Prevalence and Associated Factors of Posttraumatic Stress Symptoms and Stigma among Health Care Workers in Contact with COVID-19 Patients
-
Atefeh Zandifar
,
Rahim Badrfam
,
Nami Mohammadian Khonsari
,
Mohammad Reza Mohammadi
,
Hamid Asayesh
,
Mostafa Qorbani
Abstract
Objective: The global spread of COVID-19 has caused great psychological stress in health care workers (HCWs). This study aims to assess the prevalence and associated factors of posttraumatic stress symptoms (PTSS) and stigma among health care workers (HCWs) who are involved in treating COVID-19 patients. This study was conducted as part of studies related to assessing the mental health status of HCWs in Iran during the COVID-19 pandemic.
Method: Overall, in this cross sectional study, 894 HCWs working in 9 general hospitals in Alborz province, Iran, in the field of diagnostic and treatment care of patients with COVID-19 were selected using multistage sampling method. PTSS and its subscales, including intrusion, avoidance, and hyper vigilance were obtained based on the Posttraumatic Stress Disorder-8 Item validated questionnaire. Information on Stigma's perception among HCWs was also obtained based on a questionnaire adopted from the HIV Stigma Scale. Predictors of PTSS and Stigma's perception among HCWs were assessed using multivariate logistic regression analysis.
Results: Overall, 71.4% of the participants were women and 46.9% were front line staff. The prevalence of intrusion, avoidance, and hyper vigilance symptoms was 44.2% (95% CI: 40.8-47.6), 31. 8% (95% CI: 28.8-35.0), and 37.7% (95% CI: 34.5-41.0), respectively. A strong and positive significant correlation was found between stigma score with PTSD total score (coefficient: 0.83) and its components. In multivariate logistic regression model, female gender was associated with intrusion (OR: 1.46, 95% CI: 1.03-2.06) and avoidance (OR: 1.66, 95% CI: 1.147-2.417) and working in frontline increased the odds of intrusion (OR: 1.45, 95% CI: 1.06-1.97) and hyper vigilance (OR: 1.41, 95% CI: 1.03-1.91).
Conclusion: The prevalence of PTSS is high among HCWs during COVID-19 pandemic and it is associated with some demographic characteristics of HCWs. This situation should be considered by health policymakers so that while trying to control the disease, the mental health status of this group of personnel should be given much attention.
1. Zandifar A, Badrfam R. Iranian mental health during the COVID-19 epidemic. Asian J Psychiatr. 2020;51:101990.
2. Lu W, Wang H, Lin Y, Li L. Psychological status of medical workforce during the COVID-19 pandemic: A cross-sectional study. Psychiatry Res. 2020;288:112936.
3. Simione L, Gnagnarella C. Differences between health workers and general population in risk perception, behaviors, and psychological distress related to COVID-19 spread in Italy. 2020.https://doi.org/10.31234/osf.io/84d2c
4. Bohlken J, Schömig F, Lemke MR, Pumberger M, Riedel-Heller SG. [COVID-19 Pandemic: Stress Experience of Healthcare Workers - A Short Current Review]. Psychiatr Prax. 2020;47(4):190-7.
5. DePierro J, Lowe S, Katz C. Lessons learned from 9/11: Mental health perspectives on the COVID-19 pandemic. Psychiatry Res. 2020;288:113024.
6. Toth S, J AY, DePinto N. HIV stigma: perceptions from HIV-positive and HIV-negative patients in a community dental clinic. J Dent Res Dent Clin Dent Prospects. 2016;10(4):263-9.
7. Zheng W. Mental health and a novel coronavirus (2019-nCoV) in China. J Affect Disord. 2020;269:201-2.
8. Sękowski M, Gambin M, Hansen K, Holas P, Hyniewska S, Pluta A, et al. Risk of Developing Posttraumatic Stress Disorder in COVID-19 Survivors: What Should Mental Health Specialists Prepare For? 2020. doi:10.31234/osf.io/bnkve.
9. Dutheil F, Mondillon L, Navel V. PTSD as the second tsunami of the SARS-Cov-2 pandemic. Psychol Med. 2020:1-2.
10. Verma S, Mythily S, Chan YH, Deslypere JP, Teo EK, Chong SA. Post-SARS psychological morbidity and stigma among general practitioners and traditional Chinese medicine practitioners in Singapore. Ann Acad Med Singap. 2004;33(6):743-8.
