Epidemiology of Post-Traumatic Stress Disorder in Intensive Care Nurses: A Systematic Review
-
Zohreh Gehisari
,
Elnaz Hashemzadeh
,
Sevda Fazlizade
,
Hamed Razaghpour
,
Mohammad Abdi
,
Maryam Asadi Aghajari
Abstract
Background: The intensive care unit environment poses a substantial risk for Post-Traumatic Stress Disorder (PTSD) among nurses, stemming from frequent exposure to traumatic events and patient death This systematic review aimed to determine the epidemiology of PTSD among ICU nurses.
Methods: We systematically searched PubMed, Scopus, and Web of Science from Jan 2000 to Dec 2024 for studies reporting PTSD prevalence among ICU nurses. Inclusion criteria were observational studies with validated PTSD assessment tools; Exclusion criteria included case reports and non-English publications. Data were synthesized using a random-effects model.
Results: The study reviewed 25 papers that provided quantitative data and were included in the analysis; the sample sizes varied from 98 to 748 ICU nurses. The published frequency of PTSD among ICU nurses has been identified to range between 3.3% and 64%. The pooled prevalence was estimated to be approximately 32.78 % (CI 95%[31.6%, 33.9%]). The specific factors influencing risk for PTSD included exposure to traumatic events: having a high workload, staff shortage, and organizational issues with the absence of psychological support, as well as individual characteristics, including younger age and prior mental health disorders. The impacts of PTSD included psychological distress, poor sleep quality, feelings of loneliness, and a reduced health-related quality of life.
Conclusion: The high prevalence of PTSD among ICU nurses underscores an urgent need for targeted interventions and support programs. Providing essential support through staffing, psychological resources, and resilience training is critical. Further research should examine the longitudinal course of PTSD and evaluate intervention outcomes.
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2. Baxter A (2004). Posttraumatic stress disor-der and the intensive care unit patient: implications for staff and advanced practice critical care nurses. Dimens Crit Care Nurs, 23(4): 145-50.
3. Levi P, Moss J (2022). Intensive care unit nurses’ lived experiences of psychologi-cal stress and trauma caring for COVID-19 patients. Workplace Health Saf, 70(8): 358-67.
4. Mealer M, Jones J, Moss M (2012). A qualita-tive study of resilience and posttraumat-ic stress disorder in United States ICU nurses. Intensive Care Med, 38: 1445-51.
5. Deltour V, Poujol AL, Laurent A (2023). Post-traumatic stress disorder among ICU healthcare professionals before and after the Covid-19 health crisis: a narrative review. Ann Intensive Care, 13(1):66.
6. Righy C, Rosa RG, da Silva RTA, et al (2019). Prevalence of post-traumatic stress disorder symptoms in adult criti-cal care survivors: a systematic review and meta-analysis. Crit Care, 23(1):213.
7. Crowe S, Howard AF, Vanderspank-Wright B, et al (2021). The effect of COVID-19 pandemic on the mental health of Ca-nadian critical care nurses providing pa-tient care during the early phase pan-demic: A mixed method study. Intensive Crit Care Nurs, 63: 102999.
8. Asadi Aghajari M, Fazlizade S, Hashemza-deh E, et al (2024). The Relationship be-tween Occupational Stress and Depres-sion in Emergency Medical Techni-cians: Post-Corona Consideration. Evi-dence Based Care, 13(4): 18-27.
9. Asadi Aghajari M, Hashemzadeh E, Fazlizade S, et al (2023). Post-Traumatic Stress Disorder among Emergency Med-ical Technicians and its Relationship with Occupational Stress and Depres-sion: Post-Corona Screening, Zanjan, 2022. Bull Emerg Trauma, 11(3): 138-45.
10. Saeidi M, Safaei A, Sadat Z, et al (2021). Prevalence of Depression, Anxiety and Stress Among Patients Discharged from Critical Care Units. J Crit Care Med (Targu Mures), 7(2): 113-22.
11. Adriaenssens J, De Gucht V, Maes S (2012). The impact of traumatic events on emergency room nurses: Findings from a questionnaire survey. Int J Nurs Stud, 49(11): 1411-22.
12. Mehta S, Yarnell C, Shah S, et al (2022). The impact of the COVID-19 pandemic on intensive care unit workers: a nationwide survey. Can J Anaesth, 69(4): 472-84.
13. Damico V, Demoro G, Bolgi S, et al (2022). Impact of COVID-19 outbreak on ICU nurses' mental health. An Italian multi-center study. Prof Inferm, 75(1): 51-8.
