Post-Traumatic Stress Disorder among Frontline Nurses during the COVID-19 Pandemic and Its Relationship with Occupational Burnout
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Abstract
Objective: This study aimed to determine the level of post-traumatic stress disorder (PTSD) among nurses and its relationship with occupational burnout.
Method: This online cross-sectional survey was conducted from late November to early January 2020 in six hospitals in Iran. 309 frontline nurses in COVID-19 wards were selected via stratified random sampling and asked to complete a sociodemographic questionnaire, the Impact of Event Scale-revised version (IES-R), and the Maslach Burnout Inventory–Human Services Survey (MBI-HSS) in an anonymous online survey. Data management and analysis were performed in SPSS 25.0 using descriptive and inferential statistics, including Pearson’s correlation coefficient, independent samples t-test, ANOVA, and linear regression.
Results: The majority of the participants were women (81.6%) with a mean ± SD age of 31.56 ± 6.42 years. The mean ± SD of the total PTSD score was 39.2 ± 16.44 years, indicating severe PTSD among nurses. The mean ± SD of the total occupational burnout score was 82.77 ± 19.38, expressing moderate burnout. The findings also demonstrated a significant moderate correlation between PTSD and occupational burnout (r = 0.363, P < 0.001). Univariate analysis revealed a significant relationship of occupational burnout with PTSD, work experience, number of night shifts per month, and employment status (P < 0.05). However, in multivariate analysis, only PTSD had a positive and significant relationship with occupational burnout (P < 0.001; R2 = 160; β = 0.339) and was a predicting factor for it.
Conclusion: We found that both PTSD and burnout are common among nurses. Given the role of PTSD especially as a predictor of burnout and the significant impact of these disorders on occupational and non-occupational activities, immediate and appropriate measures are necessary to monitor and reduce their effects on the nurses who are at the forefront of fighting the pandemic.
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10. Liu CY, Yang YZ, Zhang XM, Xu X, Dou QL, Zhang WW, et al. The prevalence and influencing factors in anxiety in medical workers fighting COVID-19 in China: a cross-sectional survey. Epidemiol Infect. 2020;148:e98.
11. Said RM, El-Shafei DA. Occupational stress, job satisfaction, and intent to leave: nurses working on front lines during COVID-19 pandemic in Zagazig City, Egypt. Environ Sci Pollut Res Int. 2021;28(7):8791-801.
12. Naldi A, Vallelonga F, Di Liberto A, Cavallo R, Agnesone M, Gonella M, et al. COVID-19 pandemic-related anxiety, distress and burnout: prevalence and associated factors in healthcare workers of North-West Italy. BJPsych Open. 2021;7(1):e27.
13. Giusti EM, Pedroli E, D'Aniello GE, Stramba Badiale C, Pietrabissa G, Manna C, et al. The Psychological Impact of the COVID-19 Outbreak on Health Professionals: A Cross-Sectional Study. Front Psychol. 2020; 11:1684.
14. Ornell F, Halpern SC, Kessler FHP, Narvaez JCM. The impact of the COVID-19 pandemic on the mental health of healthcare professionals. Cad Saude Publica. 2020;36(4):e00063520.
15. Carmassi C, Foghi C, Dell'Oste V, Cordone A, Bertelloni CA, Bui E, et al. PTSD symptoms in healthcare workers facing the three coronavirus outbreaks: What can we expect after the COVID-19 pandemic. Psychiatry Res. 2020; 292:113312.
16. Foa EB, McLean CP, Zang Y, Zhong J, Powers MB, Kauffman BY, Rauch S, Porter K, Knowles K. Psychometric properties of the posttraumatic diagnostic scale for DSM–5 (PDS–5). APA PsycNet. 2016;28(10):1166.
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20. 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.
21. Si MY, Su XY, Jiang Y, Wang WJ, Gu XF, Ma L, et al. Psychological impact of COVID-19 on medical care workers in China. Infect Dis Poverty. 2020;9(1):113.
