Prevalence of post-traumatic stress disorder on health professionals in the era of COVID-19 pandemic, Northwest Ethiopia, 2020: A multi-centered cross-sectional study

Sintayehu Asnakew; Getasew Legas; Tewachew Muche Liyeh; Amsalu Belete; Kalkidan Haile; Getachew Yideg Yitbarek; Wubet Alebachew Bayih; Dejen Getaneh Feleke; Binyam Minuye Birhane; Haile Amha; Shegaye Shumet; Ermias Sisay Chanie

doi:10.1371/journal.pone.0255340

. 2021 Sep 14;16(9):e0255340. doi: 10.1371/journal.pone.0255340

Prevalence of post-traumatic stress disorder on health professionals in the era of COVID-19 pandemic, Northwest Ethiopia, 2020: A multi-centered cross-sectional study

Sintayehu Asnakew ^1,^*, Getasew Legas ¹, Tewachew Muche Liyeh ², Amsalu Belete ¹, Kalkidan Haile ³, Getachew Yideg Yitbarek ⁴, Wubet Alebachew Bayih ⁵, Dejen Getaneh Feleke ⁵, Binyam Minuye Birhane ⁵, Haile Amha ⁶, Shegaye Shumet ⁷, Ermias Sisay Chanie ⁵

Editor: Frank T Spradley⁸

PMCID: PMC8439479 PMID: 34520471

Abstract

Objective

This study aimed to assess the prevalence and associated factors of post-traumatic stress disorder among health professionals working in South Gondar Zone hospitals in the era of the COVID-19 pandemic, Amhara Ethiopia 2020.

Methods

Institutional based cross-sectional study design was conducted. A total of 396 respondents completed the questionnaire and were included in the analysis. A previously adapted self-administered pretested standard questionnaire, Impact of Event Scale-Revised (IES-R-22) was used to measure post-traumatic stress disorder. Data was entered into Epi data version 4.4.2 then exported to SPSS version 24 for analysis. Descriptive and analytical statistical procedures, bivariate, and multivariate binary logistic regressions with odds ratios and 95% confidence interval were employed. The level of significance of association was determined at a p-value < 0.05.

Results

The prevalence of post-traumatic stress disorder among health care providers in this study was 55.1% (95% CI: 50.3, 59.6). Lack of standardized PPE supply (AOR = 2.5 7,95CI;1.37,4.85), respondents age > 40 years (AOR = 3.95, 95CI; 1.74, 8.98), having medical illness (AOR = 4.65, 95CI;1.65,13.12), perceived stigma (AOR = 1.97, 95CI;1.01, 3.85), history of mental illness(AOR = 8.08,95IC;2.18,29.98) and having poor social support (AOR = 4.41,95CI;2.65,7.3) were significantly associated with post-traumatic stress disorder at p-value < 0.05. Conversely, being a physician (AOR = 0.15, 95CI; 0.04, 0.56) was less affected by PTSD.

Conclusions

The prevalence of post-traumatic stress disorder among health care providers in this study was high. Adequate and standardized PPE supply, giving especial emphasis to those care providers with medical illness, history of mental illness, and having poor social support, creating awareness in the community to avoid the stigma faced by health care providers who treat COVID patients is recommended.

Introduction

The COVID-19 pandemic is the largest outbreak [1] that initially was seen at the end of December 2019 in China, Wuhan city [2]. Within a short time, the number of cases has radically increased within and beyond China, and WHO declared the COVID-19 outbreak as a pandemic [3]. In Ethiopia, the first COVID-19 cases were reported on 13 March 2020. To prevent the spread of the pandemic the government interrupted schools, restricted public assembly and mass transport, ordered civil servants who had a chronic illness to work from home, and closed borders. The government also banned flights to countries, restricted mass transport and declared a five-month national state of emergency, and officially postponed the election for unspecified periods. All these circumstances make, people feel afraid, worried, anxious, and depressed [4].

Since health care workers are involved in the direct care of patients, they are more likely to be infected than the general population [5]. This makes them fear of contagion, concern for family health, interpersonal isolation, trust in and support from their organization, information about risks, and stigma [6–8]. Consequently, health professionals are under overwhelming psychological pressure, which may lead to various psychological problems, such as post-traumatic stress disorder, fear, depression, and insomnia [9].

As it has been shown by different research, greater numbers of health care workers are at risk of developing posttraumatic stress disorder (PTSD) and posttraumatic stress symptoms (PTSS). In a study done in China during the initial phase of the COVID-19 outbreak, more than half of the respondents were psychologically affected as moderate-to-severe [10]. Different studies done in Italy showed that the prevalence of PTSD was 24.73% [11], 43% [12], 49.38% [13], 39.8% [14]. Similarly, the research done in Taiwan on nurses who worked during the outbreak of SARS showed that 11% of the nurses had stress reaction syndrome [15]. Moreover, the studies conducted on mental health outcomes of the COVID-19 pandemic in the United States and Toronto hospitals revealed that the prevalence of post-traumatic stress disorder was 22.8% [16], and 13.8% [17] respectively. Likewise, a systematic review and meta-analysis studies showed that the estimated pooled prevalence of post-traumatic stress disorder on health workers was found to be 21.5%, 31.4%, and 26.9% [18–20]. Moreover, in studies done in Norway and Greece among health workers during the COVID-19 outbreak, the prevalence of PTSD was 28.9% [21] and 16.7% [22] respectively. The study conducted in Wuhan, China revealed that PTSD symptoms occurred among 31.6% of health care providers [23]. According to previously published research works on health care workers, the risk of developing post-traumatic stress disorder was affected by exposure level, working role, years of work experience, social and work support, quarantine, age, gender, marital status, and coping styles, healthcare worker stigma by the community [11, 13, 16, 24].

Studying the effects of COVID-19 on the mental health of health care professionals is important to provide baseline data for health care managers for early screening of the mental health status of health professionals.

Additionally, conducting research on this area is critically needed to provide scientific evidence for the development of prevention and treatment strategies for mental problems during the present as well as future pandemics.

Therefore, the study aimed to assess the prevalence and associated factors of post-traumatic stress disorder on health professionals in the ear of the COVID-19 pandemic in South Gondar Zone hospitals, Amhara, Ethiopia, 2020.

Materials and methods

Study setting and period

A multi-centered institutional-based cross-sectional study was conducted at South Gondar Zone, hospitals, Amhara, from April up to May 2020. South Gondar is about 666 km north of the capital city of Addis Ababa. There are 8 hospitals in this zone which include Debretabor general hospital, Andabet, Estie, Addis Zemen, Ebnat, Lay Gaynt, Tach Gaynt, and Simada primary hospitals. There are about 736 health professionals currently serving these hospitals. Mental health care is one of the services rendered within these hospitals.

Sample size determination

We determined the sample size by using the single population proportion formula with the assumptions of the prevalence of post-traumatic stress disorder = 50% (as there were no studies done in Ethiopia in this area), 1.96 Z (standard normal distribution), α = 0.05, and 10% non-response rate. Accordingly, a representative sample was calculated to be 423.

Sampling technique, study participants, and participating hospitals

This study was conducted among health professionals working in eight South Gondar Zone governmental hospitals. There are 736 health professionals in these hospitals. Health professionals were from Debretabor (N = 325), Andabet (N = 62), Estie (N = 55), Addis Zemen (N = 75), Ebnat (N = 45), Lay Gaynt (N = 69), Tach Gaynt (N = 53), Simada (N = 52).

All health professionals working in South Gondar Zone hospitals fulfilled the inclusion criteria, and those participants who were on annual leave and severely ill were excluded. We proportionally allocated the sample size to each hospital and we invited 423 participants by using a simple random sampling technique. Of these, twelve (12) of the eligible participants refused to participate and five (5) of the questionnaires were discarded because of incomplete data. Finally, 396 participants completed the questionnaires and were included in the analysis.

Study variables

The dependent variable was post-traumatic stress disorder measured by the 22 items of the Impact of Event scale-22 (IES-R-22). We measured post-traumatic stress disorder as a dichotomous variable (yes/ no). Independent variables include socio-demographic factors (age, gender, ethnicity, marital status, religion, profession, and having children), clinical variables (family history of medical illness, history of mental illness, having medical illness, psychosocial and material factors consist of social support, perceived stigma and lack of adequate and standardized PPE supply.

Data sources, measurement and operational definitions

Data was collected by standardized self-administered questionnaires by 16 trained health professionals using the Amharic version of the tool. The questionnaire was designed in English and translated to Amharic and back to English to maintain its consistency. Data collectors were trained on how to collect the data and explain the unclear questions and the purpose of the study. Furthermore, they were made aware of ethical principles, such as confidentiality/anonymity/data management, and securing respondents’ informed consent for participation.

The post-traumatic stress disorder was measured using the Impact of Event Scale-Revised (IES-R-22). The IES-R was a self-administered questionnaire for determining the extent of post-traumatic stress disorder after exposure to a public health crisis within one week of exposure. The Impact event scale can be used for repeated measurements over time to monitor progress. It is an appropriate instrument to measure the subjective response to a specific traumatic event in an adult population [25]. The IES-R is available in a variety of languages and the scale is used to measure PTSD symptoms in many cultures globally [26].

A total IES-R cutoff score of 24 was used to classify PTSD as a clinical concern. The total IES-R-22 score was divided into 0–23 (normal), 24–32 (mild PTSD) 33–36 (moderate PTSD), and >37 (severe PTSD) with an internal consistency of (alpha = 0.96) [27].

We conducted a reliability analysis for the IES-R-22questionnaire (Amharic version) and found that it had a high score (Cronbach’s α = 0.92). A socio-demographic questionnaire was used to assess the patients’ background information. Clinical, psychosocial, and material factors were used to assess by yes/no answers of respondents. Social support was measured by the Oslo 3-item Social Support Scale. The social support scores range from 3–14, in that scores from 3–8 as poor, 9–11 as moderate, and 12–14 as strong social support, but for this research purpose, it was categorized as poor for scores less than nine. The scores from 9–14 were considered moderate to strong support and merged as having social support [28].

The Oslo Social Support Scale has been used in population-level studies in Ethiopia [29, 30] and showed good predictive value [31].

Perceived stigma

To examine the perceived stigma, respondents were asked, ‘Did you feel stigmatized by the public because of your profession?’ (Like being refused access to public transport, being isolated from any social affairs, and even evicted from rented homes) and the responses were Yes/No.

History of mental illness

To examine a history of mental illness, respondents were asked: ‘Have you ever been diagnosed with mental illness and treated’ and responses were yes/no.

History of medical illness

To examine a history of medical illness, respondents were asked: ‘Did you have any medical illness?’ and responses were yes/no.

Families with medical illness

To examine families with medical illness, respondents were asked: ‘Did you have a family member who had a medical illness?’ and responses were yes/no.

Data processing and analysis

All collected data was checked for completeness and consistency and entered into Epi-data version 4.4.2 and then exported to SPSS for version 24 for analysis. We computed descriptive statistics, bivariate, and multivariate logistic regression analyses. The bivariate results may have been subject to confounding. Therefore, we conducted a multivariate analysis containing all variables associated with PTSD. Variables for the multivariate model were selected based on a combination of known risk factors for PTSD from existing literature, and variables significantly associated with PTSD in the bivariate analyses. Those variables whose p-values <0.05 with 95CI and AOR in the multivariate model were declared predictors of PTSD.

Hosmer-Lemeshow’s test (p = 0.494) was used to check model fitness. Multi-co linearity was checked to see the correlation among the independent variables by using variance inflation factor and tolerance. In this case, the value of the variance inflation factor was <10 and tolerance was greater than 0.1, which indicated that there is no dependency between independent factors.