14. Zhang M, Bo M, Wang H, et al (2024). Prev-alence and influencing factors of post-traumatic stress disorder among Chinese healthcare workers during the COVID-19 epidemic: a systematic review and meta-analysis. Front Psychiatry, 15: 1323111.
15. Page MJ, McKenzie JE, Bossuyt PM, et al (2021). The PRISMA 2020 statement: an updated guideline for reporting system-atic reviews. BMJ, 372:n71.
16. Wells GA, Shea B, O’Connell D, et al (2000). The Newcastle-Ottawa Scale (NOS) for assessing the quality of non-randomised studies in meta-analyses.
17. Dettori JR, Norvell DC, Chapman JR (2022). Fixed-effect vs random-effects models for meta-analysis: 3 points to consider. Global Spine J, 12(7): 1624-1626.
18. Kc S, Gooden TE, Aryal D, et al (2024). The burden of anxiety, depression, and stress, along with the prevalence of symptoms of PTSD, and perceptions of the drivers of psychological harms, as perceived by doctors and nurses work-ing in ICUs in Nepal during the COVID-19 pandemic; a mixed method evaluation. BMC Health Serv Res, 24(1):450.
19. Kim S, Im Y (2024). Factors Related to Post-traumatic Stress Disorder Symp-toms Among Intensive Care Unit Nurs-es. Asian Nurs Res (Korean Soc Nurs Sci), 18(2): 159-66.
20. Taheri M, Ardabili FM, Najafighezeljeh T, et al (2023). General Health, Posttrau-matic Stress Disorder, and Coping Strat-egies of Nurses Working in the COVID-19 Intensive Care Units. J Client Centered Nurs Care, 9(3):231-240.
21. Mathew C, Mathew C (2023). How Much is Too Much! The Prevalence of Post-traumatic Stress Disorder Symptoms in Critical Care Nurses of Tertiary Care Hospitals in South India: A Multicenter Cross-sectional Cohort Study. Indian J Crit Care Med, 27(5): 330-4.
22. Hovland IS, Skogstad L, Stafseth S, et al. (2023). Prevalence of psychological dis-tress in nurses, physicians and leaders working in intensive care units during the COVID-19 pandemic: a national one-year follow-up study. BMJ Open, 13(12): e075190.
23. Vadi S, Shah S, Bajpe S, et al. (2022). Mental Health Indices of Intensive Care Unit and Emergency Room Frontliners dur-ing the Severe Acute Respiratory Syn-drome Coronavirus 2 Pandemic in In-dia. Indian J Crit Care Med, 26(1): 100-7.
24. Stafseth SK, Skogstad L, Ræder J, et al. (2022). Symptoms of Anxiety, Depres-sion, and Post-Traumatic Stress Disor-der in Health Care Personnel in Norwe-gian ICUs during the First Wave of the COVID-19 Pandemic, a Prospective, Observational Cross-Sectional Study. Int J Environ Res Public Health, 19(12):7010.
25. Hall CE, Milward J, Spoiala C, et al. (2022). The mental health of staff working on intensive care units over the COVID-19 winter surge of 2020 in England: a cross sectional survey. Br J Anaesth, 128(6): 971-9.
26. Guttormson JL, Calkins K, McAndrew N, et al (2022). Critical Care Nurse Burnout, Moral Distress, and Mental Health Dur-ing the COVID-19 Pandemic: A United States Survey. Heart Lung, 55: 127-33.
27. Pan L, Xu Q, Kuang X, et al. (2021). Preva-lence and factors associated with post-traumatic stress disorder in healthcare workers exposed to COVID-19 in Wu-han, China: a cross-sectional survey. BMC Psychiatry, 21(1): 572.
28. Li P, Kuang H, Tan H (2021). The occur-rence of post-traumatic stress disorder (PTSD), job burnout and its influencing factors among ICU nurses. Am J Transl Res, 13(7): 8302-8.
29. Heesakkers H, Zegers M, van Mol MMC, et al (2021). The impact of the first COVID-19 surge on the mental well-being of ICU nurses: A nationwide sur-vey study. Intensive Crit Care Nurs, 65: 103034.
30. Zhang J, Guo F, Chen ZY, et al (2020). Re-lationship between social support, resili-ence, self-esteem and post-traumatic stress disorder in intensive care unit nurses. Zhonghua Yi Xue Za Zhi, 100(1):32-36.
