Post-traumatic stress in healthcare workers during the COVID-19 pandemic: A systematic review and meta-analysis

Abstract

The SARS-CoV-2 (COVID-19) pandemic has increased healthcare worker (HCW) susceptibility to mental illness. We conducted a meta-analysis to investigate the prevalence and possible factors associated with post-traumatic stress disorder (PTSD) symptoms among HCW during the COVID-19 pandemic. We searched PubMed, SCOPUS and EMBASE databases up to May 4th, 2022. We performed random effects meta-analysis and moderator analyses for the prevalence of PTSD-relevant symptoms and severe PTSD symptoms. We identified 1276 studies, reviewed 209 full-text articles, and included 119 studies (117,143 participants) with a total of 121 data points in our final analysis. 34 studies (24,541 participants) reported prevalence of severe PTSD symptoms. Approximately 25.2% of participants were physicians, 42.8% nurses, 12.4% allied health professionals, 8.9% auxiliary health professionals, and 10.8% "other". The pooled prevalence of PTSD symptoms among HCWs was 34% (95% CI, 0.30-0.39, I² >90%), and 14% for severe PTSD (95% CI, 0.11 - 0.17, I² >90%). The introduction of COVID vaccines was associated with a sharp decline in the prevalence of PTSD, and new virus variants were associated with small increases in PTSD rates. It is important that policies work towards allocating adequate resources towards protecting the well-being of healthcare workers to minimize adverse consequences of PTSD.

Keywords: COVID-19; Healthcare workers; Mental health; Pandemic; Post-stress distress; SARS-CoV-2.

Fig. 1

PRISMA flow diagram for study selection.

Fig. 2

A: Forest Plot from random effects meta-analysis of studies reporting any PTSD among health care workers during the Coronavirus Disease 2019 (COVID-19) pandemic. B. Sensitivity analysis of random effects meta-analysis of studies reporting any PTSD among health care workers during the Coronavirus 2019 pandemic. The sensitivity analysis used a one-study-removed method.

Fig. 2

A: Forest Plot from random effects meta-analysis of studies reporting any PTSD among health care workers during the Coronavirus Disease 2019 (COVID-19) pandemic. B. Sensitivity analysis of random effects meta-analysis of studies reporting any PTSD among health care workers during the Coronavirus 2019 pandemic. The sensitivity analysis used a one-study-removed method.

Fig. 3

Forest Plot from random effects meta-analysis of studies reporting prevalence of severe PTSD among health care workers during the Coronavirus Disease 2019 (COVID-19) pandemic.

Fig. 4

A. Time series analysis depicting the prevalence of participants who reported any or severe PTSD symptoms and the monthly global cases of COVID-19. Legend: The Dashed Red Line with Squares (Line 1) indicates the prevalence of participants who had any symptoms of PTSD over the course of the pandemic. The Dashed Green Line with Triangles (Line 2) indicates the prevalence of participants who had severe symptoms of PTSD. The Solid Blue Line with Dots (Line 3) indicates the global number of COVID-19 cases as a factor of 10 million. We mark key events during the pandemic with a solid arrow. Key events include the availability of COVID-19 vaccines, the start of the Delta variant, and the start of the Omicron variant. B. Time series analysis depicting the percentages of participants who reported any or severe PTSD symptoms and the monthly global NEW cases of COVID-19. Legend: The Solid Blue Line with Dots (Line 1) indicates the prevalence of participants who had any symptoms of PTSD over the course of the pandemic. The Dashed Red Line with Triangles (Line 2) indicates the prevalence of participants who had severe symptoms of PTSD. The Dashed Green Line with Diamonds indicates (Line 3) the global number of new COVID-19 cases as a factor of 1 million. We mark key events during the pandemic with a solid arrow. Key events include the availability of COVID-19 vaccines, the start of the Delta variant, and the start of the Omicron variant.

Fig. 4

A. Time series analysis depicting the prevalence of participants who reported any or severe PTSD symptoms and the monthly global cases of COVID-19. Legend: The Dashed Red Line with Squares (Line 1) indicates the prevalence of participants who had any symptoms of PTSD over the course of the pandemic. The Dashed Green Line with Triangles (Line 2) indicates the prevalence of participants who had severe symptoms of PTSD. The Solid Blue Line with Dots (Line 3) indicates the global number of COVID-19 cases as a factor of 10 million. We mark key events during the pandemic with a solid arrow. Key events include the availability of COVID-19 vaccines, the start of the Delta variant, and the start of the Omicron variant. B. Time series analysis depicting the percentages of participants who reported any or severe PTSD symptoms and the monthly global NEW cases of COVID-19. Legend: The Solid Blue Line with Dots (Line 1) indicates the prevalence of participants who had any symptoms of PTSD over the course of the pandemic. The Dashed Red Line with Triangles (Line 2) indicates the prevalence of participants who had severe symptoms of PTSD. The Dashed Green Line with Diamonds indicates (Line 3) the global number of new COVID-19 cases as a factor of 1 million. We mark key events during the pandemic with a solid arrow. Key events include the availability of COVID-19 vaccines, the start of the Delta variant, and the start of the Omicron variant.