Ethical consideration

The ethical clearance was obtained from the ethical review committee of Debre Tabor University and a permission letter was obtained from each hospital. We received written informed consent from study participants and confidentiality was maintained by omitting personal identifiers.

Patient and public involvement

In the current study, participants were people who were working in South Gondar Zone hospitals, Amhara, Ethiopia. Participants were not involved in the study design and recruitment. The result of this study has been disseminated to the Amhara Regional Health Bureau and each study hospital.

Results

Of all invited 423 respondents, a total of 396 individuals completed the questionnaire. The majority of the respondents were males 274 (69.2%) and in the age group 25–30 years. Most of the participants were single 222(52.9%), orthodox followers 369(87.9%), and Amhara by ethnicity 418(99.5%). Regarding their educational status and department, the majorities of them were degree holders 292(73.7%) and nurses 230 (58.1) respectively (Table 1).

Table 1. Sociodemographic characteristics of health professionals working in South Gondar zone hospitals, Ethiopia, 2020(n = 396).

Characteristics		Frequency	Percent
Age	<25	12	3
	25–30	243	61.4
	31–40	65	16.4
	41–50	55	13.9
	>50	21	5.3
Sex	Female	122	30.8
Sex	Male	274	69.2
Marital status	Married	200	50.5
	Divorced	43	10.9
	Single	132	33.3
	^*Others	21	5.3
Educational status	Diploma	28	7.1
	Degree	292	73.7
	Msc	44	11.1
	Specialist	32	8.1
Ethnicity	Amhara	375	94.7
	Tigray	5	1.3
	Oromo	16	4
Religious status	Orthodox	332	83.8
	Catholic	10	2.5
	Muslim	33	8.3
	Protestant	11	2.8
	Adventist	10	2.5
Profession	Nurse	230	58.1
	Physician	77	19.4
	Laboratory	62	15.7
	Pharmacists	27	6.8
Having children	Yes	180	45.5
Having children	No	216	54.5

Open in a new tab

Note that:

*other–separated and widowed.

Clinical factors of the respondents

Of all respondents, about 56(14.1%) had a history of medical problems, 140(35.4%) had families with chronic illness, and 24(6.1%) had a history of mental illness (Table 2).

Table 2. Clinical factors of health care providers working in South Gondar zone hospitals, Amhara, Ethiopia, 2020.

Characteristics	Category	Frequency	percent
History of medical illness	yes	56	14.1
History of medical illness	No	340	85.9
Having a family member with chronic illness	yes	140	35.4
Having a family member with chronic illness	No	256	64.6
History of mental illness	yes	24	6.1
History of mental illness	No	372	93.9

Open in a new tab

Psychosocial and material factors

About 95 (24%) of the respondents felt stigmatized because of their profession. The majority of the participants had poor social support, 233 (58.8%), and 163 (41.2%) of the respondents had moderate and strong social support. Most of the respondents 307 (77.5%) responded as they did not get standardized PPE in compacting the COVID-19 pandemic.

Prevalence of post-traumatic stress disorder (PTSD)

Of the 423 invited health care workers, 396 (93.6%) of them completed the questionnaire. The prevalence of PTSD on health care providers in this study was 55.1% (95% CI: 50.3, 59.6).

The severity of post-traumatic stress disorder

About 108(23.5%) of the participants had experienced severePTSD (Fig 1).

Factors associated with post-traumatic stress disorder

To determine the association of independent variables with post-traumatic stress disorder, bivariate and multivariate binary logistic regression analyses were carried out.

In this regard, the analysis was made between the dependent variable (PTSD) and independent variables including socio-demographic factors (age, gender, marital status, profession, educational status, and having children), clinical variables (family history of medical illness, history of mental illness, having medical illness, psychosocial and material factors consist social support, perceived stigma and lack of adequate and standardized PPE supply.

On the bivariate analysis of post-traumatic stress disorder with each explanatory variable: age > 40 years, being a physician, divorced, poor social support, not getting standardized PPE, having medical problems, history of mental illness, having families with medical health problems and perceived stigma were found to be significantly associated with PTSD at a P-value <0.05 (Table 3).

Table 3. Bivariate analysis showing factors associated with PTSD on health care providers in South Gondar hospitals, Ethiopia, 2020.

Characteristics	Category	PTSD		COR(95%CI)
Characteristics	Category	Yes	No	COR(95%CI)
Age	≤ 30	124	131	1
	31–40	39	26	1.25(0.73,2.16)
	>40	55	21	*4.02(2.20,7.36)
Sex	Female	76	46	1.54(0.99,2.38)
Sex	Male	142	132	1
Marital status	Married	111	89	1
	Divorced	31	12	*2.07(1.01,4.27)
	Single	63	69	0.73(0.47,1.14)
	Others	13	8	1.30(0.52,3.28)
Profession	Nurse	136	94	0.72(0.31,1.68)
	Physician	21	56	*0.19(0.73,0.48)
	Laboratory	43	19	1.13(0.43,2.97)
	Pharmacists	18	9	1
Educational status	Diploma	19	9	1.02(0.37,2.81)
	Degree	149	143	1.13(0.54,2.35)
	Msc	32	12	0.88(0.36,2.19)
	Specialist	18	14	1
Having children	Yes	106	74	1.33(0.89,1.98)
Having children	No	112	104	1
Personal protective equipment	Yes	39	50	1
Personal protective equipment	No	179	128	*1.79(1.11,2.89)
Medical problems	Yes	49	7	*7.08(3.12,16.08)
Medical problems	No	169	171	1
Families with chronic illness	Yes	87	53	*1.57(1.03,2.39)
Families with chronic illness	No	131	125	1
History of mental illness	Yes	40	4	*9.78(3.43,27.90)
History of mental illness	No	178	174	1
Perceived stigma	Yes	72	23	*3.32(1.97,5.59)
Perceived stigma	No	146	155	1
Social support	Poor	163	70	*4.57(2.98,7.02)
Social support	Moderate and Strong	55	108	1

Open in a new tab

All variables analyzed in bivariate analysis were taken into the multivariate analysis. In multivariate analysis, age >40 years, being a physician, lack of standardized PPE supply, having a medical illness, had perceived stigma, history of mental illness, and poor social support was significantly associated with post-traumatic stress disorder at a p-value < 0.05.

When controlling for other variables, the odds of developing post-traumatic stress disorder among health care providers were 2.57 times higher among those participants who had not standardized PPE supply as compared with those who had standardized PPE supply (AOR = 2.5 7,95CI;1.37,4.85). Those health professionals age greater than 40 years were 3.95 times more likely to develop PTSD as compared with those younger participants (AOR = 3.95, 95CI; 1.74, 8.98). The risk of developing PTSD among physicians was reduced by 15% as compared with other health professionals (AOR = 0.15, 95CI; 0.04, 0.56).

Likewise, those health care providers who felt stigmatized because of their profession were 1.97 times more likely to develop post-traumatic stress disorder as compared with those health workers who did not feel stigmatized (AOR = 1.97, 95CI;1.01, 3.85) Social support has a greater impact on the development of mental problems. Those health care providers who had poor social support were 4.41 times more likely to develop post-traumatic stress disorder as compared with those who had strong and moderate social support (AOR = 4.41,95CI;2.65,7.34).

Moreover, those participants who had a history of mental illness were 8.08 times more affected as compared with their counterparts (AOR = 8.08IC;2.18, 29.98) (Table 4).

Table 4. Multivariable analysis showing factors associated with PTSD on health care providers in South Gondar hospitals, Ethiopia, 2020.

characteristics	category	PTSD		COR(95%CI)	COR(95%CI)
characteristics	category	Yes	No	COR(95%CI)	COR(95%CI)
Age	<30	124	131	1	1
	31–40	39	26	1.59(0.91,2.76)	1.16(0.57,2.39)
	>40	55	21	^*2.77(1.58,4.84)	3.95(1.74, 8.98)
Sex	Female	76	46	1.54(0.99,2.38)	1.47(0.82,2.65)
Sex	Male	142	132	1	1
Marital status	Married	111	89	1	1
	Divorced	31	12	^*2.07(1.01,4.27)	0.65(0.25,1.69)
	Single	63	69	0.73(0.47,1.14)	1.08(0.52,2.23)
	Others	13	8	1.30(0.52,3.28)	0.54(0.15,1.96)
Profession	Nurse	136	94	0.72(0.31,1.68)	0.63(0.20,1.94)
	Physician	21	56	^*0.19(0.73,0.48)	^*0.15(0.04,0.56)
	Laboratory	43	19	1.13(0.43,2.97)	0.82(0.23,2.92)
	Pharmacists	18	9	1	1
Educational status	Diploma	19	9	1.64(0.57,4.72)	1.73(0.50,5.95)
	Degree	149	143	0.81(0.39,1.69)	1.51(0.61,3.72)
	Msc	32	12	2.07(0.79,5.44)	0.84(0.28,2.57)
	Specialist	18	14	1
Having children	Yes	106	74	1.33(0.89,1.98)	0.62(0.33,1.17)
Having children	No	112	104	1
Personal protective equipment	Yes	39	50	1	1
Personal protective equipment	No	179	128	^*1.79(1.11,2.89)	^*2.57(1.37,4.85)
Medical problems	Yes	49	7	^*7.08(3.12,16.08)	^*4.65(1.65,13.12)
Medical problems	No	169	171	1	1
Families with chronic illness	Yes	87	53	^*1.57(1.03,2.39)	1.08(0.58,2.03)
Families with chronic illness	No	131	125	1	1
History of mental illness	Yes	40	4	^*9.78(3.43,27.90)	^*8.08(2.18,29.98)
History of mental illness	No	178	174	1	1
Perceived stigma	Yes	72	23	^*3.32(1.97,5.59)	^*1.97(1.01,3.85)
Perceived stigma	No	146	155	1	1
Social support	Poor	163	70	^*4.57(2.98,7.02)	^*4.41(2.65,7.34)
Social support	Moderate and Strong	55	108	1	1

Open in a new tab

The results shown in the table are adjusted for all of the other variables listed.

NB: PTSD = post traumatic stress disorder, others = Separated and Widowed, Model fitness = (Hosmer and Lemshow Test = 0.494),

* = p = <0.05.

Discussions

Health professionals treating COVID-19 cases are at risk of developing mental health symptoms than the general population. Most importantly, the present study indicated that during the COVID-19 outbreak, healthcare workers who performed COVID-19 related tasks scored significantly higher on the total IES-R. This suggests that they should be the main targets of psychiatric assessment and care.

In this study, the prevalence of post-traumatic stress disorder on health care providers during the COVID-19 pandemic was found to be 55.1% (95% CI: 50.3, 59.6) and about 93 (23.5%) of care providers experienced severe post-traumatic stress disorder.

This finding was in line with the previous study conducted in China during the initial COVID-19 pandemic 53.8% [10], and the Spanish study 56.6% [32]. In contrast, the finding of this study was higher than the studies done in Korea, 40.3% [33], Israel11.5% [34], Toronto and Hamilton hospitals 13.8% [17], Singapore study 20% [35], china study 7% [36], systematic review studies 21,7% [37], 27% [38] andTaiwan5% [39]. The reasons for this may include reduced accessibility to formal psychological support, less first–hand medical information on the outbreak, less intensive training on personal protective equipment including PPE supply shortage, and an underdeveloped health care system in Ethiopia as compared with those countries.

