Prevalence of post-traumatic stress disorder in healthcare workers before and during COVID-19: a systematic review and meta-analysis

TL;DR

This study finds that healthcare workers had higher rates of PTSD during the early years of the COVID-19 pandemic compared to before, with the highest rates in 2020.

Contribution

The study provides updated pooled prevalence estimates of PTSD in healthcare workers before and during the pandemic, including time trends and subgroup analyses.

Findings

Pooled PTSD prevalence increased from 15.5% before the pandemic to 24.8% during the pandemic.

PTSD rates peaked in 2020 and returned to pre-pandemic levels by 2022.

Nurses and workers in high mortality rate countries had higher PTSD prevalence during the pandemic.

Abstract

The COVID-19 pandemic exacerbated many known risk factors for post-traumatic stress disorder (PTSD) among healthcare workers. This systematic review and meta-analysis examines pooled prevalence estimates of probable PTSD among this cohort prior to COVID-19 compared to during COVID-19 and investigates time trends in prevalence. Systematic multi-database literature searches were conducted to identify studies published between January 2017 and July 2023. Included studies reported the prevalence of probable PTSD, measured by validated screening tools, in clinical healthcare workers. Two reviewers independently conducted study screening, data extraction, and quality assessment. Random-effects meta-analyses were performed to estimate pooled prevalence of probable PTSD among healthcare workers in each time period. Subgroup analyses were carried out for year, profession, quality of study, COVID-19 mortality rates, and income level within the country of study. Screening identified 21 papers comprising 11,838 healthcare workers published in the 3 years preceding the pandemic, and 129 papers reporting on 130,363 healthcare workers during the pandemic. The pooled prevalence estimate of probable PTSD prior to the pandemic was 15.5% (95% CI: 12.3–19.3%) and this significantly increased during the pandemic to 24.8% (95% CI: 22.0–27.8%), peaking early in the pandemic in 2020 before returning to pre-pandemic levels in 2022. During the pandemic, prevalence estimates were significantly higher among nurses and those in countries with high COVID-19 mortality rates, whilst no significant difference was observed between studies conducted in high-income versus low- and middle-income countries. Substantial heterogeneity was observed. The findings of this review suggest that prevalence of PTSD among healthcare workers significantly increased following the COVID-19 outbreak. By the third year of the pandemic, probable PTSD prevalence rates appear to return to pre-pandemic levels, although these levels remain concerningly high. These findings support the call for targeted interventions to protect healthcare worker wellbeing, particularly during healthcare emergencies.

https://www.crd.york.ac.uk/PROSPERO/view/CRD42022364955, unique identifier is CRD42022364955

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