11. Huang JZ, Han MF, Luo TD, Ren AK, Zhou XP. [Mental health survey of medical staff in a tertiary infectious disease hospital for COVID-19]. Zhonghua Lao Dong Wei Sheng Zhi Ye Bing Za Zhi. 2020;38(3):192-5.
12. Wu K, Wei X. Analysis of Psychological and Sleep Status and Exercise Rehabilitation of Front-Line Clinical Staff in the Fight Against COVID-19 in China. Med Sci Monit Basic Res.2020;26:e924085.doi:10.12659/MSMBR.924085
13. Gunawan J, Juthamanee S, Aungsuroch Y. Current Mental Health Issues in the Era of Covid-19. Asian J Psychiatr. 2020;51:102103.
14. Badrfam R, Zandifar A. Stigma Over COVID-19; New Conception Beyond Individual Sense. Arch Med Res. 2020.
15. Zandifar A, Karim H, Qorbani M, Badrfam R. Mental Health Care for Medical Staff in Iran during the COVID-19 Pandemic; Different Performance in Alborz Province.Iranian J Psychiatry. 2020;15(3):243-7.
16. Hajian Motlagh N, Zandifar A, Mohammadi MR, Badrfam R, Ahmadi N, Khaleghi A, et al. Mental Health Profile in the Population of 6 to 18 Years Old in Alborz Province, Iran. J Iranian Med Council. 2019;2(3):10-9.
17. Hansen M, Andersen TE, Armour C, Elklit A, Palic S, Mackrill T. PTSD-8: A Short PTSD Inventory. Clin Pract Epidemiol Ment Health. 2010;6:101-8.
18. Andersen TE, Hansen M, Ravn SL, Seehuus R, Nielsen M, Vaegter HB. Validation of the PTSD-8 Scale in Chronic Pain Patients. Pain Med. 2018;19(7):1365-72.
19. Vaughn-Sandler V, Sherman C, Aronsohn A, Volk ML. Consequences of perceived stigma among patients with cirrhosis. Dig Dis Sci. 2014;59(3):681-6.
20. Saine ME, Moore TM, Szymczak JE, Bamford LP, Barg FK, Mitra N, et al. Validation of a modified Berger HIV stigma scale for use among patients with hepatitis C virus (HCV) infection. PLoS One. 2020;15(2):e0228471.
21. Genberg BL, Hlavka Z, Konda KA, Maman S, Chariyalertsak S, Chingono A, et al. A comparison of HIV/AIDS-related stigma in four countries: negative attitudes and perceived acts of discrimination towards people living with HIV/AIDS. Soc Sci Med. 2009;68(12):2279-87.
22. Aghaei A, Mohraz M, Shamshirband S. Effects of media, interpersonal communication and religious attitudes on HIV-related stigma in Tehran, Iran. Inform Med Unlocked. 2020;18:100291.
23. Mak IW, Chu CM, Pan PC, Yiu MG, Ho SC, Chan VL. Risk factors for chronic post-traumatic stress disorder (PTSD) in SARS survivors. Gen Hosp Psychiatry. 2010;32(6):590-8.
24. Wu P, Fang Y, Guan Z, Fan B, Kong J, Yao Z, et al. The psychological impact of the SARS epidemic on hospital employees in China: exposure, risk perception, and altruistic acceptance of risk. Can J Psychiatry. 2009;54(5):302-11.
25. Badrfam R, Zandifar A. Coronavirus disease 2019 in Iran: the need for more attention to primary health care. Public Health. 2020;182:187.
26. Badrfam R, Zandifar A. COVID-19 and mental health: An Iranian perspective. Asian J Psychiatr. 2020;54:102266.
27. Zandifar A, Badrfam R. Fighting COVID-19 in Iran; Economic Challenges Ahead. Arch Iran Med. 2020;23(4):284.
28. Busby Grant J, Bruce CP, Batterham PJ. Predictors of personal, perceived and self-stigma towards anxiety and depression. Epidemiol Psychiatr Sci. 2016;25(3):247-54.
29. Zandifar A, Badrfam R, Mohammadian Khonsari N, Assareh M, Karim H, Azimzadeh M, et al. COVID-19 and medical staff's mental health in educational hospitals in Alborz Province, Iran. Psychiatry Clin Neurosci. 2020.
30. Badrfam R, Zandifar A, Arbabi M. Mental Health of Medical Workers in COVID-19 Pandemic: Restrictions and Barriers. J Res Health Sci. 2020;20(2):e00481.
31. Badrfam R, Zandifar A. COVID-19 and Melancholia; Different Perception of the Concept of Stigma and Loss.Iranian J Psychiatry. 2020;15(3):264-5.