On the other hand, the finding of this study was lower than the previous study done on the impact of the SARS epidemic on the mental health of health care workers 82% [40]. This could be because of tool differences, socio-cultural factors. When controlling for other variables in the model, lack of a standardized PPE supply, age >40 years, having a medical illness, perceived stigma, history of mental illness, and poor social support were negatively associated with post-traumatic stress disorder. Conversely, being a physician affected PTSD positively.

Specifically, the greater likelihood of post-traumatic stress disorder occurred among those who lack a standardized PPE supply as compared with those respondents who had standardized PPE supply. This is similar to another systematic review study [41]. This might be due to that personal protective equipment is critical to protecting health care professionals’ physical and mental well-being. Without this protection, they worry that they will get sick and infect others. The risk of infection, especially if it is asymptomatic, instills the fear of spreading the virus to their patients and families [42].

The likelihood of developing post-traumatic stress disorder among those respondents who had medical problems was 4.65 times as compared with those participants who had no medical problems. This is in line with the study done on evidence from a systematic review from the previous outbreaks on the potential impact of COVID-19 on mental health outcomes of health care providers [41] and a study done on mental health and psychosocial problems between medical and non-medical health workers [43]. This might be because health care providers with existing medical illnesses knew as their immunity is compromised, which made them more vulnerable and risky for the bad outcome of COVID-19 pandemic leading to psychologically more affected as compared with those individuals without medical illness.

Similarly, those health care providers who felt stigmatized because of their profession were 1.97times more likely to develop post-traumatic stress disorder as compared with those health workers who did not feel stigmatized. This was supported by previous studies [39, 40]. The evidence clearly shows that stigma could hinder HCWs of different roles and responsibilities from responding correctly. They are facing an unprecedented emergency and insidious invisible danger which, increasing workload, physical and mental stress [44]. Moreover, HCWs who expected to experience higher levels of stigma reported increased psychological distress [45]. This indicates the need to increase the community awareness about COVID-19 and the appropriate prevention strategies which in turn reduce the stigmatization of the frontline health care workers and enhances the care of patients especially COVID-19 cases.

Those health care workers age >40 years had 3.95 times the risk of developing PTSD as compared with those health care workers < = 30 years old. This was contrary to the previous studies [46–48]. This could be population, and sample size difference, scarcity of researches on older age and old ages expresses PTSD symptoms physically but less experience of emotional symptoms which decrease the detection rate. Moreover, in the current study old ages are more vulnerable to PTSD because of their risk of contracting and developing the fatal illness during the pandemic as compared with the younger adults.

Those health care providers who had poor social support were 3.89 times more likely to develop post-traumatic stress disorder as compared with those who had moderate and strong social support. This was also affirmed by previous studies [35, 40, 49]. Social support is an important factor for reducing both physical and psychological distress when faced with stressful events [50]. Moreover, respondents who had a history of mental illness were more likely affected by PTSD as compared with their counterparts. The reason could be participants with a history of mental illness might have more neuronal damage compared with those who had no history of mental illness. As a result, they might be prone to develop PTSD during this COVID-19 pandemic. This finding was supported by the results of previous studies [51–53]. Conversely physicians were less affected by PTSD as compared with nurses. This was in agreement with the previous study [54]. This could be the fact that physicians had shorter contact and less exposure to COVID-19 patients compared with the nursing staff. This calls improving the mental wellbeing of health workers with attention to the reduction of stigma, ensuring an adequate support system such as personal protective equipment, and family support for those with a history of mental health problems.

Limitations

The cross-sectional nature of the study design might not show temporal relationships between PTSD and its predictors. Moreover, important factors such as coping style, emotional status, and taking training about COVID-19 have been missed which could predict PTSD. Even if IES-R showed good internal consistency (Cronbach alpha = 0.92) in this study, it lacks validity in this population that it may necessitate being validated by other interested researchers.

Conclusions

The prevalence of post-traumatic stress disorder among health care providers in this study was high. More than 1/4^th of participants experienced severe post-traumatic stress disorder. Lack of standardized PPE supply, age > 40 years, having a medical illness, history of mental illness, perceived stigma, and poor social support were significantly associated with post-traumatic stress disorder at a p-value less than 0.05. Conversely, physicians were less likely to develop PTSD in this study. Therefore, regular screening for the mental health status of health care providers by trained health professionals is essential. It is also necessary to provide adequate and standardized PPE supply, giving especial emphasis to those health care providers age> 40 years, those with medical illness, history of mental illness, having poor social support, creating awareness in the community to avoid the stigma faced by health care providers who treat COVID patients. Furthermore, it would be better if other interested researchers do another study on this area by validating IES-R and including important factors that have been missed in this research.

Supporting information

S1 File. Questionnaire, to assess the prevalence of post-traumatic stress disorder on health professionals in the era of COVID-19 pandemic.

(DOCX)

Click here for additional data file.^{(53.9KB, docx)}

Acknowledgments

The authors acknowledge Debretabor University for reviewing and approval of ethical issues. We extend our gratitude to data collectors, supervisors, and study participants for their time and effort.

Data Availability

All relevant data are within the manuscript and its Supporting information files.

Funding Statement

The authors received no specific funding for this work.

