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Kamra M, Dhaliwal S, Li W, Acharya S, Wong A, Zhu A, Vemulakonda J, Wilson J, Gibb M, Maskerine C, Spilg E, Tanuseputro P, Myran DT, Solmi M, Sood MM. Physician Posttraumatic Stress Disorder During COVID-19: A Systematic Review and Meta-Analysis. JAMA Netw Open 2024; 7:e2423316. [PMID: 39046740 PMCID: PMC11270139 DOI: 10.1001/jamanetworkopen.2024.23316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Accepted: 05/22/2024] [Indexed: 07/25/2024] Open
Abstract
Importance The COVID-19 pandemic placed many physicians in situations of increased stress and challenging resource allocation decisions. Insight into the prevalence of posttraumatic stress disorder in physicians and its risk factors during the COVID-19 pandemic will guide interventions to prevent its development. Objective To determine the prevalence of posttraumatic stress disorder (PTSD) among physicians during the COVID-19 pandemic and examine variations based on factors, such as sex, age, medical specialty, and career stage. Data Sources A Preferred Reporting Items for Systematic Reviews and Meta-analyses-compliant systematic review was conducted, searching MEDLINE, Embase, and PsychInfo, from December 2019 to November 2022. Search terms included MeSH (medical subject heading) terms and keywords associated with physicians as the population and PTSD. Study Selection Peer-reviewed published studies reporting on PTSD as a probable diagnosis via validated questionnaires or clinician diagnosis were included. The studies were reviewed by 6 reviewers. Data Extraction and Synthesis A random-effects meta-analysis was used to pool estimates of PTSD prevalence and calculate odds ratios (ORs) for relevant physician characteristics. Main Outcomes and Measures The primary outcome of interest was the prevalence of PTSD in physicians, identified by standardized questionnaires. Results Fifty-seven studies with a total of 28 965 participants and 25 countries were included (of those that reported sex: 5917 of 11 239 [52.6%] were male and 5322 of 11 239 [47.4%] were female; of those that reported career stage: 4148 of 11 186 [37.1%] were medical trainees and 7038 of 11 186 [62.9%] were attending physicians). The estimated pooled prevalence of PTSD was 18.3% (95% CI, 15.2%-22.8%; I2 = 97%). Fourteen studies (22.8%) reported sex, and it was found that female physicians were more likely to develop PTSD (OR, 1.93; 95% CI, 1.56-2.39). Of the 10 studies (17.5%) reporting age, younger physicians reported less PTSD. Among the 13 studies (22.8%) reporting specialty, PTSD was most common among emergency department doctors. Among the 16 studies (28.1%) reporting career stage, trainees were more prone to developing PTSD than attendings (OR, 1.33; 95% CI, 1.12-1.57). Conclusions and Relevance In this meta-analysis examining PTSD during COVID-19, 18.3% of physicians reported symptoms consistent with PTSD, with a higher risk in female physicians, older physiciansy, and trainees, and with variation by specialty. Targeted interventions to support physician well-being during traumatic events like pandemics are required.
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Affiliation(s)
- Mihir Kamra
- McMaster University, Hamilton, Ontario, Canada
| | - Shan Dhaliwal
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Wenshan Li
- The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | | | - Adrian Wong
- McMaster University, Hamilton, Ontario, Canada
| | - Andy Zhu
- McMaster University, Hamilton, Ontario, Canada
| | | | - Janet Wilson
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Maya Gibb
- The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | | | - Edward Spilg
- The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Peter Tanuseputro
- The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada
- ICES, Ontario, Canada
- Bruyere Research Institute, Ottawa, Ontario, Canada
| | - Daniel T. Myran
- ICES, Ontario, Canada
- Bruyere Research Institute, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Marco Solmi
- The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
- Department of Psychiatry, University of Ottawa, Ottawa, Ontario, Canada
- Deptartment of Mental Health, The Ottawa Hospital, Ottawa, Ontario, Canada
- Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany
| | - Manish M. Sood
- The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada
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Hernández-Bojorge S, Campos A, Parikh J, Beckstead J, Lajeunesse M, Wildman D. The prevalence and risk factors of PTSD symptoms among nurses during the COVID-19 pandemic-A systematic review and meta-analysis. Int J Ment Health Nurs 2024; 33:523-545. [PMID: 38059541 DOI: 10.1111/inm.13257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 10/20/2023] [Accepted: 11/07/2023] [Indexed: 12/08/2023]
Abstract
Since the first reported outbreak in China, the Coronavirus disease 2019 (COVID-19) has raised serious concerns globally. The COVID-19 pandemic has caused a severe psychological impact on healthcare workers (HCWs), and especially nurses, who are the most numerous and exposed frontline group. This systematic review and meta-analysis aims to summarise extant literature on the effects of the COVID-19 pandemic on the psychological health of nurses, particularly concerning the prevalence and risk factors for post-traumatic stress disorder (PTSD). A systematic search was conducted on PubMed, Embase and PsycInfo from March 2020 to July 2023. Articles were included/excluded on predetermined eligibility criteria. A random-effect meta-analysis was performed using proportions to determine the pooled prevalence for PTSD among nurses. Subgroup analyses were also performed, and heterogeneity across studies was analysed using meta-regression. Relatively high prevalence rates of PTSD were reported among nurse populations during the COVID-19 pandemic in twenty-six different countries, globally. Risk factors associated with PTSD include having prior mental health co-morbidities, being a female, having high exposure/contact with COVID-19 patients, having insufficient protective conditions and having intensive workloads. The overall pooled prevalence was 29.1% (95% C.I. = 23.5%, 35.5%) using a random-effects model in 55 studies. The regression test of funnel plot asymmetry indicated a significant level of publication bias among studies. The COVID-19 pandemic is associated with significant levels of PTSD among frontline nurses globally. A high level of heterogeneity was observed across studies. Psychological, social and administrative interventions should be implemented to mitigate heavy psychological distress in nurses.