32. Zandifar A, Badrfam R. COVID-19: Considering the prevalence of schizophrenia in the coming decades. Psychiatry Res. 2020;288:112982.
33. Badrfam R, Zandifar A. From encephalitis lethargica to COVID-19: Is there another epidemic ahead? Clin Neurol Neurosurg. 2020;196:106065.
34. Pereira-Sanchez V, Adiukwu F, El Hayek S, Bytyçi DG, Gonzalez-Diaz JM, Kundadak GK, et al. COVID-19 effect on mental health: patients and workforce. Lancet Psychiatry. 2020;7(6):e29-e30.
35. Khaleghi A, Mohammadi MR, Jahromi GP, Zarafshan H. New Ways to Manage Pandemics: Using Technologies in the Era of COVID-19, a Narrative Review. Iranian J Psychiatry. 2020;15(3),236-242.
36. Mohammadi MR, Khaleghi A, Badrfam R, Alavi SS, Zandifar A, Ahmadi A, et al. Social capital in general population of Tehran province in comparison with other provinces of Iran. J Iranian Med Council. 2019;2(3):26-34.
37. Liu N, Zhang F, Wei C, Jia Y, Shang Z, Sun L, et al. Prevalence and predictors of PTSS during COVID-19 outbreak in China hardest-hit areas: Gender differences matter. Psychiatry Res. 2020;287:112921.
38. Yin Q, Sun Z, Liu T, Ni X, Deng X, Jia Y, et al. Posttraumatic stress symptoms of health care workers during the corona virus disease 2019. Clin Psychol Psychother. 2020;27(3):384-95.
39. Chew NWS, Lee GKH, Tan BYQ, Jing M, Goh Y, Ngiam NJH, et al. A multinational, multicentre study on the psychological outcomes and associated physical symptoms amongst healthcare workers during COVID-19 outbreak. Brain Behav Immun. 2020;88:559-65.
40. Maunder R, Hunter J, Vincent L, Bennett J, Peladeau N, Leszcz M, et al. The immediate psychological and occupational impact of the 2003 SARS outbreak in a teaching hospital. Cmaj. 2003;168(10):1245-51.
41. Ho SM, Kwong-Lo RS, Mak CW, Wong JS. Fear of severe acute respiratory syndrome (SARS) among health care workers. J Consult Clin Psychol. 2005;73(2):344-9.
42. Bonfils KA, Lysaker PH, Yanos PT, Siegel A, Leonhardt BL, James AV, et al. Self-stigma in PTSD: Prevalence and correlates. Psychiatry Res. 2018;265:7-12.
43. Schneider A, Conrad D, Pfeiffer A, Elbert T, Kolassa IT, Wilker S. Stigmatization Is Associated With Increased PTSD Risk After Traumatic Stress and Diminished Likelihood of Spontaneous Remission-A Study With East-African Conflict Survivors. Front Psychiatry. 2018;9:423.
44. Murphy D, Busuttil W. PTSD, stigma and barriers to help-seeking within the UK Armed Forces. J R Army Med Corps. .2015;161(4):322-6.
2. Lu W, Wang H, Lin Y, Li L. Psychological status of medical workforce during the COVID-19 pandemic: A cross-sectional study. Psychiatry Res. 2020;288:112936.
3. Simione L, Gnagnarella C. Differences between health workers and general population in risk perception, behaviors, and psychological distress related to COVID-19 spread in Italy. 2020.https://doi.org/10.31234/osf.io/84d2c
4. Bohlken J, Schömig F, Lemke MR, Pumberger M, Riedel-Heller SG. [COVID-19 Pandemic: Stress Experience of Healthcare Workers - A Short Current Review]. Psychiatr Prax. 2020;47(4):190-7.
5. DePierro J, Lowe S, Katz C. Lessons learned from 9/11: Mental health perspectives on the COVID-19 pandemic. Psychiatry Res. 2020;288:113024.
6. Toth S, J AY, DePinto N. HIV stigma: perceptions from HIV-positive and HIV-negative patients in a community dental clinic. J Dent Res Dent Clin Dent Prospects. 2016;10(4):263-9.
7. Zheng W. Mental health and a novel coronavirus (2019-nCoV) in China. J Affect Disord. 2020;269:201-2.
8. Sękowski M, Gambin M, Hansen K, Holas P, Hyniewska S, Pluta A, et al. Risk of Developing Posttraumatic Stress Disorder in COVID-19 Survivors: What Should Mental Health Specialists Prepare For? 2020. doi:10.31234/osf.io/bnkve.