22. Kim Y, Seo E, Seo Y, Dee V, Hong E. Effects of Middle East Respiratory Syndrome Coronavirus on post-traumatic stress disorder and burnout among registered nurses in South Korea.Int.J.Healthc.2018;4(2):27-33.
23. Pothiawala S. Psychological Impact of the COVID-19 on Health Care Workers in the Emergency Department. Adv J Emerg Med. 2020;4(2s):e58.
24. Hosseininejad SM, Jahanian F, Elyasi F, Mokhtari H, Koulaei ME, Pashaei SM. The prevalence of post-traumatic stress disorder among emergency nurses: a cross sectional study in northern Iran. Biomedicine (Taipei). 2019;9(3):19.
25. Aminizadeh M, Tirgari B, Iranmanesh S, Garoosi B, Karimi M, Sheikh-Bardsiri H. Post-traumatic stress disorder prevalence in employees of emergency departments of teaching hospitals affiliated to Kerman University of Medical Sciences, Iran.J Manage Med Inform Sch 2013;1(1):18-25.
26. Panaghi L, Mogadam JA. Persian version validation in impact of event Scale-Revised. TU MJ. 2006;64(3):52-60.
27. Sheykhi M, Naderifar M, Firouzkohi M, Abdollahimohammad A, Akbarizadeh MR. The effect of group logo therapy on burnout of nurses in special wards.IJPN.2020;8(2):57-65.
28. Firouzkohi M, Abdollahimohammad A, Akbarizadeh MR. The Effect of Group Logo therapy on Burnout of Nurses in Special Wards. IJPN. 2020;8(2):57-65.
29. Moalemi S, Kavosi Z, Beygi N, Deghan A, Karimi A, Parvizi MM. Evaluation of the Persian Version of Maslach Burnout Inventory-Human Services Survey among Iranian Nurses: Validity and Reliability. Galen Med J. 2018;7:e995.
30. 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(1):84.
31. Hu D, Kong Y, Li W, Han Q, Zhang X, Zhu LX, et al. Frontline nurses' burnout, anxiety, depression, and fear statuses and their associated factors during the COVID-19 outbreak in Wuhan, China: A large-scale cross-sectional study. EClinicalMedicine.2020;24:100424.
32. Johnson SU, Ebrahimi OV, Hoffart A. PTSD symptoms among health workers and public service providers during the COVID-19 outbreak. PLoS One. 2020;15(10):e0241032.
33. Tomar BS, Suman S, Singh P, Raj P, Nathiya D. Mental health outcome and professional quality of life among healthcare workers during COVID-19 pandemic: A frontline-COVID survey. HMJ.2020;13(4):196.
34. d'Ettorre G, Ceccarelli G, Santinelli L, Vassalini P, Innocenti GP, Alessandri F, et al. Post-Traumatic Stress Symptoms in Healthcare Workers Dealing with the COVID-19 Pandemic: A Systematic Review. Int J Environ Res Public Health. 2021;18(2):601.
35. Lee SM, Kang WS, Cho AR, Kim T, Park JK. Psychological impact of the 2015 MERS outbreak on hospital workers and quarantined hemodialysis patients. Compr Psychiatry. 2018;87:123-7.
36. Kwek SK, Chew WM, Ong KC, Ng AW, Lee LS, Kaw G, et al. Quality of life and psychological status in survivors of severe acute respiratory syndrome at 3 months postdischarge. J Psychosom Res. 2006;60(5):513-9.
37. Salvagioni DAJ, Melanda FN, Mesas AE, González AD, Gabani FL, Andrade SM. Physical, psychological and occupational consequences of job burnout: A systematic review of prospective studies. PLoS One. 2017;12(10):e0185781.
38. Ferry AV, Wereski R, Strachan FE, Mills NL. Predictors of UK healthcare worker burnout during the COVID-19 pandemic. Qjm. 2021;114(6):374-80.