31. Azoulay E, Cariou A, Bruneel F, et al. (2020). Symptoms of anxiety, depression, and peritraumatic dissociation in critical care clinicians managing patients with COVID-19 a cross-sectional study. Am J Respir Crit Care Med, 202(10): 1388-98.
32. Mealer M, Jones J, Meek P (2017). Factors affecting resilience and development of posttraumatic stress disorder in critical care nurses. Am J Crit Care, 26(3): 184-92.
33. Cho GJ, Kang J (2017). Type D personality and post-traumatic stress disorder symp-toms among intensive care unit nurses: The mediating effect of resilience. PLoS One, 12(4): e0175067.
34. Ong YZ, Siddiqui S, John S, et al (2016). The prevalence of post-traumatic stress disorder in intensive care unit staff and the common coping strategies used. Ann Acad Med Singap, 45(5): 215-8.
35. Janda R, Jandová E (2015). Symptoms of posttraumatic stress disorder, anxiety and depression among Czech critical care and general surgical and medical ward nurses. J Res Nurs, 20(4): 298-309.
36. Mealer M, Jones J, Newman J, et al (2012). The presence of resilience is associated with a healthier psychological profile in intensive care unit (ICU) nurses: Results of a national survey. Int J Nurs Stud, 49(3): 292-9.
37. Mealer M, Burnham EL, Goode CJ, et al (2009). The prevalence and impact of post traumatic stress disorder and burn-out syndrome in nurses. Depress Anxiety, 26(12): 1118-26.
38. Su TP, Lien TC, Yang CY, et al (2007). Prev-alence of psychiatric morbidity and psychological adaptation of the nurses in a structured SARS caring unit during outbreak: A prospective and periodic as-sessment study in Taiwan. J Psychiatr Res, 41(1-2): 119-30.
39. Mealer ML, Shelton A, Berg B, et al (2007). Increased prevalence of post-traumatic stress disorder symptoms in critical care nurses. Am J Respir Crit Care Med, 175(7): 693-7.
40. Saracoglu KT, Simsek T, Kahraman S, et al. (2020). The Psychological Impact of COVID-19 Disease is more Severe on Intensive Care Unit Healthcare Provid-ers: A Cross-sectional Study. Clin Psycho-pharmacol Neurosci, 18(4): 607-15.
41. Jones GAL, Colville GA, Ramnarayan P, et al. (2020). Psychological impact of work-ing in paediatric intensive care. A UK-wide prevalence study. Arch Dis Child, 105(5): 470-5.
42. Tang L, Pan L, Yuan L, et al (2016). Preva-lence and related factors of post-traumatic stress disorder among medical staff members exposed to H7N9 pa-tients. Int J Nurs Sci, 4(1): 63-7.
43. Rasouli N, Abdi M (2019). Comparison of occupational stress level of nurses in public and private hospitals in Qom, 2016. Q J Nurs Manag, 8(2): 10-17.
2. Baxter A (2004). Posttraumatic stress disor-der and the intensive care unit patient: implications for staff and advanced practice critical care nurses. Dimens Crit Care Nurs, 23(4): 145-50.
3. Levi P, Moss J (2022). Intensive care unit nurses’ lived experiences of psychologi-cal stress and trauma caring for COVID-19 patients. Workplace Health Saf, 70(8): 358-67.
4. Mealer M, Jones J, Moss M (2012). A qualita-tive study of resilience and posttraumat-ic stress disorder in United States ICU nurses. Intensive Care Med, 38: 1445-51.
5. Deltour V, Poujol AL, Laurent A (2023). Post-traumatic stress disorder among ICU healthcare professionals before and after the Covid-19 health crisis: a narrative review. Ann Intensive Care, 13(1):66.
6. Righy C, Rosa RG, da Silva RTA, et al (2019). Prevalence of post-traumatic stress disorder symptoms in adult criti-cal care survivors: a systematic review and meta-analysis. Crit Care, 23(1):213.
7. Crowe S, Howard AF, Vanderspank-Wright B, et al (2021). The effect of COVID-19 pandemic on the mental health of Ca-nadian critical care nurses providing pa-tient care during the early phase pan-demic: A mixed method study. Intensive Crit Care Nurs, 63: 102999.
8. Asadi Aghajari M, Fazlizade S, Hashemza-deh E, et al (2024). The Relationship be-tween Occupational Stress and Depres-sion in Emergency Medical Techni-cians: Post-Corona Consideration. Evi-dence Based Care, 13(4): 18-27.
