hu S, Zhang B, Tang S, Bai H, Guo X, Wu J, Du H, Kang L, Tan H, Li R, Yao L, Wang G, Liu Z. Acute psychological effects of Coronavirus Disease 2019 outbreak among healthcare workers in China: a cross-sectional study. Transl Psychiatry 2020;10:348. https://doi.org/10.1038/s41398-020-01031-w
  42. Wanigasooriya K, Palimar P, Naumann DN, Ismail K, Fellows JL, Logan P, Thompson CV, Bermingham H, Beggs AD, Ismail T. Mental health symptoms in a cohort of hospital healthcare workers following the first peak of the COVID-19 pandemic in the UK. BJPsych Open 2020;7(1):e24.
  43. Xia L, Yan Y, Wu D. Protective predictors associated with posttraumatic stress and psychological distress in Chinese nurses during the outbreak of COVID-19. Front Psychol 2021;12:684222. https://doi.org/10.3389/fpsyg.2021.684222
  44. Zhang H, 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 Res 2020;294:1135-41.
  45. Jiayao B, Ling L, Xia L. Post-traumatic stress disorder and its influencing factors among nurses in Wuhan city during the period of New Coronavirus pneumonia prevention and control. Mod Nurse 2021;28:18e22 [in chinese].
  46. Mei C, Faguo L, Guangbi L. Investigation and study on mental status among first line nurses against new type coronavirus pneumonia epidemic under systematic support. J Mod Med Health 2020;36:2671-4 [in chinese].
  47. Hui F, Xianghong F. Post-traumatic stress disorder in nursing staff during a COVID-19 outbreak. J Nurs Sci 2020;35:84-6 [in chinese].
  48. Chuansgeng L, Yuanyuan M, Jing c. Investigation and analysis of posttraumatic stress disorder among first-line nursing staff in New Coronavirus. J Nurses Train 2020;35:615e8 [in chinese].
  49. Yalan L, Ping J, Yinghua C. Investigation on psychological stress of nursing staff during COVID-19 and related factors. Nurs Integrated Traditional Chin West Med 2020;6:179-83 [in chinese].
  50. Cuizhen W, Yan L, Mingfeng T. Investigation of psychological stress among medical staff for hemodialysis in the epidemic context of COVID-19. J Youjiang Med Univ Nationalit 2021;43:108-12 [in chinese].
  51. Alshehri AS, Alghamdi AH. Post-traumatic stress disorder among healthcare workers diagnosed with COVID-19 in Jeddah, Kingdom of Saudi Arabia, 2020 to 2021. Cureus 2021;13:e17371.
  52. Bahadirli S. Post-traumatic stress disorder in healthcare workers of emergency departments during the pandemic: a cross-sectional study. Am J Emerg Med 2021;50:251-5. https://doi.org/10.1016/j.ajem.2021.08.027
  53. Rodriguez RM. Symptoms of anxiety, burnout, and PTSD and the mitigation effect of serologic testing in emergency department personnel during the COVID-19 pandemic. Ann Emerg Med 2021;78:35-43. https://doi.org/10.1016/j.annemergmed.2021.01.028
  54. Egger M, Davey Smith G, Schneider M, Minder C. Bias in meta-analysis detected by a simple, graphical test. Bmj 1997;315:629-34. https://doi.org/10.1136/bmj.315.7109.629
  55. Cenat JM, Blais-Rochette C, Kokou-Kpolou CK, Noorishad PG, Mukunzi JN, McIntee SE, Dalexis RD, Goulet MA, Labelle PR. Prevalence of symptoms of depression, anxiety, insomnia, posttraumatic stress disorder, and psychological distress among populations affected by the COVID-19 pandemic: a systematic review and meta-analysis. Psychiatry Res 2021;295:113599. https://doi.org/10.1016/j.psychres.2020.113599
  56. Cooke JE, Eirich R, Racine N, Madigan S. Prevalence of posttraumatic and general psychological stress during COVID-19: a rapid review and metaanalysis. Psychiatry Res 2020;292:1133-47.
  57. Sahebi A, Nejati-Zarnaqi B, Moayedi S, Yousefi K, Torres M, Golitaleb M. The prevalence of anxiety and depression among healthcare workers during the COVID-19 pandemic: an umbrella review of meta-analyses. Prog Neuropsychopharmacol Biol Psychiatry 2021;107:110247. https://doi.org/10.1016/j.pnpbp.2021.110247
  58. Sahebi A, Abdi K, Moayedi S, Torres M, Golitaleb M. The prevalence of insomnia among health care workers amid the COVID-19 pandemic: an umbrella review of meta-analyses. J Psychosom Res 2021;149:110597. https://doi.org/10.1016/j.jpsychores.2021.110597
  59. Nations U. The impact of COVID-19 on the Arab region an opportunity to build back better; 2020 [cited 2021 step. 30]. Available from: https://apps.who.int/gb/ebwha/pdf_files/EBSS5/EBSS5_2-ch.pdf.
  60. Lim EC, Seet RC, Lee KH, Wilder-Smith EP, Chuah BY, Ong BK. Headaches and the N95 face-mask amongst healthcare providers. Acta Neurol Scand 2006;113:199-202. https://doi.org/10.1111/j.1600-0404.2005.00560.x
  61. Ong JJY, Chan ACY, Teoh HL, Chan YC, Sharma VK. Headache related to PPE use during the COVID-19 pandemic. Curr Pain Headache Rep 2021;25:53. https://doi.org/10.1007/s11916-021-00968-x
  62. Robert R, Kentish-Barnes N, Boyer A, Laurent A, Azoulay E, Reignier J. Ethical dilemmas due to the Covid-19 pandemic. Ann Intensive Care 2020;10:84. https://doi.org/10.1186/s13613-020-00702-7
  63. Williamson V, Murphy D, Greenberg N. COVID-19 and experiences of moral injury in front-line key workers. Occup Med (Lond) 2020;70:317-9. https://doi.org/10.1093/occmed/kqaa052
  64. Karanikola MN, Albarran JW, Giannakopoulou M, Kalafati M, Mpouzika M, Tsiaousis GZ, Papathanassoglou ED. Moral distress, autonomy and nursephysician collaboration among intensive care unit nurses in Italy. J Nurs Manag 2014;22:472-84. https://doi.org/10.1111/jonm.12046
  65. Christiansen DM, Berke ET. Gender- and sex-based contributors to sex differences in PTSD. Curr Psychiatry Rep 2020;22:19. https://doi.org/10.1007/s11920-020-1140-y
  66. Geoffroy PA, Goanvic V, Sabbagh O, Richoux C, Weinstein A, Dufayet G, Lejoyeux M. Psychological support system for hospital workers during the covid-19 outbreak: rapid design and implementation of the covid-psy hotline. Front Psychiatry 2020;11:511.
  67. Lefevre H, Stheneur C, Cardin C, Fourcade L, Fourmaux C, Tordjman E, Touati M, Voisard F, Minassian S, Chaste P, Moro MR, Lachal J. The bulle: support and prevention of psychological decompensation of health care workers during the trauma of the COVID-19 epidemic. J Pain Symptom Manage 2021;61:416-22. https://doi.org/10.1016/j.jpainsymman.2020.09.023