References

1.Wang C, Horby PW, Hayden FG, Gao GF. A novel coronavirus outbreak of global health concern. The lancet. 2020;395(10223):470–3. doi: 10.1016/S0140-6736(20)30185-9 [DOI] [PMC free article] [PubMed] [Google Scholar]
2.Nishiura H, Jung S-m, Linton NM, Kinoshita R, Yang Y, Hayashi K, et al. The extent of transmission of novel coronavirus in Wuhan, China, 2020. Multidisciplinary Digital Publishing Institute; 2020. [DOI] [PMC free article] [PubMed] [Google Scholar]
3.Mahase E. China coronavirus: WHO declares international emergency as death toll exceeds 200. BMJ: British Medical Journal (Online). 2020;368. doi: 10.1136/bmj.m408 [DOI] [PubMed] [Google Scholar]
4.Stankovska G, Memedi I, Dimitrovski D. Coronavirus COVID-19 disease, mental health and psychosocial support. Society Register. 2020;4(2):33–48. [Google Scholar]
5.Organization WH. Health worker Ebola infections in Guinea, Liberia and Sierra Leone: a preliminary report 21 May 2015. World Health Organization, 2015.
6.Koh Y, Hegney DG, Drury V. Comprehensive systematic review of healthcare workers’ perceptions of risk and use of coping strategies towards emerging respiratory infectious diseases. International Journal of Evidence-Based Healthcare. 2011;9(4):403–19. doi: 10.1111/j.1744-1609.2011.00242.x [DOI] [PubMed] [Google Scholar]
7.Ives J, Greenfield S, Parry JM, Draper H, Gratus C, Petts JI, et al. Healthcare workers’ attitudes to working during pandemic influenza: a qualitative study. BMC public health. 2009;9(1):1–13. doi: 10.1186/1471-2458-9-56 [DOI] [PMC free article] [PubMed] [Google Scholar]
8.Maunder RG, Lancee WJ, Mae R, Vincent L, Peladeau N, Beduz MA, et al. Computer-assisted resilience training to prepare healthcare workers for pandemic influenza: a randomized trial of the optimal dose of training. BMC health services research. 2010;10(1):1–10. [DOI] [PMC free article] [PubMed] [Google Scholar]
9.Li W, Yang Y, Liu Z-H, Zhao Y-J, Zhang Q, Zhang L, et al. Progression of mental health services during the COVID-19 outbreak in China. International journal of biological sciences. 2020;16(10):1732. doi: 10.7150/ijbs.45120 [DOI] [PMC free article] [PubMed] [Google Scholar]
10.Wang C, Pan R, Wan X, Tan Y, Xu L, Ho CS, et al. Immediate psychological responses and associated factors during the initial stage of the 2019 coronavirus disease (COVID-19) epidemic among the general population in China. International journal of environmental research and public health. 2020;17(5):1729. doi: 10.3390/ijerph17051729 [DOI] [PMC free article] [PubMed] [Google Scholar]
11.Rossi R, Socci V, Pacitti F, Di Lorenzo G, Di Marco A, Siracusano A, et al. Mental health outcomes among frontline and second-line health care workers during the coronavirus disease 2019 (COVID-19) pandemic in Italy. JAMA network open. 2020;3(5):e2010185–e. doi: 10.1001/jamanetworkopen.2020.10185 [DOI] [PMC free article] [PubMed] [Google Scholar]
12.Riello M, Purgato M, Bove C, MacTaggart D, Rusconi E. Prevalence of post-traumatic symptomatology and anxiety among residential nursing and care home workers following the first COVID-19 outbreak in Northern Italy. Royal Society open science. 2020;7(9):200880. doi: 10.1098/rsos.200880 [DOI] [PMC free article] [PubMed] [Google Scholar]
13.Rossi R, Socci V, Pacitti F, Di Lorenzo G, Di Marco A, Siracusano A, et al. Mental health outcomes among front and second line health workers associated with the COVID-19 pandemic in Italy. medRxiv. 2020. [DOI] [PMC free article] [PubMed] [Google Scholar]
14.Bassi M, Negri L, Delle Fave A, Accardi R. The relationship between post-traumatic stress and positive mental health symptoms among health workers during COVID-19 pandemic in Lombardy, Italy. Journal of affective disorders. 2021;280:1–6. doi: 10.1016/j.jad.2020.11.065 [DOI] [PMC free article] [PubMed] [Google Scholar]
15.Chen C-S, Wu H-Y, Yang P, Yen C-F. Psychological distress of nurses in Taiwan who worked during the outbreak of SARS. Psychiatric Services. 2005;56(1):76–9. doi: 10.1176/appi.ps.56.1.76 [DOI] [PubMed] [Google Scholar]
16.Hennein R, Mew EJ, Lowe SR. Socio-ecological predictors of mental health outcomes among healthcare workers during the COVID-19 pandemic in the United States. PloS one. 2021;16(2):e0246602. doi: 10.1371/journal.pone.0246602 [DOI] [PMC free article] [PubMed] [Google Scholar]
17.Maunder RG, Lancee WJ, Balderson KE, Bennett JP, Borgundvaag B, Evans S, et al. Long-term psychological and occupational effects of providing hospital healthcare during SARS outbreak. Emerging infectious diseases. 2006;12(12):1924. doi: 10.3201/eid1212.060584 [DOI] [PMC free article] [PubMed] [Google Scholar]
18.Li Y, Scherer N, Felix L, Kuper H. Prevalence of depression, anxiety and post-traumatic stress disorder in health care workers during the COVID-19 pandemic: A systematic review and meta-analysis. PloS one. 2021;16(3):e0246454. doi: 10.1371/journal.pone.0246454 [DOI] [PMC free article] [PubMed] [Google Scholar]
19.Yuan K, Gong Y-M, Liu L, Sun Y-K, Tian S-S, Wang Y-J, et al. Prevalence of posttraumatic stress disorder after infectious disease pandemics in the twenty-first century, including COVID-19: a meta-analysis and systematic review. Molecular psychiatry. 2021:1–17. doi: 10.1038/s41380-021-01036-x [DOI] [PMC free article] [PubMed] [Google Scholar]
20.Marvaldi M, Mallet J, Dubertret C, Moro MR, Guessoum SB. Anxiety, depression, trauma-related, and sleep disorders among healthcare workers duirng the covid-19 pandemic: A systematic review and meta-analysis. Neuroscience & Biobehavioral Reviews. 2021. [DOI] [PMC free article] [PubMed] [Google Scholar]
21.Johnson SU, Ebrahimi OV, Hoffart A. PTSD symptoms among health workers and public service providers during the COVID-19 outbreak. PloS one. 2020;15(10):e0241032. doi: 10.1371/journal.pone.0241032 [DOI] [PMC free article] [PubMed] [Google Scholar]
22.Blekas A, Voitsidis P, Athanasiadou M, Parlapani E, Chatzigeorgiou AF, Skoupra M, et al. COVID-19: PTSD symptoms in Greek health care professionals. Psychological Trauma: Theory, Research, Practice, and Policy. 2020. doi: 10.1037/tra0000914 [DOI] [PubMed] [Google Scholar]
23.Li X, Li S, Xiang M, Fang Y, Qian K, Xu J, et al. The prevalence and risk factors of PTSD symptoms among medical assistance workers during the COVID-19 pandemic. Journal of Psychosomatic Research. 2020;139:110270. doi: 10.1016/j.jpsychores.2020.110270 [DOI] [PMC free article] [PubMed] [Google Scholar]
24.Zandifar A, Badrfam R, Khonsari NM, Mohammadi MR, Asayesh H, Qorbani M. Prevalence and associated factors of posttraumatic stress symptoms and stigma among health care workers in contact with COVID-19 patients. Iranian journal of psychiatry. 2020;15(4):340. doi: 10.18502/ijps.v15i4.4303 [DOI] [PMC free article] [PubMed] [Google Scholar]
25.Christianson S, Marren J. The impact of event scale—revised (IES-R). Medsurg Nursing. 2012;21(5):321–3. [PubMed] [Google Scholar]
26.Weiss D, Marmar C. The Impact of Event Scale—Revised. W: Wilson J., Keane T.(red.). Assessing psychological trauma and PTSD: A handbook for practitioners. Guildford Press, New York; 1997. [Google Scholar]
27.Creamer M, Bell R, Failla S. Psychometric properties of the impact of event scale—revised. Behaviour research and therapy. 2003;41(12):1489–96. doi: 10.1016/j.brat.2003.07.010 [DOI] [PubMed] [Google Scholar]
28.Abiola T, Udofia O, Zakari M. Psychometric properties of the 3-item oslo social support scale among clinical students of Bayero University Kano, Nigeria. Malaysian Journal of Psychiatry. 2013;22(2):32–41. [Google Scholar]
29.Fekadu A, Medhin G, Selamu M, Hailemariam M, Alem A, Giorgis TW, et al. Population level mental distress in rural Ethiopia. BMC psychiatry. 2014;14(1):1–13. doi: 10.1186/1471-244X-14-194 [DOI] [PMC free article] [PubMed] [Google Scholar]
30.Asnakew S, Shumet S, Ginbare W, Legas G, Haile K. Prevalence of post-traumatic stress disorder and associated factors among Koshe landslide survivors, Addis Ababa, Ethiopia: a community-based, cross-sectional study. BMJ open. 2019;9(6):e028550. doi: 10.1136/bmjopen-2018-028550 [DOI] [PMC free article] [PubMed] [Google Scholar]
31.Bøen H, Dalgard OS, Bjertness E. The importance of social support in the associations between psychological distress and somatic health problems and socio-economic factors among older adults living at home: a cross sectional study. BMC geriatrics. 2012;12(1):1–12. doi: 10.1186/1471-2318-12-27 [DOI] [PMC free article] [PubMed] [Google Scholar]
32.Luceño-Moreno L, Talavera-Velasco B, García-Albuerne Y, Martín-García J. Symptoms of posttraumatic stress, anxiety, depression, levels of resilience and burnout in Spanish health personnel during the COVID-19 pandemic. International journal of environmental research and public health. 2020;17(15):5514. doi: 10.3390/ijerph17155514 [DOI] [PMC free article] [PubMed] [Google Scholar]
33.Lee SM, Kang WS, Cho A-R, Kim T, Park JK. Psychological impact of the 2015 MERS outbreak on hospital workers and quarantined hemodialysis patients. Comprehensive psychiatry. 2018;87:123–7. doi: 10.1016/j.comppsych.2018.10.003 [DOI] [PMC free article] [PubMed] [Google Scholar]
34.Shacham M, Hamama-Raz Y, Kolerman R, Mijiritsky O, Ben-Ezra M, Mijiritsky E. COVID-19 factors and psychological factors associated with elevated psychological distress among dentists and dental hygienists in Israel. International Journal of Environmental Research and Public Health. 2020;17(8):2900. doi: 10.3390/ijerph17082900 [DOI] [PMC free article] [PubMed] [Google Scholar]
35.Chan AO, Huak CY. Psychological impact of the 2003 severe acute respiratory syndrome outbreak on health care workers in a medium size regional general hospital in Singapore. Occupational Medicine. 2004;54(3):190–6. doi: 10.1093/occmed/kqh027 [DOI] [PMC free article] [PubMed] [Google Scholar]
36.Liu N, Zhang F, Wei C, Jia Y, Shang Z, Sun L, et al. Prevalence and predictors of PTSS during COVID-19 outbreak in China hardest-hit areas: Gender differences matter. Psychiatry research. 2020:112921. doi: 10.1016/j.psychres.2020.112921 [DOI] [PMC free article] [PubMed] [Google Scholar]
37.Carmassi C, Foghi C, Dell’Oste V, Cordone A, Bertelloni CA, Bui E, et al. PTSD symptoms in healthcare workers facing the three coronavirus outbreaks: What can we expect after the COVID-19 pandemic. Psychiatry research. 2020:113312. doi: 10.1016/j.psychres.2020.113312 [DOI] [PMC free article] [PubMed] [Google Scholar]
38.Krishnamoorthy Y, Nagarajan R, Saya GK, Menon V. Prevalence of psychological morbidities among general population, healthcare workers and COVID-19 patients amidst the COVID-19 pandemic: A systematic review and meta-analysis. Psychiatry research. 2020;293:113382. doi: 10.1016/j.psychres.2020.113382 [DOI] [PMC free article] [PubMed] [Google Scholar]
39.Bai Y, Lin C-C, Lin C-Y, Chen J-Y, Chue C-M, Chou P. Survey of stress reactions among health care workers involved with the SARS outbreak. Psychiatric Services. 2004;55(9):1055–7. doi: 10.1176/appi.ps.55.9.1055 [DOI] [PubMed] [Google Scholar]
40.Cabello IR, Echavez JFM, Serrano-Ripoll MJ, Fraile-Navarro D, de Roque MAF, Moreno GP, et al. Impact of viral epidemic outbreaks on mental health of healthcare workers: a rapid systematic review. medRxiv. 2020. doi: 10.1016/j.jad.2020.08.034 [DOI] [PMC free article] [PubMed] [Google Scholar]
41.Nobles J, Martin F, Dawson S, Moran P, Savovic J. The potential impact of COVID-19 on mental health outcomes and the implications for service solutions. Royaume Uni, Centre for Academic Mental Health of the University of Bristol …; 2020.
42.Gold J. The COVID-19 crisis too few are talking about: health care workers’ mental health. StatReports April. 2020;3. [Google Scholar]
43.Zhang W-r, Wang K, Yin L, Zhao W-f, Xue Q, Peng M, et al. Mental health and psychosocial problems of medical health workers during the COVID-19 epidemic in China. Psychotherapy and psychosomatics. 2020:1–9. doi: 10.1159/000507639 [DOI] [PMC free article] [PubMed] [Google Scholar]
44.Deacon H, Boulle A. Commentary: Factors affecting HIV/AIDS-related stigma and discrimination by medical professionals. International journal of epidemiology. 2007;36(1):185–6. doi: 10.1093/ije/dyl255 [DOI] [PubMed] [Google Scholar]
45.O’Donnell AT, Corrigan F, Gallagher S. The impact of anticipated stigma on psychological and physical health problems in the unemployed group. Frontiers in psychology. 2015;6:1263. doi: 10.3389/fpsyg.2015.01263 [DOI] [PMC free article] [PubMed] [Google Scholar]
46.Cook JM, McCarthy E, Thorp SR. Older adults with PTSD: Brief state of research and evidence-based psychotherapy case illustration. The American Journal of Geriatric Psychiatry. 2017;25(5):522–30. doi: 10.1016/j.jagp.2016.12.016 [DOI] [PubMed] [Google Scholar]
47.Pless Kaiser A, Cook JM, Glick DM, Moye J. Posttraumatic stress disorder in older adults: a conceptual review. Clinical gerontologist. 2019;42(4):359–76. doi: 10.1080/07317115.2018.1539801 [DOI] [PMC free article] [PubMed] [Google Scholar]
48.d’Ettorre G, Ceccarelli G, Santinelli L, Vassalini P, Innocenti GP, Alessandri F, et al. Post-Traumatic Stress Symptoms in Healthcare Workers Dealing with the COVID-19 Pandemic: A Systematic Review. International Journal of Environmental Research and Public Health. 2021;18(2):601. doi: 10.3390/ijerph18020601 [DOI] [PMC free article] [PubMed] [Google Scholar]
49.Naushad VA, Bierens JJ, Nishan KP, Firjeeth CP, Mohammad OH, Maliyakkal AM, et al. A systematic review of the impact of disaster on the mental health of medical responders. Prehospital and disaster medicine. 2019;34(6):632–43. doi: 10.1017/S1049023X19004874 [DOI] [PubMed] [Google Scholar]
50.Brummett BH, Mark DB, Siegler IC, Williams RB, Babyak MA, Clapp-Channing NE, et al. Perceived social support as a predictor of mortality in coronary patients: effects of smoking, sedentary behavior, and depressive symptoms. Psychosomatic medicine. 2005;67(1):40–5. doi: 10.1097/01.psy.0000149257.74854.b7 [DOI] [PubMed] [Google Scholar]
51.North CS, Nixon SJ, Shariat S, Mallonee S, McMillen JC, Spitznagel EL, et al. Psychiatric disorders among survivors of the Oklahoma City bombing. The Science of Mental Health: Stress and the Brain: Taylor and Francis; 2013. p. 159–67. [DOI] [PubMed] [Google Scholar]
52.Brewin CR, Andrews B, Valentine JD. Meta-analysis of risk factors for posttraumatic stress disorder in trauma-exposed adults. Journal of consulting and clinical psychology. 2000;68(5):748. doi: 10.1037//0022-006x.68.5.748 [DOI] [PubMed] [Google Scholar]
53.Tsujiuchi T, Yamaguchi M, Masuda K, Tsuchida M, Inomata T, Kumano H, et al. High prevalence of post-traumatic stress symptoms in relation to social factors in affected population one year after the Fukushima nuclear disaster. PloS one. 2016;11(3):e0151807. doi: 10.1371/journal.pone.0151807 [DOI] [PMC free article] [PubMed] [Google Scholar]
54.Tham KY, Tan YH, Loh OH, Tan WL, Ong MK, Tang HK. Psychological morbidity among emergency department doctors and nurses after the SARS outbreak. Hong Kong Journal of Emergency Medicine. 2005;12(4):215–23. [PubMed] [Google Scholar]

PLoS One. doi: 10.1371/journal.pone.0255340.r001

Decision Letter 0

Frank T Spradley

11 Feb 2021

PONE-D-20-34499

Prevalence of post-traumatic stress disorder on health professionals in the era of COVID-19 pandemic, Northwest Ethiopia, 2020: multi-centred cross-sectional study.

PLOS ONE

Dear Dr. Alemayehu,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

Two experts in the field handled your manuscript, and we are appreciative of their time and contributions. Although interest was found in your study, several major concerns arose that require your attention. Please address ALL of the reviewers' comments in your revised manuscript and detail your revisions in a response-to-reviewers document.