39. Orrù G, Marzetti F, Conversano C, Vagheggini G, Miccoli M, Ciacchini R, et al. Secondary Traumatic Stress and Burnout in Healthcare Workers during COVID-19 Outbreak. Int J Environ Res Public Health. 2021;18(1).
40. Hamed RA, Abd Elaziz SY, Ahmed AS. Prevalence and predictors of burnout syndrome, post-traumatic stress disorder, depression, and anxiety in nursing staff in various departments. MECP.2020;27(1):1-8.
41. Restauri N, Sheridan AD. Burnout and Posttraumatic Stress Disorder in the Coronavirus Disease 2019 (COVID-19) Pandemic: Intersection, Impact, and Interventions. J Am Coll Radiol. 2020;17(7):921-6.
42. Zhang SX, Liu J, Afshar Jahanshahi A, Nawaser K, Yousefi A, Li J, et al. At the height of the storm: Healthcare staff's health conditions and job satisfaction and their associated predictors during the epidemic peak of COVID-19. Brain Behav Immun. 2020; 87:144-6.
43. Chen R, Sun C, Chen JJ, Jen HJ, Kang XL, Kao CC, et al. A Large-Scale Survey on Trauma, Burnout, and Posttraumatic Growth among Nurses during the COVID-19 Pandemic. Int J Ment Health Nurs. 2021;30(1):102-16.
44. Mealer M, Burnham EL, Goode CJ, Rothbaum B, Moss M. The prevalence and impact of post traumatic stress disorder and burnout syndrome in nurses. Depress Anxiety. 2009;26(12):1118-2.
2. Yang Y, Peng F, Wang R, Yange M, Guan K, Jiang T, et al. The deadly coronaviruses: The 2003 SARS pandemic and the 2020 novel coronavirus epidemic in China. J Autoimmun. 2020; 109:102434.
3. Habibi R, Burci GL, de Campos TC, Chirwa D, Cinà M, Dagron S, et al. Do not violate the International Health Regulations during the COVID-19 outbreak. Lancet. 2020;395(10225):664-6.
4. Wilson ME, Chen LH. Travellers give wings to novel coronavirus (2019-nCoV). J Travel Med. 2020;27(2):taaa015.
5. WHO. world health organization. Coronavirus disease 2019(covid-19) situation report. 2021;22-March.
6. Zhu N, Zhang D, Wang W, Li X, Yang B, Song J, et al. A novel coronavirus from patients with pneumonia in China, 2019.N Engl J Med. 2020;382:727-733.
7. Behzadnia MJ, Saboori F. COVID-19 Outbreak Management in Hospitals of Iran; Strengths and Weaknesses. J Mil Med. 2020;22(2):203-4.
8. Meskarpour-Amiri M, Shams L, Nasiri T. Identifying and Categorizing the Dimensions of Iran's Health System Response to the Covid-19 Pandemic.JMilMed.2020;22(2):108-14.
9. Li S, Wang Y, Xue J, Zhao N, Zhu T. The Impact of COVID-19 Epidemic Declaration on Psychological Consequences: A Study on Active Weibo Users. Int J Environ Res Public Health. 2020;17(6).
10. Liu CY, Yang YZ, Zhang XM, Xu X, Dou QL, Zhang WW, et al. The prevalence and influencing factors in anxiety in medical workers fighting COVID-19 in China: a cross-sectional survey. Epidemiol Infect. 2020;148:e98.
11. Said RM, El-Shafei DA. Occupational stress, job satisfaction, and intent to leave: nurses working on front lines during COVID-19 pandemic in Zagazig City, Egypt. Environ Sci Pollut Res Int. 2021;28(7):8791-801.
12. Naldi A, Vallelonga F, Di Liberto A, Cavallo R, Agnesone M, Gonella M, et al. COVID-19 pandemic-related anxiety, distress and burnout: prevalence and associated factors in healthcare workers of North-West Italy. BJPsych Open. 2021;7(1):e27.
13. Giusti EM, Pedroli E, D'Aniello GE, Stramba Badiale C, Pietrabissa G, Manna C, et al. The Psychological Impact of the COVID-19 Outbreak on Health Professionals: A Cross-Sectional Study. Front Psychol. 2020; 11:1684.