9. Asadi Aghajari M, Hashemzadeh E, Fazlizade S, et al (2023). Post-Traumatic Stress Disorder among Emergency Med-ical Technicians and its Relationship with Occupational Stress and Depres-sion: Post-Corona Screening, Zanjan, 2022. Bull Emerg Trauma, 11(3): 138-45.
10. Saeidi M, Safaei A, Sadat Z, et al (2021). Prevalence of Depression, Anxiety and Stress Among Patients Discharged from Critical Care Units. J Crit Care Med (Targu Mures), 7(2): 113-22.
11. Adriaenssens J, De Gucht V, Maes S (2012). The impact of traumatic events on emergency room nurses: Findings from a questionnaire survey. Int J Nurs Stud, 49(11): 1411-22.
12. Mehta S, Yarnell C, Shah S, et al (2022). The impact of the COVID-19 pandemic on intensive care unit workers: a nationwide survey. Can J Anaesth, 69(4): 472-84.
13. Damico V, Demoro G, Bolgi S, et al (2022). Impact of COVID-19 outbreak on ICU nurses' mental health. An Italian multi-center study. Prof Inferm, 75(1): 51-8.
14. Zhang M, Bo M, Wang H, et al (2024). Prev-alence and influencing factors of post-traumatic stress disorder among Chinese healthcare workers during the COVID-19 epidemic: a systematic review and meta-analysis. Front Psychiatry, 15: 1323111.
15. Page MJ, McKenzie JE, Bossuyt PM, et al (2021). The PRISMA 2020 statement: an updated guideline for reporting system-atic reviews. BMJ, 372:n71.
16. Wells GA, Shea B, O’Connell D, et al (2000). The Newcastle-Ottawa Scale (NOS) for assessing the quality of non-randomised studies in meta-analyses.
17. Dettori JR, Norvell DC, Chapman JR (2022). Fixed-effect vs random-effects models for meta-analysis: 3 points to consider. Global Spine J, 12(7): 1624-1626.
18. Kc S, Gooden TE, Aryal D, et al (2024). The burden of anxiety, depression, and stress, along with the prevalence of symptoms of PTSD, and perceptions of the drivers of psychological harms, as perceived by doctors and nurses work-ing in ICUs in Nepal during the COVID-19 pandemic; a mixed method evaluation. BMC Health Serv Res, 24(1):450.
19. Kim S, Im Y (2024). Factors Related to Post-traumatic Stress Disorder Symp-toms Among Intensive Care Unit Nurs-es. Asian Nurs Res (Korean Soc Nurs Sci), 18(2): 159-66.
20. Taheri M, Ardabili FM, Najafighezeljeh T, et al (2023). General Health, Posttrau-matic Stress Disorder, and Coping Strat-egies of Nurses Working in the COVID-19 Intensive Care Units. J Client Centered Nurs Care, 9(3):231-240.
21. Mathew C, Mathew C (2023). How Much is Too Much! The Prevalence of Post-traumatic Stress Disorder Symptoms in Critical Care Nurses of Tertiary Care Hospitals in South India: A Multicenter Cross-sectional Cohort Study. Indian J Crit Care Med, 27(5): 330-4.
22. Hovland IS, Skogstad L, Stafseth S, et al. (2023). Prevalence of psychological dis-tress in nurses, physicians and leaders working in intensive care units during the COVID-19 pandemic: a national one-year follow-up study. BMJ Open, 13(12): e075190.
23. Vadi S, Shah S, Bajpe S, et al. (2022). Mental Health Indices of Intensive Care Unit and Emergency Room Frontliners dur-ing the Severe Acute Respiratory Syn-drome Coronavirus 2 Pandemic in In-dia. Indian J Crit Care Med, 26(1): 100-7.
24. Stafseth SK, Skogstad L, Ræder J, et al. (2022). Symptoms of Anxiety, Depres-sion, and Post-Traumatic Stress Disor-der in Health Care Personnel in Norwe-gian ICUs during the First Wave of the COVID-19 Pandemic, a Prospective, Observational Cross-Sectional Study. Int J Environ Res Public Health, 19(12):7010.
25. Hall CE, Milward J, Spoiala C, et al. (2022). The mental health of staff working on intensive care units over the COVID-19 winter surge of 2020 in England: a cross sectional survey. Br J Anaesth, 128(6): 971-9.
26. Guttormson JL, Calkins K, McAndrew N, et al (2022). Critical Care Nurse Burnout, Moral Distress, and Mental Health Dur-ing the COVID-19 Pandemic: A United States Survey. Heart Lung, 55: 127-33.