Please submit your revised manuscript by Mar 27 2021 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

Please include the following items when submitting your revised manuscript:

A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'.
A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'.
An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'.

If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter.

We look forward to receiving your revised manuscript.

Kind regards,

Frank T. Spradley

Academic Editor

PLOS ONE

Journal requirements:

When submitting your revision, we need you to address these additional requirements.

1. Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. The PLOS ONE style templates can be found at

https://journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf and

https://journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdf

2. Please include in your Methods section (or in Supplementary Information files) the participating hospitals/institutions.

Furthermore, please include additional information regarding the survey or questionnaire used in the study and ensure that you have provided sufficient details that others could replicate the analyses. For instance, if you developed a questionnaire as part of this study and it is not under a copyright more restrictive than CC-BY, please include a copy, in both the original language and English, as Supporting Information.

3.Thank you for stating the following financial disclosure:

"he funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript."

At this time, please address the following queries:

Please clarify the sources of funding (financial or material support) for your study. List the grants or organizations that supported your study, including funding received from your institution.
State what role the funders took in the study. If the funders had no role in your study, please state: “The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.”
If any authors received a salary from any of your funders, please state which authors and which funders.
If you did not receive any funding for this study, please state: “The authors received no specific funding for this work.”

Please include your amended statements within your cover letter; we will change the online submission form on your behalf.

4. Your ethics statement should only appear in the Methods section of your manuscript. If your ethics statement is written in any section besides the Methods, please move it to the Methods section and delete it from any other section. Please ensure that your ethics statement is included in your manuscript, as the ethics statement entered into the online submission form will not be published alongside your manuscript.

5.Thank you for submitting the above manuscript to PLOS ONE. During our internal evaluation of the manuscript, we found significant text overlap between your submission and the following previously published works, some of which you are an author.

https://www.healthcarefinancenews.com/news/healthcare-workers-treating-covid-19-show-more-negative-mental-health-effects

https://www.researchsquare.com/article/rs-23828/v1

https://pubmed.ncbi.nlm.nih.gov/30343247/

https://www.newkerala.com/news/2020/60792.htm

https://www.statnews.com/2020/04/03/the-covid-19-crisis-too-few-are-talking-about-health-care-workers-mental-health/

https://www.mdpi.com/2071-1050/12/9/3834/html

http://www.ephysician.ir/2017/5212.pdf

https://link.springer.com/article/10.1186/s12992-020-00621-z?code=c5fb9c70-dc49-4d3d-8d9c-ae8d56f4a3d9&error=cookies_not_supported

We would like to make you aware that copying extracts from previous publications, especially outside the methods section, word-for-word is unacceptable. In addition, the reproduction of text from published reports has implications for the copyright that may apply to the publications.

Please revise the manuscript to rephrase the duplicated text, cite your sources, and provide details as to how the current manuscript advances on previous work. Please note that further consideration is dependent on the submission of a manuscript that addresses these concerns about the overlap in text with published work.

We will carefully review your manuscript upon resubmission, so please ensure that your revision is thorough.

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

Reviewer #2: Partly

**********

2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #2: No

**********

3. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: No

Reviewer #2: No

**********

4. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: No

Reviewer #2: No

**********

5. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: This manuscript intended to reveal the prevalence and predictors of PTSD in health professionals, which addressed an important question. However, the current version suffered from several problems.

1. In introduction, predictors of PTSD under COVID-19 should be addressed with latest literature.

2. More information was expected about the participants: e.g., educational level, department.

3. 423 was calculated as sufficient sample size. However, only 396 participants were included finally, which was insufficient. How is the process of recruitment of participants? Why not more people were invited initially?

4. The instrument Oslo needs more information, such as validity, sample question, et al.

5. In regression, I wonder why not all variables were included in the analysis such as age, gender, and profession? Maybe these variables predicted PTSD significantly.

6. Very limited predictors were analyzed in the current survey, in which other potentially important factors were not discussed, such as coping style, emotional status. Authors should list this in limitations at least.

7. Overall, authors should pay more attention on the writing, including space, capitalization, punctuation, et al.

Reviewer #2: Thank you for the opportunity to review this paper. It highlights the prevalence of PTSD among health care workers responding to the COVID-19 pandemic in Amhara, Ethiopia, and also points out risk factors (e.g., access to PPE, social support, medical problems) associated with PTSD. This is a useful addition to the growing literature on COVID-19. In order to get the message across effectively, I recommend heavily proofreading with an eye for English sentence structure and grammar. In addition, I have some comments about the analysis:

Major comments on analysis:

1. What variables were in the multivariate logistic regression? Were demographic characteristics included? Things that affect the exposure and also affect PTSD should be included. I think it would be important to control for age, sex, marital status, profession, and perhaps some others, if possible. Whether to include all of the risk factors of interest in a single model should also be carefully considered. For example, perhaps social support should not be included in the assessment of marital status, as it may be a mediator of the effect of marital status on PTSD. Regardless, please indicate details about the variables in the model in both the text and a footnote to Table 3.

2. “Social support = strong” only has 11 people with PTSD. This makes it a poor reference group and perhaps its use leads to the very large confidence intervals for the social support estimates. I recommend combining the “moderate” and “strong” categories, and making this the reference group.

3. Please report either in the Methods section, or as the first comment in the Results section (not later) how many people were invited to participate and how many actually participated. In addition, please state whether people who chose not to participate were different than people who did participate in terms of key demographic characteristics.

Minor comments:

4. The abstract should clearly state that the aims of the paper were to assess the prevalence of PTSD in this population and to assess the association of certain risk factors with PTSD in this population.

5. I would be interested to see more discussion of the “perceived stigma” findings. What types of stigma have health care workers in the Amhara region faced as a result of COVID-19 (or generally)?

6. Is the IES-R validated for use in this population (e.g., Northwestern Ethiopia or Ethiopia in general)?

7. A “limitations” section should be added.

8. Be consistent with labeling the pandemic as “COVID-19” versus “Corona” or other labels.

9. The underlying data do not appear to be in the manuscript, as stated.

**********

6. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #1: Yes: Qin Dai

Reviewer #2: No

[NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.]

While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step.

PLoS One. 2021 Sep 14;16(9):e0255340. doi: 10.1371/journal.pone.0255340.r002

Author response to Decision Letter 0

21 Apr 2021

Reviewers’ comments and authors response

After going through the entire manuscript, you forwarded your constructive comments which have been missed to touch. Therefore, we are glad enough to express our sincerest thanks for your constructive editorial comments that could help improve novelty of our work. All the comments that have been included are highlighted in the track changes

Editors’ comment and suggestions(1)

1. Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming.

Authors Response

Thank you very much, we got these comments with paramount significant and we tried to rewrite the manuscript using PLOS ONE's style requirements per the academic editors’ suggestion

Editors’ comment and suggestions(2)

2. Please include in your Methods section (or in Supplementary Information files) the participating hospitals/institutions. Furthermore, please include additional information regarding the survey or questionnaire used in the study and ensure that you have provided sufficient details that others could replicate the analyses. For instance, if you developed a questionnaire as part of this study and it is not under a copyright more restrictive than CC-BY, please include a copy, in both the original language and English, as Supporting Information./963.

Authors Response

Yes indeed! We authors included the participating hospitals /institutions in the method section and the questionnaire has been supplied as supporting file both in Amharic and English versions

Editors’ comment and suggestions(3)

3. Thank you for stating the following financial disclosure:

"he funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript."

At this time, please address the following queries:

a. Please clarify the sources of funding (financial or material support) for your study. List the grants or organizations that supported your study, including funding received from your institution.

b. State what role the funders took in the study. If the funders had no role in your study, please state: “The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.”

c. If any authors received a salary from any of your funders, please state which authors and which funders.

d. If you did not receive any funding for this study, please state: “The authors received no specific funding for this work.”

Please include your amended statements within your cover letter; we will change the online submission form on your behalf.

Authors Response

Since the authors did not receive any fund for this work, we included in the previous submitted form but to make it in PLOS ONE's writing format, we amended and included in the cover letter as “The authors received no specific funding for this work”.

Editors’ comment and suggestions (4)

Authors Response

Yes indeed! The ethical statement was written in both declaration and methods section so that we deleted the part in the declaration section and only included in the method section per the editors’ comment and suggestion.

Editors’ comment and suggestions (5)

5. Thank you for submitting the above manuscript to PLOS ONE. During our internal evaluation of the manuscript, we found significant text overlap between your submission and the following previously published works, some of which you are an author.

Authors Response

� Great thanks! The whole manuscript was edited by language expert and the changes are included throughout the revised version of the manuscript and the whole manuscript has been rephrased to remove the duplicated text.

Review Comments to the Author

Reviewer #1:

This manuscript intended to reveal the prevalence and predictors of PTSD in health professionals, which addressed an important question. However, the current version suffered from several problems.

Reviewer s’ comment and suggestions (1)

1. In introduction, predictors of PTSD under COVID-19 should be addressed with latest literature.

Authors Response

Yes indeed! This is the part that has been missed. Thus, we have intensively searched the previous published literatures and those factors which predicted PTSD has been included in the revised manuscript.

Reviewer s’ comment and suggestions (2)

2. More information was expected about the participants: e.g., educational level, department.

Authors Response

Yes, we authors missed the details especially about the educational status of the participants and other socidempgrpahic characteristics and now their detail is included in the revised manuscript.

Reviewer s’ comment and suggestions (3)

Authors Response

In this study there are 8 participating hospitals with a total of 736 health professionals

We proportionally allocated the sample size to each hospital and we invited 423 participants by using simple random sampling technique. Of these, twelve (12) of the eligible participants refused to participate and five (5) of the questionnaire were discarded because of incomplete data. Finally, 396 questionnaires were included for the analysis. That is why we included the 10% percent non-response rate to the initially calculated sample size.

Reviewer s’ comment and suggestions (4)

4. The instrument Oslo needs more information, such as validity, sample question, et al.

Authors Response

Social support was measured by the Oslo 3-item Social Support Scale. The social support scores ranges from 3-14 , in that scores from 3-8 as poor,9-11 as moderate and 12-14 as strong social support but for this research purpose it was categorized into poor for scores less than nine . The scores from 9–14 were considered moderate to strong support and merged together as social support. The OSSS-3 is the three items questionnaire assessing the possibility of social support. The three questions assessing social support in OSSS-3 are:

1. How many people are you so close to that you can count on them if you have great personal problems?

2. How much interest and concern do people show in what you do?

3. How easy is it to get practical help from neighbors if you should need it?

The Oslo Social Support Scale has been used in population level studies in Ethiopia and showed good predictive value.

Reviewer’s comment and suggestions (5)

5. In regression, I wonder why not all variables were included in the analysis such as age, gender, and profession? Maybe these variables predicted PTSD significantly.

Authors Response

Yes indeed! all variables including socio-demographic factors (age, gender, profession, marital status, educational status, and having children), clinical variables (family history of medical illness, history of mental illness, having medical illness, psychosocial and material factors consists social support, perceived stigma and lack of adequate and standardized PPE supply were included in the bivariate analysis. However, only divorced, poor social support, not getting standardized PPE, having medical problems, history of mental illness, having families with medical health problems and perceived stigma were found to be significant with PTSD in the bivariate analysis. These variables were interred into multivariate logistic regression for further analysis to control confounding factors. Finally, perceived stigma, lack of standardized and adequate PPE supply, poor social support, having history of medical and mental illness were significantly associated with PTSD.

