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. 2025 Aug 1;8(8):e2527443.
doi: 10.1001/jamanetworkopen.2025.27443.

Posttraumatic Growth in Intensive Care Unit Health Care Professionals After COVID-19

Élie Azoulay  1 , Laurent Argaud  2 , Vincent Labbé  3 , Guillaume Dumas  4 , Fabrice Bruneel  5 , Mercé Jourdain  6 , Christophe Guitton  7 , Amélie Seguin  8 , Samir Jaber  9 , David Schnell  10 , Isabelle Vinatier  11 , Fanny Ardisson  12 , Michel Ramakers  13 , Antoine Herault  14 , Olivier Lesieur  15 , Alain Cariou  16 , Antoine Vieillard-Baron  17 , Olivier Guisset  18 , Frédéric Pochard  1 , Michael Darmon  1 , Nancy Kentish-Barnes  1
Affiliations

Posttraumatic Growth in Intensive Care Unit Health Care Professionals After COVID-19

Élie Azoulay et al. JAMA Netw Open. .

Abstract

Importance: Posttraumatic growth (PTG) refers to positive psychological changes following adversity, including deeper relationships and a greater appreciation for life.

Objective: To assess PTG among intensive care unit (ICU) health care professionals 4 years after the COVID-19 pandemic and explore its association with resilience, anxiety, and depression.

Design, setting, and participants: This cross-sectional study invited ICU health care professionals (nursing staff, medical staff [residents, interns, clinical fellows, and senior intensivists], and other professionals providing patient care) in ICUs in general or university-affiliated hospitals in France and Belgium to complete online questionnaires between March 15 and May 15, 2024.

Exposures: PTG, resilience, anxiety, and depression.

Main outcomes and measures: The primary outcome was PTG, and secondary outcomes were anxiety, depression, and resilience. Participants completed validated self-reported questionnaires, including the Posttraumatic Growth Inventory (PTGI), Hospital Anxiety and Depression Scale (HADS), and 10-item Connor-Davidson Resilience Scale (CD-RISC 10). Visual analog scales (VASs) assessed professional experiences and psychological impact. Multivariate linear regression identified factors associated with PTG.

Results: Among 1371 health care professionals in 23 ICUs, 850 (62%) responded (median age, 39 years [IQR, 32-46 years]; 574 [68%] women). The median PTGI score was 50 (IQR, 33-64), with nursing staff reporting higher PTG than medical staff (51 [IQR, 34-65] vs 47 [IQR, 28-61]; P = .02), mainly in personal strength, spiritual change, and appreciation of life. Anxiety and depression symptoms were present in 492 respondents (58%) and 219 respondents (26%), respectively. Lower PTG was associated with psychological fatigue (regression coefficient, 1.43; 95% CI, 0.91-1.96; P < .001), ICU conflicts (regression coefficient, 0.62; 95% CI, 0.05-1.19; P = .03), and perceived deterioration in family-centered care (regression coefficient, -7.47; 95% CI, -1.10 to -13.80; P = .02). Higher PTG was correlated with higher resilience (Spearman correlation coefficient, 0.24; 95% CI, 0.17-0.30; P < .001) and was associated with a change in personal life since the pandemic (regression coefficient, 1.80 [95% CI, 1.13-2.47] per VAS point; P < .001).

Conclusions and relevance: In this cross-sectional study performed 4 years after the start of the COVID-19 pandemic, ICU health care professionals, particularly nursing staff, exhibited significant PTG. Resilience, rather than psychological distress, emerged as a key driver of PTG, and deterioration in family-centered care was a major contributing factor, underscoring the need for targeted well-being and resilience-building strategies to enhance health care professionals' mental health and professional fulfillment while also improving patient and family care.

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Conflict of interest statement

Conflict of Interest Disclosures: Prof Azoulay reported receiving personal fees from Alexion, Baxter, Pfizer, and Gilead for lectures outside the submitted work. Dr Labbé reported receiving personal fees from AOP Health and grants from LEO Pharma outside the submitted work. Prof Darmon reported serving on the advisory board for Gilead outside the submitted work. Dr Kentish-Barnes reported receiving grants from AP-HP and a grant from the French Ministry of Health during the conduct of the study. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Intensity of Unidimensional Measures in Intensive Care Unit Health Care Professionals With and Without Symptoms of Anxiety, Depression, and Resilience
Ratings were in response to the question “Looking back to the pandemic, could you rate if the experience is still frightening, exhausting, frustrating?” and used a visual analog scale (VAS) with 2 anchors: 0 (no symptom) and 10 (most intense symptom). The horizontal bar inside the boxes indicates the median VAS score and the lower and upper ends of the boxes, the first and third quartiles. The whiskers indicate variability outside the upper and lower quartiles, and data more extreme than the whiskers are plotted individually as outliers (shaded circles).
Figure 2.
Figure 2.. Correlation Between Posttraumatic Growth Inventory (PTGI) Scores and Anxiety, Depression, and Resilience
Anxiety was measured with the Hospital Anxiety and Depression Scale (HADS)–Anxiety subscale and depression with the HADS-Depression subscale (scores greater than 7 of 21 on each subscale indicate presence of symptoms of anxiety or depression); resilience was measured with the 10-item Connor-Davidson Resilience Scale (CD-RISC 10; score range, 0-40, with higher scores indicating greater resilience). PTGI scores range from 0 to 105, with higher scores indicating greater PTG. There was a significant positive correlation between PTG and resilience but not between PTG and anxiety or depression.
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Comment in

  • doi: 10.1001/jamanetworkopen.2025.27452

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