This study aimed to assess the PTSD symptoms among nursing staff working during the COVID-19 pandemic and its relationship with different work-related characteristics. Our findings showed that COVID-dealing nurses providing direct care to patients with COVID-19 were three times more likely to have PTSD than non-COVID-dealing nurses not providing direct care to COVID-19 patients.

We found that 64.7% of the COVID-dealing nurses had severe PTSD symptoms, and 51% were diagnosed with PTSD. Less frequent short breaks, inadequate organizational support and compensation, and inadequate time off work were the most work-related characteristics significantly associated with PTSD among COVID-dealing nurses.

Providing care to COVID-19 patients coupled with more time spent in the hospital leads to repeated exposure to trauma, which may have significantly increased the risk of PTSD [5].

Additionally, fear of transmitting the disease to family members, paucity of resources, heavy workloads, caring for potentially rapidly deteriorating patients, seeing colleagues continuously fall sick, and lack of psychological and social support also increase the risk of PTSD [6].

Similarly, a study that assessed the mental health of healthcare workers during the COVID-19 pandemic in Italy revealed that healthcare professionals working in COVID-19 wards reported higher levels of depressive symptoms and post-traumatic stress symptoms compared to those who work in other healthcare units. Also, the authors noted that being an older female is related to higher levels of post-traumatic stress symptoms [7].

Moreover, in China, a mental health survey of medical staff in a tertiary infectious disease hospital for COVID-19 showed that the incidence of anxiety and PTSD is high among medical staff, especially female nurses [8].

Another Chinese online survey carried out on medical health workers during the COVID-19 outbreak reported that medical health workers had a higher prevalence of insomnia, anxiety, depression, somatization, and obsessive–compulsive symptoms compared with non-medical health workers [9].

According to another cross-sectional online survey conducted in Turkey to assess psychological responses of healthcare workers and related factors during the COVID-19 outbreak, being female, being young, being single, having less work experience, and working in frontline jobs were associated with higher scores of stress [10].

Also, several previous studies described acute and post-traumatic stress among healthcare staff working with patients during viral outbreaks, which was related to a variety of sociodemographic and work-related characteristics [11].

Predisposing factors were being women [12, 13], younger [14], parents of dependent children [15], exposed to prolonged quarantine [16], having pre-existing psychological or physical illness [17], and fear of infecting or having an infected family member [18].

Significantly work-related risk factors among nurses were being less experienced, part-time employment, and frustration about the effect of precautionary measures on their ability to do their jobs [19].

Other factors included inadequate staff training, organizational support, compensation, and societal stigma against healthcare workers [20].

Protective factors found by previous studies were being older, having greater clinical experience, frequent short breaks from clinical duties, adequate time off work, family support, adequate training, a supportive work environment, clear communication, and faith in precautionary measures. [21].

Having access to psychologically supportive interventions was also noted to be protective [22]. Although nurses are more vulnerable to psychological distress than other healthcare workers, they are more likely to adhere to infection control procedures [23]. Lastly, seeing infected colleagues getting better, as well as a general drop in disease transmission, improved psychological outcomes [24].

This study highlights the importance of healthcare workers’ mental health caring for patients during a viral outbreak. The COVID-19 pandemic has burdened our nursing population and exacerbated previously existing problems such as post-traumatic stress, so effective interventions including communication, access to adequate personal protective equipment (PPE), more frequent short breaks, adequate rest, and psychological support should be immediately implemented.

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