Reviewer s’ comment and suggestions (6)

Authors Response

Great look! We got this comment with paramount significance i.e. not only coping style, emotional status but also training about COVID-19 has been missed that should be included as factors. So we included in the limitation part which can for possible indication of other interested research in this area

Reviewer s’ comment and suggestions (7)

7. Overall, authors should pay more attention on the writing, including space, capitalization, punctuation, et al.

Authors Response

We have not any doubt with this comment. Hence from repeated proof-reading of the whole manuscript, we found several grammatical errors, interlinings, punctuation errors, wording and spelling errors. Thus, the whole manuscript was edited by language expert and the changes are included throughout the revised version of the manuscript.

Review Comments to the Author

Reviewer‘s comment and suggestions (1)

Major comments on analysis:

Authors Response

Yes indeed! all variables including socio-demographic factors (age, gender, profession, marital status, educational status, and having children), clinical variables (family history of medical illness, history of mental illness, having medical illness, psychosocial and material factors consists social support, perceived stigma and lack of adequate and standardized PPE supply were included in the bivariate analysis. However, only divorced, poor social support, not getting standardized PPE, having medical problems, history of mental illness, having families with medical health problems and perceived stigma were found to be significant with PTSD in the bivariate analysis. Furthermore those variables significantly associated with PTSD in the bivariate analysis were entered into the multivariate logistic regression to control the confounding variables. All these has been included in the text and table form in the revised manuscript

Reviewer‘s comment and suggestions (2)

Authors Response

Great thanks! We authors took very important lesson and we made the corrections per the reviewer’s recommendation that is we combined moderate and strong social support in to one and made it the reference group.

Reviewer‘s comment and suggestions (3)

Authors Response

In this study there were 8 participating hospitals with a total of 736 health professionals.

We invited 423 participants by using simple random sampling technique by proportionally allocating the sample size to each hospital. Of these, twelve (12) of the eligible participants refused to participate and five (5) of the questionnaire were discarded because of incomplete data. Finally, 396 questionnaires were included for the analysis. Those individuals who were on annual leave and severally ill were excluded. This has been included in the methods and the result section

Minor comments:

Reviewer‘s comment and suggestions (4)

Authors Response

Corrected per the reviewer suggestion

Reviewer‘s comment and suggestions (5)

Authors Response

Sure! Stigma during the era of COVID-19 pandemic is too high as reported by the general public and this condition is even worse in case of health care providers. This is because the communities’ perception that the health care providers have close contact with the COVID-19 patents so that being far away from them by any means is recommended. In this study the participants (health professionals) were asked as “Do you perceived as you are stigmatized because you are health professional in relation to COVID-19? (Like refused access to public transport, being isolated from any social affairs, and even evicted from rented homes) and the response was yes/no. Thus significant numbers of health professionals 95(24%) were stigmatized by the public. This indicates the need to increase the communities awareness about COVID-19 and the appropriate prevention strategies instead of stigmatizing the frontline health care workers which in turn enhances the care of patients especially COVID-19 cases.

Reviewer‘s comment and suggestions (6)

6. Is the IES-R validated for use in this population (e.g., Northwestern Ethiopia or Ethiopia in general)?

Authors Response

Great thanks for your constructive comment you provided us. Actually IES-R is not validated in Ethiopia case in these populations as to our searching knowledge. In this study, we conducted a reliability analysis for the IES-R-22questionnaire (Amharic version) and that it had a high score (Cronbach’s α=0.92). Thus, we assumed as a good measure PTSD in this study. In fact, it would be acceptable if it was validated but we cannot do this because of time constraints and we put as a limitation to show the necessity of its validation in this population by other interested researchers.

Reviewer‘s comment and suggestions (7)

7. A“limitations”section should be added.

Authors Response

We added this section per the reviewer’s recommendation and suggestion as Limitation

Reviewer‘s comment and suggestions (8)

8. Be consistent with labeling the pandemic as “COVID-19” versus “Corona” or other labels.

Authors Response

With no doubt, we took the comment and we made correction as COVID-19 pandemic through the revised manuscript

Reviewer‘s comment and suggestions (9)

9. The underlying data do not appear to be in the manuscript, as stated.

Authors Response

Sure! All the data can be accessible with reasonable request from the corresponding author

Attachment

Submitted filename: Response to Reviewers.docx

Click here for additional data file.^{(46.5KB, docx)}

PLoS One. doi: 10.1371/journal.pone.0255340.r003

Decision Letter 1

Frank T Spradley

12 May 2021

PONE-D-20-34499R1

Prevalence of post-traumatic stress disorder on health professionals in the era of COVID-19 pandemic, Northwest Ethiopia, 2020: multi-centred cross-sectional study

PLOS ONE

Dear Dr. Alemayehu,

The reviewers have remaining comments that must be addressed. In addition, the authors need to contact a professional copyeditor to proof the manuscript before resubmission.

Please submit your revised manuscript by Jun 26 2021 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

Please include the following items when submitting your revised manuscript:

A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'.
A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'.
An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'.

If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: http://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols. Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols.

We look forward to receiving your revised manuscript.

Kind regards,

Frank T. Spradley

Academic Editor

PLOS ONE

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #1: All comments have been addressed

Reviewer #2: (No Response)

**********

2. Is the manuscript technically sound, and do the data support the conclusions?

Reviewer #1: Yes

Reviewer #2: Yes

**********

3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #2: Yes

**********

4. Have the authors made all data underlying the findings in their manuscript fully available?

Reviewer #1: No

Reviewer #2: No

**********

5. Is the manuscript presented in an intelligible fashion and written in standard English?

Reviewer #1: No

Reviewer #2: No

**********

6. Review Comments to the Author

Reviewer #1: The manuscript intended to reveal the prevalence of PTSD in health care professionals in Ethiopia during COVID-19 pandemic. The topic is interesting and deserves to explore. However, the writing of this version suffered from several major shortcomings.

1. The English need to be improved by native speaker.

2. The relationship between IES and PTSD need more exploration in introduction.

3. The significance of this investigation to the current pandemic need to be clearly addressed in the introduction.

4. How to health care professionals? This point need to be addressed in introduction or methods.

5. In introduction, latest literature referring to the PTSD in health care professionals especially during the current pandemic should be systematically reviewed.

6. 423 participants are insufficient for the sample size, which indicated that the current sample size is in a low power of effect size. Any statistic methods carried out to improve the effect size? Or any other methods could be carried out to solve the problem?

7. The format of Figure and Table need to be attended, especially the capitalization and the accuracy of English (severe instead of sever)

8. Model information about the regression should be given in the results.

Reviewer #2: Thank you for the opportunity to review the revised version of this manuscript. It is greatly improved. After the authors clarified the multivariate regression methods, I have do have some remaining concerns about that set of analyses.

Major comments:

1. I am interested in seeing the bivariate results in addition to the multivariate results. These should all be displayed. I suggest one table with bivariate results, and another table with results of the multivariate analysis. Even the “non-significant” results should be shown, along with 95% CI. This would allow the reader to assess the size and precision of each association.

2. In the multivariate analysis, I think that it is more important to choose variables to add in the multivariable model based on conceptual reasons/based on existing literature, rather than p<0.05 in the bivariate analyses. P>0.05 might be driven by small sample size or other statistical reasons. I think it would be particularly important to include age and gender in the multivariable model, since they are strongly associated with PTSD and many of the other factors in the model.

3. When interpreting results of the multivariable model, add “when controlling for the other variables in the model.” For example, “The odds of developing post-traumatic stress disorder among health care providers were 2.27 times higher among those participants who had not standardized PPE supply as compared with those who had standardized PPE supply, *controlling for the other variables in the model* (AOR=2.27,95CI;1.29,3.98).” Similarly, in the discussion, it should be made clear that the results described are from the multivariate (adjusted) models.

4. The following phrase on page 6 should be revise for clarity: “Factors associated with post-traumatic stress disorder were selected during the bivariate analysis with p<0.05 for further analysis in the multivariable logistic regression analysis. In the multivariable logistic regression analysis, variables with p<0.05 at 95% CI with adjusted OR were considered statistically significant.”

5. I suspect that marital status is not significantly associated with PTSD in the multivariate model because social support is a mediator of this relationship (i.e., being unmarried leads to poor social support, which then leads to PTSD), and social support is controlled for. This does not have to be mentioned in the discussion, but could be.

Minor comments:

1. On page 3, several previous studies of the prevalence of PTSD are mentioned. Were these all among health care workers? Nurses, specifically? Please specify.

2. Is South Gondar 666 *kilometers* from Addis Ababa? Miles? Please specify.

3. In describing the sample size calculations, does P refer to prevalence? Also, I think that specifying Z=1.96, 95% CI, and alpha=0.05 is repetitive. I think just specifying a standard normal distribution and alpha=0.05 would be enough.

4. The sentence about the number of participants from each hospital could be rewritten as, “Health professionals were from Debretabor (N=325), Andabet (N=62), Estie (N=55)..." for clarity.

5. Please specify that 396 participants, not 396 questionnaires, were included.

6. It is noted that, “All health professionals working in South Gondar Zone hospitals were included, and those participants who were on annual leave and severely ill were excluded.” This is confusing following the statement that there were 396 participants included. Perhaps this comment should be moved to the beginning of the paragraph, if it is referring to initial eligibility criteria?

7. When describing the tools used to measure PTSD, social support, etc. the authors seems to discuss each tool, and then describe them all again in the same order. Can this section be restructured to have a single section on each tool?

8. In “data processing and analysis” please change “descriptive, bivariate, and multivariate logistic regression” to “descriptive statistics, and bivariate and multivariate logistic regression” (i.e., the word “statistics” is missing.)

9. Page 9: State that the *prevalence*, not magnitude, of PTSD was 55.1%. Magnitude can be confused with severity.

10. Unless specified otherwise by editors, limitations may be better off before the conclusions.

11. I suggest removing the detail about the number of participants invited from the abstract (and only leave the number that actually were included), as it is distracting from the primary message of the abstract. There is sufficient detail in the main manuscript.

**********

7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #1: No

Reviewer #2: No

PLoS One. 2021 Sep 14;16(9):e0255340. doi: 10.1371/journal.pone.0255340.r004

Author response to Decision Letter 1

1 Jun 2021

Reviewers’ comments and authors response

In the first place we would like to forward our great thanks for your constructive comments and suggestions for the improvement of the manuscript. Thus, all the comments that have been included are highlighted in the track changes.

Reviewer 1 comments and suggestions (1)

1. The English need to be improved by native speaker.

Response

Great thanks! We invited the language expert and the manuscript has been edited and the changes are included throughout the revised version of the manuscript.

Reviewer 1 comments and suggestions (2)

2. The relationship between IES and PTSD need more exploration in introduction.

Response

The relationships between IES and PTSD have been stated per the reviewer’s suggestion and comment

Reviewer 1 comments and suggestions (3)

3. The significance of this investigation to the current pandemic need to be clearly addressed in the introduction.

Response

Yes indeed! This is the part that we missed and correction has been made per the reviewer’s comments and suggestions

Reviewer 1 comments and suggestions (4)

4. How to health care professionals? This point need to be addressed in introduction or methods.

Response

We included this point in the introduction part per the reviewer’s suggestions and comments

Reviewer 1 comments and suggestions (5)

5. In introduction, latest literature referring to the PTSD in health care professionals especially during the current pandemic should be systematically reviewed.

Response

Certainly! We reviewed the newly published articles and included them in the introduction part.