14. Ornell F, Halpern SC, Kessler FHP, Narvaez JCM. The impact of the COVID-19 pandemic on the mental health of healthcare professionals. Cad Saude Publica. 2020;36(4):e00063520.
15. Carmassi C, Foghi C, Dell'Oste V, Cordone A, Bertelloni CA, Bui E, et al. PTSD symptoms in healthcare workers facing the three coronavirus outbreaks: What can we expect after the COVID-19 pandemic. Psychiatry Res. 2020; 292:113312.
16. Foa EB, McLean CP, Zang Y, Zhong J, Powers MB, Kauffman BY, Rauch S, Porter K, Knowles K. Psychometric properties of the posttraumatic diagnostic scale for DSM–5 (PDS–5). APA PsycNet. 2016;28(10):1166.
17. Pitman RK, Rasmusson AM, Koenen KC, Shin LM, Orr SP, Gilbertson MW, Milad MR, Liberzon I. Biological studies of post-traumatic stress disorder. Nat.Rev. Neurosci.2012;13(11):769-87.
18. Rauch SA, Favorite T, Giardino N, Porcari C, Defever E, Liberzon I. Relationship between anxiety, depression, and health satisfaction among veterans with PTSD. J Affect Disord. 2010;121(1-2):165-8.
19. Asim M, van Teijlingen E, Sathian B. Coronavirus Disease (COVID-19) and the risk of Post-Traumatic Stress Disorder: A mental health concern in Nepal. Nepal J Epidemiol. 2020;10(2):841-4.
20. 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.
21. Si MY, Su XY, Jiang Y, Wang WJ, Gu XF, Ma L, et al. Psychological impact of COVID-19 on medical care workers in China. Infect Dis Poverty. 2020;9(1):113.
22. Kim Y, Seo E, Seo Y, Dee V, Hong E. Effects of Middle East Respiratory Syndrome Coronavirus on post-traumatic stress disorder and burnout among registered nurses in South Korea.Int.J.Healthc.2018;4(2):27-33.
23. Pothiawala S. Psychological Impact of the COVID-19 on Health Care Workers in the Emergency Department. Adv J Emerg Med. 2020;4(2s):e58.
24. Hosseininejad SM, Jahanian F, Elyasi F, Mokhtari H, Koulaei ME, Pashaei SM. The prevalence of post-traumatic stress disorder among emergency nurses: a cross sectional study in northern Iran. Biomedicine (Taipei). 2019;9(3):19.
25. Aminizadeh M, Tirgari B, Iranmanesh S, Garoosi B, Karimi M, Sheikh-Bardsiri H. Post-traumatic stress disorder prevalence in employees of emergency departments of teaching hospitals affiliated to Kerman University of Medical Sciences, Iran.J Manage Med Inform Sch 2013;1(1):18-25.
26. Panaghi L, Mogadam JA. Persian version validation in impact of event Scale-Revised. TU MJ. 2006;64(3):52-60.
27. Sheykhi M, Naderifar M, Firouzkohi M, Abdollahimohammad A, Akbarizadeh MR. The effect of group logo therapy on burnout of nurses in special wards.IJPN.2020;8(2):57-65.
28. Firouzkohi M, Abdollahimohammad A, Akbarizadeh MR. The Effect of Group Logo therapy on Burnout of Nurses in Special Wards. IJPN. 2020;8(2):57-65.
29. Moalemi S, Kavosi Z, Beygi N, Deghan A, Karimi A, Parvizi MM. Evaluation of the Persian Version of Maslach Burnout Inventory-Human Services Survey among Iranian Nurses: Validity and Reliability. Galen Med J. 2018;7:e995.
30. 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(1):84.
31. Hu D, Kong Y, Li W, Han Q, Zhang X, Zhu LX, et al. Frontline nurses' burnout, anxiety, depression, and fear statuses and their associated factors during the COVID-19 outbreak in Wuhan, China: A large-scale cross-sectional study. EClinicalMedicine.2020;24:100424.