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Affiliation(s)
- Santiago Hernández-Bojorge
- Department of Global and Planetary Health, College of Public Health, University of South Florida, Tampa, Florida, USA
| | - Adriana Campos
- Department of Global and Planetary Health, College of Public Health, University of South Florida, Tampa, Florida, USA
| | - Jeegan Parikh
- Department of Global and Planetary Health, College of Public Health, University of South Florida, Tampa, Florida, USA
| | - Jason Beckstead
- Department of Epidemiology, College of Public Health, University of South Florida, Tampa, Florida, USA
| | - Marc Lajeunesse
- Department of Integrative Biology, College of Arts and Sciences, University of South Florida, Tampa, Florida, USA
| | - Derek Wildman
- Department of Genomics, College of Public Health, University of South Florida, Tampa, Florida, USA
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Zhang M, Bo M, Wang H, Fan W, Kong L, Zhou C, Zhang Z. Prevalence and influencing factors of post-traumatic stress disorder among Chinese healthcare workers during the COVID-19 epidemic: a systematic review and meta-analysis. Front Psychiatry 2024; 15:1323111. [PMID: 38425999 PMCID: PMC10902088 DOI: 10.3389/fpsyt.2024.1323111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 01/29/2024] [Indexed: 03/02/2024] Open
Abstract
Background Post-traumatic stress disorder is an important psychological problem affecting the physical mental health of Chinese healthcare workers during the COVID-19 pandemic. Aims To estimate the prevalence and influencing factors of post-traumatic stress disorder (PTSD) among Chinese healthcare workers during COVID-19. Methods Search of Chinese and English literature in PubMed, EMbase, Web of Science, Medline, Elsevier, SpringerLink, China Biomedical Literature Database, CNKI, Wan-fang, and CQVIP for the period from December 2019 to August 2023. Stata 14.0 software was used for data analysis. The methodological quality of each study was scored, and data were extracted from the published reports. Pooled prevalence was estimated using the Random-effects model. Publication bias was evaluated using Egger's test and Begg's test. Results Twenty-one studies included 11841 Chinese healthcare workers in this review. First, the overall prevalence of Post-traumatic stress disorder among Chinese healthcare workers during the COVID-19 epidemic was 29.2% (95% CI: 20.7% to 33.7%). Twelve factors included in the meta-analysis were found to be protective against PTSD among Chinese healthcare workers: female, nurse, married, front-line work, less work experience, family or friend diagnosed with COVID-19, history of chronic disease and fear of COVID-19. Conversely, outside Hubei, higher education, social support and psychological resilience are protective factors. Conclusion These recent findings increase our understanding of the psychological status of Chinese healthcare workers and encourage that long-term monitoring and long-term interventions should be implemented to improve the mental health of Chinese healthcare workers in the aftermath of the COVID-19.
