High Psychological Impact of Covid-19 on French Healthcare Workers: An Observational Cohort Study of PTSD, Depression and Burn-Out

Abstract

Introduction: The Covid-19 outbreak hit the world forcing public institutions to rethink their core functioning. Healthcare workers (HCWs) were particularly at risk for negative mental health outcomes, given their direct exposure to many pandemic-related stressors. Our study aimed to assess the psychological outcomes of French HCWs during the Covid-19 pandemic, including PTSD, depression and burn-out.

Methods: This study presents the baseline data of a large cohort study conducted during the pandemic. Participants were 849 French HCWs (mostly single women, working as nurses) assessed for PTSD with the PCL-5 (PTSD Checklist for DSM-5), for depression with the PHQ-9 (Patient Health Questionnaire), and for burn-out and compassion satisfaction with the ProQOL (Professional Quality of Life). Other pandemic-related variables were also collected, including characteristics related to participants' Covid-19 experience, as well as psychological and clinical measures.

Results: The prevalence rates of PTSD, moderately severe depression, and high risk for burn-out were 17.7% (n = 146), 14.0% (n = 118) and 0.9% (n = 7), respectively. Further, findings suggested that working conditions were challenging, though they still found pride in their work. Univariate analyses showed that being a woman, not being a physician, and lacking protective equipment were each associated with higher scores on several negative psychological outcomes (PTSD, depression, burn-out and secondary traumatic stress), though not consistently across all dimensions. Notably, satisfaction scores on the ProQOL did not differ by gender and were higher among physicians. In the multivariate analyses, not being a physician was independently associated with higher levels of PTSD, depression and burn-out symptoms. Being a woman was independently associated with increased PTSD symptom severity. Higher levels of positivity-defined as a general tendency to view life and experiences with an optimistic and constructive outlook, as measured by the Positivity Scale-were associated with lower symptom scores across all three psychological outcomes.

Conclusion: This study highlights the considerable psychological toll of the Covid-19 pandemic on French HCWs, particularly among nurses and women, and underscores the protective role of individual psychological resources such as positivity. As one of the largest cohort studies conducted during the pandemic in France, it provides critical evidence to guide public health strategies, institutional policies and mental health interventions. The findings emphasise the urgent need to strengthen occupational mental health support systems and to promote resilience-building approaches among healthcare professionals facing prolonged crisis conditions.

Keywords: Covid‐19; PTSD; burn‐out; depression; healthcare workers.

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Flowchart.