9. Dutheil F, Mondillon L, Navel V. PTSD as the second tsunami of the SARS-Cov-2 pandemic. Psychol Med. 2020:1-2.
10. Verma S, Mythily S, Chan YH, Deslypere JP, Teo EK, Chong SA. Post-SARS psychological morbidity and stigma among general practitioners and traditional Chinese medicine practitioners in Singapore. Ann Acad Med Singap. 2004;33(6):743-8.
11. Huang JZ, Han MF, Luo TD, Ren AK, Zhou XP. [Mental health survey of medical staff in a tertiary infectious disease hospital for COVID-19]. Zhonghua Lao Dong Wei Sheng Zhi Ye Bing Za Zhi. 2020;38(3):192-5.
12. Wu K, Wei X. Analysis of Psychological and Sleep Status and Exercise Rehabilitation of Front-Line Clinical Staff in the Fight Against COVID-19 in China. Med Sci Monit Basic Res.2020;26:e924085.doi:10.12659/MSMBR.924085
13. Gunawan J, Juthamanee S, Aungsuroch Y. Current Mental Health Issues in the Era of Covid-19. Asian J Psychiatr. 2020;51:102103.
14. Badrfam R, Zandifar A. Stigma Over COVID-19; New Conception Beyond Individual Sense. Arch Med Res. 2020.
15. Zandifar A, Karim H, Qorbani M, Badrfam R. Mental Health Care for Medical Staff in Iran during the COVID-19 Pandemic; Different Performance in Alborz Province.Iranian J Psychiatry. 2020;15(3):243-7.
16. Hajian Motlagh N, Zandifar A, Mohammadi MR, Badrfam R, Ahmadi N, Khaleghi A, et al. Mental Health Profile in the Population of 6 to 18 Years Old in Alborz Province, Iran. J Iranian Med Council. 2019;2(3):10-9.
17. Hansen M, Andersen TE, Armour C, Elklit A, Palic S, Mackrill T. PTSD-8: A Short PTSD Inventory. Clin Pract Epidemiol Ment Health. 2010;6:101-8.
18. Andersen TE, Hansen M, Ravn SL, Seehuus R, Nielsen M, Vaegter HB. Validation of the PTSD-8 Scale in Chronic Pain Patients. Pain Med. 2018;19(7):1365-72.
19. Vaughn-Sandler V, Sherman C, Aronsohn A, Volk ML. Consequences of perceived stigma among patients with cirrhosis. Dig Dis Sci. 2014;59(3):681-6.
20. Saine ME, Moore TM, Szymczak JE, Bamford LP, Barg FK, Mitra N, et al. Validation of a modified Berger HIV stigma scale for use among patients with hepatitis C virus (HCV) infection. PLoS One. 2020;15(2):e0228471.
21. Genberg BL, Hlavka Z, Konda KA, Maman S, Chariyalertsak S, Chingono A, et al. A comparison of HIV/AIDS-related stigma in four countries: negative attitudes and perceived acts of discrimination towards people living with HIV/AIDS. Soc Sci Med. 2009;68(12):2279-87.
22. Aghaei A, Mohraz M, Shamshirband S. Effects of media, interpersonal communication and religious attitudes on HIV-related stigma in Tehran, Iran. Inform Med Unlocked. 2020;18:100291.
23. Mak IW, Chu CM, Pan PC, Yiu MG, Ho SC, Chan VL. Risk factors for chronic post-traumatic stress disorder (PTSD) in SARS survivors. Gen Hosp Psychiatry. 2010;32(6):590-8.
24. Wu P, Fang Y, Guan Z, Fan B, Kong J, Yao Z, et al. The psychological impact of the SARS epidemic on hospital employees in China: exposure, risk perception, and altruistic acceptance of risk. Can J Psychiatry. 2009;54(5):302-11.
25. Badrfam R, Zandifar A. Coronavirus disease 2019 in Iran: the need for more attention to primary health care. Public Health. 2020;182:187.
26. Badrfam R, Zandifar A. COVID-19 and mental health: An Iranian perspective. Asian J Psychiatr. 2020;54:102266.
27. Zandifar A, Badrfam R. Fighting COVID-19 in Iran; Economic Challenges Ahead. Arch Iran Med. 2020;23(4):284.
28. Busby Grant J, Bruce CP, Batterham PJ. Predictors of personal, perceived and self-stigma towards anxiety and depression. Epidemiol Psychiatr Sci. 2016;25(3):247-54.