Reviewer 1 comments and suggestions (6)

Response

We want to say sorry for the confusion. In fact the total health professionals in the eight hospitals were 736. We then calculated the sample using single proportion formula giving the final sample size of 423and the response rate was 94.8%. Thus, the sample size, 423 is assumed to be sufficient for the study populations of 736 which could also be a representative

Reviewer 1 comments and suggestions (7)

7. The format of Figure and Table need to be attended, especially the capitalization and the accuracy of English (severe instead of sever)

Response

Yes indeed! We got the mistake and corrected in the revised figure

Reviewer 1 comments and suggestions (8)

8. Model information about the regression should be given in the results.

Response

Great thanks! This comment has been also raised by reviewer2 so that we revised the regression and put in the revised manuscript

Major comments:

Reviewer 2 comments and suggestions (1)

Response

Certainly! We revised the analysis and we put the analysis as bivariate and multivariate in separate tables in the revised manuscript

Reviewer 2 comments and suggestions (2)

Response

Sure! We took the comments and suggestions given by the reviewer and we took all variables analyzed in bivariate into multivariate analysis. In this case, age was re categorized because in the cell there was 1.3 % frequency which was < 5%. Thus, age was significantly associated with PTSD.

Reviewer 2 comments and suggestions (3)

Response

Corrected per the reviewer suggestions and comments

Reviewer 2 comments and suggestions (4)

Response

Great thanks! we found it as confusing and correction has been made per reviewers suggestion

Reviewer 2 comments and suggestions (5)

Response

Certainly! We took great lesson here so that we checked multi-co linearity between independent variables including marital status and social support using VIF and tolerance. However, no multicolinearity was found between independent factors.

Minor comments:

Reviewer 2 comments and suggestions (1)

1. On page 3, several previous studies of the prevalence of PTSD are mentioned. Were these all among health care workers? Nurses, specifically? Please specify.

Response

Sure! The studies were among all health care workers

Reviewer 2 comments and suggestions (2)

2. Is South Gondar 666 *kilometers* from Addis Ababa? Miles? Please specify.

Response

Sorry for the confusion, it is kilometers and correction has been made on the revised manuscript

Reviewer 2 comments and suggestions (3)

Response

Certainly! Redundancy of idea was noted and we corrected it per the reviewer’s suggestions and comments

Reviewer 2 comments and suggestions (4)

4. The sentence about the number of participants from each hospital could be rewritten as, “Health professionals were from Debretabor (N=325), Andabet (N=62), Estie (N=55)..." for clarity.

Response

Corrected per the reviewers comments and suggestions

Reviewer 2 comments and suggestions (5)

5. Please specify that 396 participants, not 396 questionnaires, were included.

Response

Corrected as participants in the revised manuscript

Reviewer 2 comments and suggestions (6)

Response

Great look! It was really confusing, thus we made the necessary correction per the reviewers suggestions

Reviewer 2 comments and suggestions (7)

Response

Sure! It was really redundant and confusing so that correction has been made by classifying as “data source and measurement” and operational definitions”

Reviewer 2 comments and suggestions (8)

Response

Great thanks! Correction has been made

Reviewer 2 comments and suggestions (9)

9. Page 9: State that the *prevalence*, not magnitude, of PTSD was 55.1%. Magnitude can be confused with severity.

Response

We replaced magnitude with prevalence per the reviewers comment

Reviewer 2 comments and suggestions (10)

10. Unless specified otherwise by editors, limitations may be better off before the conclusions.

Response

We took the comment with paramount significance and we made it before the conclusion in the revised manuscript

Reviewer 2 comments and suggestions (11)

Response

Great! Corrected per the reviewers comment and suggestions

Attachment

Submitted filename: Response to Reviewers 2nd.docx

Click here for additional data file.^{(40.2KB, docx)}

PLoS One. doi: 10.1371/journal.pone.0255340.r005

Decision Letter 2

Frank T Spradley

6 Jul 2021

PONE-D-20-34499R2

Prevalence of post-traumatic stress disorder on health professionals in the era of COVID-19 pandemic, Northwest Ethiopia, 2020: multi-centred cross-sectional study

PLOS ONE

Dear Dr. Alemayehu,

Please submit your revised manuscript by Aug 20 2021 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

Please include the following items when submitting your revised manuscript:

A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'.
A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'.
An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'.

We look forward to receiving your revised manuscript.

Kind regards,

Frank T. Spradley

Academic Editor

PLOS ONE

Journal Requirements:

Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice.

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

Reviewer #1: All comments have been addressed

Reviewer #2: (No Response)

**********

2. Is the manuscript technically sound, and do the data support the conclusions?

Reviewer #1: Yes

Reviewer #2: Yes

**********

3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #2: Yes

**********

4. Have the authors made all data underlying the findings in their manuscript fully available?

Reviewer #1: No

Reviewer #2: No

**********

5. Is the manuscript presented in an intelligible fashion and written in standard English?

Reviewer #1: No

Reviewer #2: No

**********

6. Review Comments to the Author

Reviewer #1: Authors have done a good job in revision. I have only one suggestions: The language of this manuscript still needs improve, please improve the language substantially.

Reviewer #2: Thank you for the opportunity to review a revised version of this manuscript. It is improved from the previous version. Thanks to the authors for adding the bivariate results. Although I list several comments below, they are minor in nature. I would also like to note that copy-editing is necessary.

1. First sentence is confusing. I don’t think SARS should be mentioned, as it takes the focus away from COVID-19.

2. In the first paragraph, “the election” is referenced. Which election?

3. Information about IES-R was added to the introduction in this version. In my opinion, that should be saved for the methods section.

4. Fix the last sentence of the introduction: “magnitude and associated factors” is confusing. Maybe “prevalence of PTSD, as well as risk factors for PTSD.”

5. I want to clarify point 2 in my previous review (“In the multivariate analysis, I think that it is more important to choose variables to add in the multivariable model based on conceptual reasons/based on existing literature, rather than p<0.05. P<0.05 might be driven by small sample size or other statistical reasons”). I think p<0.05 alone that this is not a good reason to choose variables for the multivariate model. The decision should also be based on existing literature. Perhaps you can say, “the bivariate results may have been subject to confounding. Therefore, we conducted a multivariate analysis containing all variables associated with PTSD. Variables for the multivariate model were selected based on a combination of known risk factors for PTSD from existing literature, and variables significantly associated with PTSD in the bivariate analyses.” Also, remove “not too large” from this section.

6. In Table 4, there should be a footnote stating that the results shown are adjusted for all of the other variables listed. I would also suggest adding, “when controlling for other variables in the model” to paragraph 2 in the Discussion. I think this information is important for interpreting the results from the multivariate (adjusted) model.

7. Thank you for your revision in response to point 7 on my last review (“When describing the tools used to measure PTSD, social support, etc. the authors seems to discuss each tool, and then describe them all again in the same order. Can this section be restructured to have a single section on each tool?”). I appreciate that you have “data sources and measurement” and then “operational definitions.” It would still be my preference for easier reading to have each tool described once (measurement and operational definition together). As previously noted, some of this information is currently in the introduction, as well.

Wording comments:

8. Page 9: Instead of “found to be significant,” should be “found to be significantly associated with PTSD.”

9. On page 12, “magnitude” should be replaced with “prevalence.”

10. On page 12, “corona outbreak” should be replaced with “COVID-19 pandemic.”

11. On page 13, I am not sure what is meant by “conversely, being a physician affected PTSD positively.” Do you mean “being a physician made PTSD less likely”?

12. Replace “likely hood” with “likelihood” throughout.

**********

7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #1: Yes: Qin Dai

Reviewer #2: No

PLoS One. 2021 Sep 14;16(9):e0255340. doi: 10.1371/journal.pone.0255340.r006

Author response to Decision Letter 2

10 Jul 2021

Reviewers’ comments and authors response

In the first place we would like to forward our great thanks for your constructive comments and suggestions for the improvement of the manuscript. In addition, we would like to thank for scientific lesson we got throughout your comments and suggestions. Thus, all the comments that have been included are highlighted in the track changes.

Reviewer #1: Authors have done a good job in revision. I have only one suggestion: The language of this manuscript still needs improve, please improve the language substantially.

Response

Great thanks again! From repeated proof-reading, we found several grammatical errors, punctuations errors, wording and spelling errors etc. Therefore we invited an expert with Masters of Arts in English; we have tried our best to thoroughly copyedit the manuscript for appropriate English language usage. Thus the changes are found throughout the revised version of the manuscript.

Reviewer 2 comments and suggestions (1)

1. First sentence is confusing. I don’t think SARS should be mentioned, as it takes the focus away from COVID-19.

Response

Great thanks! Correction has been made per the reviewer’s suggestions

Reviewer 2 comments and suggestions (2)

2. In the first paragraph, “the election” is referenced. Which election?

Response

Great! It is the sixth national election of Ethiopia

Reviewer 2 comments and suggestions (3)

3. Information about IES-R was added to the introduction in this version. In my opinion, that should be saved for the methods section.

Response

Great thanks! We removed the information about IES-R in the introduction part and added in the method section per the reviewer’s suggestions and recommendations.

4. Fix the last sentence of the introduction: “magnitude and associated factors” is confusing. Maybe “prevalence of PTSD, as well as risk factors for PTSD.”

Reviewer 2 comments and suggestions (4)

Response

Yes! We replaced magnitude with Prevalence per the reviewer’s suggestions and comments

Reviewer 2 comments and suggestions (5)

Response

Corrected per the suggestions and comments

Reviewer 2 comments and suggestions (6)

Response

Sure! Corrected per the reviewers suggestions and comments in the revised manuscript.

Reviewer 2 comments and suggestions (7)

Response

Great thanks! We made the necessary correction per the comments and suggestions in the revised manuscript.

Wording comments:

Reviewer 2 comments and suggestions (8)

8. Page 9: Instead of “found to be significant,” should be “found to be significantly associated with PTSD.

Response

Corrected per the recommendations of the reviewers

Reviewer 2 comments and suggestions (9)

9. On page 12, “magnitude” should be replaced with “prevalence.”

Response

Corrected per the reviewers recommendations

Reviewer 2 comments and suggestions (10)

10. On page 12, “corona outbreak” should be replaced with “COVID-19 pandemic.”

Response

Corrected per the reviewers recommendations

Reviewer 2 comments and suggestions (11)

11. On page 13, I am not sure what is meant by “conversely, being a physician affected PTSD positively.” Do

you mean “being a physician made PTSD less likely”?

Response

Certainly! It is really confusing and unclear sentences so that we made the corrections in the revised manuscript as “conversely physician were less affected by PTSD as compared with nurses”

Reviewer 2 comments and suggestions (12)

12. Replace “likely hood” with “likelihood” throughout.

Response

Corrected as “likelihood” throughout the revised manuscript

Attachment

Submitted filename: Response to Reviewers 3rd.docx

Click here for additional data file.^{(33.4KB, docx)}

PLoS One. doi: 10.1371/journal.pone.0255340.r007

Decision Letter 3

Frank T Spradley

15 Jul 2021

Prevalence of post-traumatic stress disorder on health professionals in the era of COVID-19 pandemic, Northwest Ethiopia, 2020: multi-centred cross-sectional study

PONE-D-20-34499R3

Dear Dr. Alemayehu,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication.

An invoice for payment will follow shortly after the formal acceptance. To ensure an efficient process, please log into Editorial Manager at http://www.editorialmanager.com/pone/, click the 'Update My Information' link at the top of the page, and double check that your user information is up-to-date. If you have any billing related questions, please contact our Author Billing department directly at authorbilling@plos.org.

If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org.

Kind regards,

Frank T. Spradley

Academic Editor

PLOS ONE

PLoS One. doi: 10.1371/journal.pone.0255340.r008

Acceptance letter

Frank T Spradley

6 Sep 2021

PONE-D-20-34499R3

Prevalence of post-traumatic stress disorder on health professionals in the era of COVID-19 pandemic, Northwest Ethiopia, 2020: a multi-centered cross-sectional study

Dear Dr. Asnakew:

I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now with our production department.