32. Johnson SU, Ebrahimi OV, Hoffart A. PTSD symptoms among health workers and public service providers during the COVID-19 outbreak. PLoS One. 2020;15(10):e0241032.
33. Tomar BS, Suman S, Singh P, Raj P, Nathiya D. Mental health outcome and professional quality of life among healthcare workers during COVID-19 pandemic: A frontline-COVID survey. HMJ.2020;13(4):196.
34. d'Ettorre G, Ceccarelli G, Santinelli L, Vassalini P, Innocenti GP, Alessandri F, et al. Post-Traumatic Stress Symptoms in Healthcare Workers Dealing with the COVID-19 Pandemic: A Systematic Review. Int J Environ Res Public Health. 2021;18(2):601.
35. Lee SM, Kang WS, Cho AR, Kim T, Park JK. Psychological impact of the 2015 MERS outbreak on hospital workers and quarantined hemodialysis patients. Compr Psychiatry. 2018;87:123-7.
36. Kwek SK, Chew WM, Ong KC, Ng AW, Lee LS, Kaw G, et al. Quality of life and psychological status in survivors of severe acute respiratory syndrome at 3 months postdischarge. J Psychosom Res. 2006;60(5):513-9.
37. Salvagioni DAJ, Melanda FN, Mesas AE, González AD, Gabani FL, Andrade SM. Physical, psychological and occupational consequences of job burnout: A systematic review of prospective studies. PLoS One. 2017;12(10):e0185781.
38. Ferry AV, Wereski R, Strachan FE, Mills NL. Predictors of UK healthcare worker burnout during the COVID-19 pandemic. Qjm. 2021;114(6):374-80.
39. Orrù G, Marzetti F, Conversano C, Vagheggini G, Miccoli M, Ciacchini R, et al. Secondary Traumatic Stress and Burnout in Healthcare Workers during COVID-19 Outbreak. Int J Environ Res Public Health. 2021;18(1).
40. Hamed RA, Abd Elaziz SY, Ahmed AS. Prevalence and predictors of burnout syndrome, post-traumatic stress disorder, depression, and anxiety in nursing staff in various departments. MECP.2020;27(1):1-8.
41. Restauri N, Sheridan AD. Burnout and Posttraumatic Stress Disorder in the Coronavirus Disease 2019 (COVID-19) Pandemic: Intersection, Impact, and Interventions. J Am Coll Radiol. 2020;17(7):921-6.
42. Zhang SX, Liu J, Afshar Jahanshahi A, Nawaser K, Yousefi A, Li J, et al. At the height of the storm: Healthcare staff's health conditions and job satisfaction and their associated predictors during the epidemic peak of COVID-19. Brain Behav Immun. 2020; 87:144-6.
43. Chen R, Sun C, Chen JJ, Jen HJ, Kang XL, Kao CC, et al. A Large-Scale Survey on Trauma, Burnout, and Posttraumatic Growth among Nurses during the COVID-19 Pandemic. Int J Ment Health Nurs. 2021;30(1):102-16.
44. Mealer M, Burnham EL, Goode CJ, Rothbaum B, Moss M. The prevalence and impact of post traumatic stress disorder and burnout syndrome in nurses. Depress Anxiety. 2009;26(12):1118-2.
| Files | ||
| Issue | Vol 17 No 4 (2022) | |
| Section | Original Article(s) | |
| DOI | https://doi.org/10.18502/ijps.v17i4.10693 | |
| Keywords | ||
| Burnout COVID-19 Nurses Post-Traumatic Stress Disorder (PTSD) | ||
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How to Cite
1.
Fateminia A, Hasanvand S, Goudarzi F, Mohammadi R. Post-Traumatic Stress Disorder among Frontline Nurses during the COVID-19 Pandemic and Its Relationship with Occupational Burnout. Iran J Psychiatry. 2022;17(4):436-445.