29. Zandifar A, Badrfam R, Mohammadian Khonsari N, Assareh M, Karim H, Azimzadeh M, et al. COVID-19 and medical staff's mental health in educational hospitals in Alborz Province, Iran. Psychiatry Clin Neurosci. 2020.
30. Badrfam R, Zandifar A, Arbabi M. Mental Health of Medical Workers in COVID-19 Pandemic: Restrictions and Barriers. J Res Health Sci. 2020;20(2):e00481.
31. Badrfam R, Zandifar A. COVID-19 and Melancholia; Different Perception of the Concept of Stigma and Loss.Iranian J Psychiatry. 2020;15(3):264-5.
32. Zandifar A, Badrfam R. COVID-19: Considering the prevalence of schizophrenia in the coming decades. Psychiatry Res. 2020;288:112982.
33. Badrfam R, Zandifar A. From encephalitis lethargica to COVID-19: Is there another epidemic ahead? Clin Neurol Neurosurg. 2020;196:106065.
34. Pereira-Sanchez V, Adiukwu F, El Hayek S, Bytyçi DG, Gonzalez-Diaz JM, Kundadak GK, et al. COVID-19 effect on mental health: patients and workforce. Lancet Psychiatry. 2020;7(6):e29-e30.
35. Khaleghi A, Mohammadi MR, Jahromi GP, Zarafshan H. New Ways to Manage Pandemics: Using Technologies in the Era of COVID-19, a Narrative Review. Iranian J Psychiatry. 2020;15(3),236-242.
36. Mohammadi MR, Khaleghi A, Badrfam R, Alavi SS, Zandifar A, Ahmadi A, et al. Social capital in general population of Tehran province in comparison with other provinces of Iran. J Iranian Med Council. 2019;2(3):26-34.
37. Liu N, Zhang F, Wei C, Jia Y, Shang Z, Sun L, et al. Prevalence and predictors of PTSS during COVID-19 outbreak in China hardest-hit areas: Gender differences matter. Psychiatry Res. 2020;287:112921.
38. Yin Q, Sun Z, Liu T, Ni X, Deng X, Jia Y, et al. Posttraumatic stress symptoms of health care workers during the corona virus disease 2019. Clin Psychol Psychother. 2020;27(3):384-95.
39. Chew NWS, Lee GKH, Tan BYQ, Jing M, Goh Y, Ngiam NJH, et al. A multinational, multicentre study on the psychological outcomes and associated physical symptoms amongst healthcare workers during COVID-19 outbreak. Brain Behav Immun. 2020;88:559-65.
40. Maunder R, Hunter J, Vincent L, Bennett J, Peladeau N, Leszcz M, et al. The immediate psychological and occupational impact of the 2003 SARS outbreak in a teaching hospital. Cmaj. 2003;168(10):1245-51.
41. Ho SM, Kwong-Lo RS, Mak CW, Wong JS. Fear of severe acute respiratory syndrome (SARS) among health care workers. J Consult Clin Psychol. 2005;73(2):344-9.
42. Bonfils KA, Lysaker PH, Yanos PT, Siegel A, Leonhardt BL, James AV, et al. Self-stigma in PTSD: Prevalence and correlates. Psychiatry Res. 2018;265:7-12.
43. Schneider A, Conrad D, Pfeiffer A, Elbert T, Kolassa IT, Wilker S. Stigmatization Is Associated With Increased PTSD Risk After Traumatic Stress and Diminished Likelihood of Spontaneous Remission-A Study With East-African Conflict Survivors. Front Psychiatry. 2018;9:423.
44. Murphy D, Busuttil W. PTSD, stigma and barriers to help-seeking within the UK Armed Forces. J R Army Med Corps. .2015;161(4):322-6.
| Files | ||
| Issue | Vol 15 No 4 (2020) | |
| Section | Original Article(s) | |
| DOI | https://doi.org/10.18502/ijps.v15i4.4303 | |
| PMCID | PMC7610075 | |
| PMID | 33240384 | |
| Keywords | ||
| COVID-19 Comorbidity Health Care Workers Prevalence Posttraumatic Stress Symptoms Stigma | ||
| Rights and permissions | |
|
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
How to Cite
1.
Zandifar A, Badrfam R, Mohammadian Khonsari N, Mohammadi MR, Asayesh H, Qorbani M. Prevalence and Associated Factors of Posttraumatic Stress Symptoms and Stigma among Health Care Workers in Contact with COVID-19 Patients. Iran J Psychiatry. 2020;15(4):340-350.