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Affiliation(s)
- Min Zhang
- Department of Applied Psychology, Binzhou Medical University, Yantai, Shandong, China
| | - Mingyu Bo
- Department of Applied Psychology, Binzhou Medical University, Yantai, Shandong, China
| | - Huixin Wang
- Department of Applied Psychology, Binzhou Medical University, Yantai, Shandong, China
| | - Wenyi Fan
- Department of Applied Psychology, Binzhou Medical University, Yantai, Shandong, China
| | - Lingling Kong
- Department of Applied Psychology, Binzhou Medical University, Yantai, Shandong, China
| | - Chunjie Zhou
- School of Information and Electrical Engineering, Ludong University, Yantai, Shandong, China
| | - Zhenxing Zhang
- School of Information and Electrical Engineering, Ludong University, Yantai, Shandong, China
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Huang J, Huang ZT, Sun XC, Chen TT, Wu XT. Mental health status and related factors influencing healthcare workers during the COVID-19 pandemic: A systematic review and meta-analysis. PLoS One 2024; 19:e0289454. [PMID: 38241316 PMCID: PMC10798549 DOI: 10.1371/journal.pone.0289454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2024] Open
Abstract
BACKGROUND The mental health of healthcare workers during the coronavirus-2019 pandemic was seriously affected, and the risk of mental health problems was high. The present study sought to systematically evaluate the mental health problems of healthcare workers worldwide during the pandemic and to determine the latest global frequency of COVID-19 associated mental health problems. METHODS Data in the Cumulative Index to Nursing and Allied Health Literature (CINAHL), EMBASE, Elsevier, MEDLINE, PubMed, PsycINFO and the Web of Science before November 11, 2022, were systematically searched. Cohort, case-control and cross-sectional studies were included. The meta-analysis used a random effects model to synthesize the comprehensive prevalence rate of mental health problems. Subgroup analyses were performed based on time of data collection; whether the country was or was not developed; continent; doctors and nurses; doctors/nurses vs. other healthcare workers; and psychological evaluation scale. RESULTS A total of 161 studies were included, including 341,014 healthcare workers worldwide, with women accounting for 82.8%. Occupationally, 16.2% of the healthcare workers were doctors, 63.6% were nurses and 13.3% were other medical staff. During the pandemic, 47% (95% confidence interval [CI], 35-60%) of healthcare workers reported job burnout, 38% (95% CI, 35-41%) experienced anxiety, 34% (95% CI 30-38%) reported depression, 30% (95% CI, 29-31%) had acute stress disorder, and 26% (95% CI, 21-31%) had post-traumatic stress disorder. CONCLUSIONS The study found that there were common mental health problems among health care workers during the COVID-19 pandemic. The most common was job burnout, followed by anxiety, depression, acute stress and post-traumatic stress disorder. Although the global pandemic has been brought under control, its long-term impact on the mental health of healthcare workers cannot be ignored. Additional research is required to develop measures to prevent, monitor and treat psychological disorders among healthcare workers.
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Affiliation(s)
- Jia Huang
- The Second Clinical Medical College, Lanzhou University, Lanzhou, Gansu, China
| | - Zhu-Tang Huang
- The Second Clinical Medical College, Lanzhou University, Lanzhou, Gansu, China
| | - Xin-Ce Sun
- The Second Clinical Medical College, Lanzhou University, Lanzhou, Gansu, China
| | - Ting-Ting Chen
- The Second Clinical Medical College, Lanzhou University, Lanzhou, Gansu, China
| | - Xiao-Tian Wu
- The First Clinical Medical College, Lanzhou University, Lanzhou, Gansu, China
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Mejia CR, Serna-Alarcón V, Vilela-Estrada MA, Armada J, Ubillus M, Beraún-Barrantes J, Álvarez-Risco A, Del-Aguila-Arcentales S, Davies NM, Yáñez JA. Prevalence of post-traumatic stress disorder risk post-COVID-19 in 12 countries in Latin America: a cross-sectional survey. Front Public Health 2024; 11:1302694. [PMID: 38264243 PMCID: PMC10804613 DOI: 10.3389/fpubh.2023.1302694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 12/06/2023] [Indexed: 01/25/2024] Open
Abstract
Introduction Latin America was the region most affected by COVID-19 in the second quarter of 2020, and consequently, the impact on mental health requires evaluation. The aim of this study was to assess the risk of post-traumatic stress disorder (PTSD) caused by bereavement due to COVID-19 in 12 countries in Latin America. Methods The current study was an analytical cross-sectional study. Validated tests were applied for PTSD, depression, anxiety, and stress (DASS-21), questions about the respondent's condition or their environment, and demographic questions, as well as the length of the mourning period of suffering. Results The outcomes demonstrated that the PTSD risk increased for women (p < 0.001), when a friend or acquaintance had COVID-19 (p = 0.002), when a close relative died from COVID-19 (p = 0.010), having severe depression (p <0.001), severe anxiety (p <0.001), severe stress (p <0.001), residing in Chile (p <0.001), Paraguay (p <0.001), Bolivia (p <0.001), Costa Rica (p <0.001) or El Salvador (p = 0.005). On the other hand, there was less risk of PTSD at an older age (p <0.001) or if respondents had a sentimental partner (p = 0.025). In the case of severe PTSD, there was a greater gender risk for women (p <0.001), a close relative dying from COVID-19 (p = 0.017), having severe depression (p <0.001), severe anxiety (p <0.001), severe stress (p <0.001), residing in Chile (p <0.001), Paraguay (p <0.001), Bolivia (p <0.001) and Costa Rica (p = 0.002). It was also observed that there was less risk of severe PTSD at an older age demographic (p <0.001). Discussion It can be concluded that the percentages of PTSD are high in its clinical presentation as severe, especially among Latin American women.
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Affiliation(s)
| | - Víctor Serna-Alarcón
- Universidad Privada Antenor Orrego, Piura, Peru
- Hospital Regional José Cayetano Heredia, EsSalud, Piura, Peru
| | - Martín A. Vilela-Estrada
- Universidad Privada Antenor Orrego, Piura, Peru
- Hospital Regional José Cayetano Heredia, EsSalud, Piura, Peru
| | | | | | | | | | | | - Neal M. Davies
- Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, AB, Canada
- Asociación Médica de Investigación y Servicios en Salud, Lima, Peru
| | - Jaime A. Yáñez
- Universidad Peruana de Ciencias Aplicadas, Facultad de Educación, Carrera de Educación y Gestión del Aprendizaje, Lima, Peru
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