27. Pan L, Xu Q, Kuang X, et al. (2021). Preva-lence and factors associated with post-traumatic stress disorder in healthcare workers exposed to COVID-19 in Wu-han, China: a cross-sectional survey. BMC Psychiatry, 21(1): 572.
28. Li P, Kuang H, Tan H (2021). The occur-rence of post-traumatic stress disorder (PTSD), job burnout and its influencing factors among ICU nurses. Am J Transl Res, 13(7): 8302-8.
29. Heesakkers H, Zegers M, van Mol MMC, et al (2021). The impact of the first COVID-19 surge on the mental well-being of ICU nurses: A nationwide sur-vey study. Intensive Crit Care Nurs, 65: 103034.
30. Zhang J, Guo F, Chen ZY, et al (2020). Re-lationship between social support, resili-ence, self-esteem and post-traumatic stress disorder in intensive care unit nurses. Zhonghua Yi Xue Za Zhi, 100(1):32-36.
31. Azoulay E, Cariou A, Bruneel F, et al. (2020). Symptoms of anxiety, depression, and peritraumatic dissociation in critical care clinicians managing patients with COVID-19 a cross-sectional study. Am J Respir Crit Care Med, 202(10): 1388-98.
32. Mealer M, Jones J, Meek P (2017). Factors affecting resilience and development of posttraumatic stress disorder in critical care nurses. Am J Crit Care, 26(3): 184-92.
33. Cho GJ, Kang J (2017). Type D personality and post-traumatic stress disorder symp-toms among intensive care unit nurses: The mediating effect of resilience. PLoS One, 12(4): e0175067.
34. Ong YZ, Siddiqui S, John S, et al (2016). The prevalence of post-traumatic stress disorder in intensive care unit staff and the common coping strategies used. Ann Acad Med Singap, 45(5): 215-8.
35. Janda R, Jandová E (2015). Symptoms of posttraumatic stress disorder, anxiety and depression among Czech critical care and general surgical and medical ward nurses. J Res Nurs, 20(4): 298-309.
36. Mealer M, Jones J, Newman J, et al (2012). The presence of resilience is associated with a healthier psychological profile in intensive care unit (ICU) nurses: Results of a national survey. Int J Nurs Stud, 49(3): 292-9.
37. Mealer M, Burnham EL, Goode CJ, et al (2009). The prevalence and impact of post traumatic stress disorder and burn-out syndrome in nurses. Depress Anxiety, 26(12): 1118-26.
38. Su TP, Lien TC, Yang CY, et al (2007). Prev-alence of psychiatric morbidity and psychological adaptation of the nurses in a structured SARS caring unit during outbreak: A prospective and periodic as-sessment study in Taiwan. J Psychiatr Res, 41(1-2): 119-30.
39. Mealer ML, Shelton A, Berg B, et al (2007). Increased prevalence of post-traumatic stress disorder symptoms in critical care nurses. Am J Respir Crit Care Med, 175(7): 693-7.
40. Saracoglu KT, Simsek T, Kahraman S, et al. (2020). The Psychological Impact of COVID-19 Disease is more Severe on Intensive Care Unit Healthcare Provid-ers: A Cross-sectional Study. Clin Psycho-pharmacol Neurosci, 18(4): 607-15.
41. Jones GAL, Colville GA, Ramnarayan P, et al. (2020). Psychological impact of work-ing in paediatric intensive care. A UK-wide prevalence study. Arch Dis Child, 105(5): 470-5.
42. Tang L, Pan L, Yuan L, et al (2016). Preva-lence and related factors of post-traumatic stress disorder among medical staff members exposed to H7N9 pa-tients. Int J Nurs Sci, 4(1): 63-7.
43. Rasouli N, Abdi M (2019). Comparison of occupational stress level of nurses in public and private hospitals in Qom, 2016. Q J Nurs Manag, 8(2): 10-17.
| Files | ||
| Issue | Vol 54 No 12 (2025) | |
| Section | Review Article(s) | |
| Keywords | ||
| Post-traumatic stress disorder Nurses Epidemiology Intensive care unit Systematic review | ||
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How to Cite
1.
Gehisari Z, Hashemzadeh E, Fazlizade S, Razaghpour H, Abdi M, Asadi Aghajari M. Epidemiology of Post-Traumatic Stress Disorder in Intensive Care Nurses: A Systematic Review. Iran J Public Health. 2025;54(12):2566-2578.