If your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information please contact onepress@plos.org.

If we can help with anything else, please email us at plosone@plos.org.

Thank you for submitting your work to PLOS ONE and supporting open access.

Kind regards,

PLOS ONE Editorial Office Staff

on behalf of

Dr. Frank T. Spradley

Academic Editor

PLOS ONE

Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Supplementary Materials

S1 File. Questionnaire, to assess the prevalence of post-traumatic stress disorder on health professionals in the era of COVID-19 pandemic.

(DOCX)

Click here for additional data file.^{(53.9KB, docx)}

Attachment

Submitted filename: Response to Reviewers.docx

Click here for additional data file.^{(46.5KB, docx)}

Attachment

Submitted filename: Response to Reviewers 2nd.docx

Click here for additional data file.^{(40.2KB, docx)}

Attachment

Submitted filename: Response to Reviewers 3rd.docx

Click here for additional data file.^{(33.4KB, docx)}

Data Availability Statement

All relevant data are within the manuscript and its Supporting information files.

[pone.0255340.ref001] 1.Wang C, Horby PW, Hayden FG, Gao GF. A novel coronavirus outbreak of global health concern. The lancet. 2020;395(10223):470–3. doi: 10.1016/S0140-6736(20)30185-9 [DOI] [PMC free article] [PubMed] [Google Scholar]

[pone.0255340.ref002] 2.Nishiura H, Jung S-m, Linton NM, Kinoshita R, Yang Y, Hayashi K, et al. The extent of transmission of novel coronavirus in Wuhan, China, 2020. Multidisciplinary Digital Publishing Institute; 2020. [DOI] [PMC free article] [PubMed] [Google Scholar]

[pone.0255340.ref003] 3.Mahase E. China coronavirus: WHO declares international emergency as death toll exceeds 200. BMJ: British Medical Journal (Online). 2020;368. doi: 10.1136/bmj.m408 [DOI] [PubMed] [Google Scholar]

[pone.0255340.ref004] 4.Stankovska G, Memedi I, Dimitrovski D. Coronavirus COVID-19 disease, mental health and psychosocial support. Society Register. 2020;4(2):33–48. [Google Scholar]

[pone.0255340.ref005] 5.Organization WH. Health worker Ebola infections in Guinea, Liberia and Sierra Leone: a preliminary report 21 May 2015. World Health Organization, 2015.

[pone.0255340.ref006] 6.Koh Y, Hegney DG, Drury V. Comprehensive systematic review of healthcare workers’ perceptions of risk and use of coping strategies towards emerging respiratory infectious diseases. International Journal of Evidence-Based Healthcare. 2011;9(4):403–19. doi: 10.1111/j.1744-1609.2011.00242.x [DOI] [PubMed] [Google Scholar]

[pone.0255340.ref007] 7.Ives J, Greenfield S, Parry JM, Draper H, Gratus C, Petts JI, et al. Healthcare workers’ attitudes to working during pandemic influenza: a qualitative study. BMC public health. 2009;9(1):1–13. doi: 10.1186/1471-2458-9-56 [DOI] [PMC free article] [PubMed] [Google Scholar]

[pone.0255340.ref008] 8.Maunder RG, Lancee WJ, Mae R, Vincent L, Peladeau N, Beduz MA, et al. Computer-assisted resilience training to prepare healthcare workers for pandemic influenza: a randomized trial of the optimal dose of training. BMC health services research. 2010;10(1):1–10. [DOI] [PMC free article] [PubMed] [Google Scholar]

[pone.0255340.ref009] 9.Li W, Yang Y, Liu Z-H, Zhao Y-J, Zhang Q, Zhang L, et al. Progression of mental health services during the COVID-19 outbreak in China. International journal of biological sciences. 2020;16(10):1732. doi: 10.7150/ijbs.45120 [DOI] [PMC free article] [PubMed] [Google Scholar]

[pone.0255340.ref010] 10.Wang C, Pan R, Wan X, Tan Y, Xu L, Ho CS, et al. Immediate psychological responses and associated factors during the initial stage of the 2019 coronavirus disease (COVID-19) epidemic among the general population in China. International journal of environmental research and public health. 2020;17(5):1729. doi: 10.3390/ijerph17051729 [DOI] [PMC free article] [PubMed] [Google Scholar]

[pone.0255340.ref011] 11.Rossi R, Socci V, Pacitti F, Di Lorenzo G, Di Marco A, Siracusano A, et al. Mental health outcomes among frontline and second-line health care workers during the coronavirus disease 2019 (COVID-19) pandemic in Italy. JAMA network open. 2020;3(5):e2010185–e. doi: 10.1001/jamanetworkopen.2020.10185 [DOI] [PMC free article] [PubMed] [Google Scholar]

[pone.0255340.ref012] 12.Riello M, Purgato M, Bove C, MacTaggart D, Rusconi E. Prevalence of post-traumatic symptomatology and anxiety among residential nursing and care home workers following the first COVID-19 outbreak in Northern Italy. Royal Society open science. 2020;7(9):200880. doi: 10.1098/rsos.200880 [DOI] [PMC free article] [PubMed] [Google Scholar]

[pone.0255340.ref013] 13.Rossi R, Socci V, Pacitti F, Di Lorenzo G, Di Marco A, Siracusano A, et al. Mental health outcomes among front and second line health workers associated with the COVID-19 pandemic in Italy. medRxiv. 2020. [DOI] [PMC free article] [PubMed] [Google Scholar]

[pone.0255340.ref014] 14.Bassi M, Negri L, Delle Fave A, Accardi R. The relationship between post-traumatic stress and positive mental health symptoms among health workers during COVID-19 pandemic in Lombardy, Italy. Journal of affective disorders. 2021;280:1–6. doi: 10.1016/j.jad.2020.11.065 [DOI] [PMC free article] [PubMed] [Google Scholar]

[pone.0255340.ref015] 15.Chen C-S, Wu H-Y, Yang P, Yen C-F. Psychological distress of nurses in Taiwan who worked during the outbreak of SARS. Psychiatric Services. 2005;56(1):76–9. doi: 10.1176/appi.ps.56.1.76 [DOI] [PubMed] [Google Scholar]

[pone.0255340.ref016] 16.Hennein R, Mew EJ, Lowe SR. Socio-ecological predictors of mental health outcomes among healthcare workers during the COVID-19 pandemic in the United States. PloS one. 2021;16(2):e0246602. doi: 10.1371/journal.pone.0246602 [DOI] [PMC free article] [PubMed] [Google Scholar]

[pone.0255340.ref017] 17.Maunder RG, Lancee WJ, Balderson KE, Bennett JP, Borgundvaag B, Evans S, et al. Long-term psychological and occupational effects of providing hospital healthcare during SARS outbreak. Emerging infectious diseases. 2006;12(12):1924. doi: 10.3201/eid1212.060584 [DOI] [PMC free article] [PubMed] [Google Scholar]

[pone.0255340.ref018] 18.Li Y, Scherer N, Felix L, Kuper H. Prevalence of depression, anxiety and post-traumatic stress disorder in health care workers during the COVID-19 pandemic: A systematic review and meta-analysis. PloS one. 2021;16(3):e0246454. doi: 10.1371/journal.pone.0246454 [DOI] [PMC free article] [PubMed] [Google Scholar]

[pone.0255340.ref019] 19.Yuan K, Gong Y-M, Liu L, Sun Y-K, Tian S-S, Wang Y-J, et al. Prevalence of posttraumatic stress disorder after infectious disease pandemics in the twenty-first century, including COVID-19: a meta-analysis and systematic review. Molecular psychiatry. 2021:1–17. doi: 10.1038/s41380-021-01036-x [DOI] [PMC free article] [PubMed] [Google Scholar]

[pone.0255340.ref020] 20.Marvaldi M, Mallet J, Dubertret C, Moro MR, Guessoum SB. Anxiety, depression, trauma-related, and sleep disorders among healthcare workers duirng the covid-19 pandemic: A systematic review and meta-analysis. Neuroscience & Biobehavioral Reviews. 2021. [DOI] [PMC free article] [PubMed] [Google Scholar]

[pone.0255340.ref021] 21.Johnson SU, Ebrahimi OV, Hoffart A. PTSD symptoms among health workers and public service providers during the COVID-19 outbreak. PloS one. 2020;15(10):e0241032. doi: 10.1371/journal.pone.0241032 [DOI] [PMC free article] [PubMed] [Google Scholar]

[pone.0255340.ref022] 22.Blekas A, Voitsidis P, Athanasiadou M, Parlapani E, Chatzigeorgiou AF, Skoupra M, et al. COVID-19: PTSD symptoms in Greek health care professionals. Psychological Trauma: Theory, Research, Practice, and Policy. 2020. doi: 10.1037/tra0000914 [DOI] [PubMed] [Google Scholar]

[pone.0255340.ref023] 23.Li X, Li S, Xiang M, Fang Y, Qian K, Xu J, et al. The prevalence and risk factors of PTSD symptoms among medical assistance workers during the COVID-19 pandemic. Journal of Psychosomatic Research. 2020;139:110270. doi: 10.1016/j.jpsychores.2020.110270 [DOI] [PMC free article] [PubMed] [Google Scholar]

[pone.0255340.ref024] 24.Zandifar A, Badrfam R, Khonsari NM, Mohammadi MR, Asayesh H, Qorbani M. Prevalence and associated factors of posttraumatic stress symptoms and stigma among health care workers in contact with COVID-19 patients. Iranian journal of psychiatry. 2020;15(4):340. doi: 10.18502/ijps.v15i4.4303 [DOI] [PMC free article] [PubMed] [Google Scholar]

[pone.0255340.ref025] 25.Christianson S, Marren J. The impact of event scale—revised (IES-R). Medsurg Nursing. 2012;21(5):321–3. [PubMed] [Google Scholar]

[pone.0255340.ref026] 26.Weiss D, Marmar C. The Impact of Event Scale—Revised. W: Wilson J., Keane T.(red.). Assessing psychological trauma and PTSD: A handbook for practitioners. Guildford Press, New York; 1997. [Google Scholar]

[pone.0255340.ref027] 27.Creamer M, Bell R, Failla S. Psychometric properties of the impact of event scale—revised. Behaviour research and therapy. 2003;41(12):1489–96. doi: 10.1016/j.brat.2003.07.010 [DOI] [PubMed] [Google Scholar]

[pone.0255340.ref028] 28.Abiola T, Udofia O, Zakari M. Psychometric properties of the 3-item oslo social support scale among clinical students of Bayero University Kano, Nigeria. Malaysian Journal of Psychiatry. 2013;22(2):32–41. [Google Scholar]

[pone.0255340.ref029] 29.Fekadu A, Medhin G, Selamu M, Hailemariam M, Alem A, Giorgis TW, et al. Population level mental distress in rural Ethiopia. BMC psychiatry. 2014;14(1):1–13. doi: 10.1186/1471-244X-14-194 [DOI] [PMC free article] [PubMed] [Google Scholar]

[pone.0255340.ref030] 30.Asnakew S, Shumet S, Ginbare W, Legas G, Haile K. Prevalence of post-traumatic stress disorder and associated factors among Koshe landslide survivors, Addis Ababa, Ethiopia: a community-based, cross-sectional study. BMJ open. 2019;9(6):e028550. doi: 10.1136/bmjopen-2018-028550 [DOI] [PMC free article] [PubMed] [Google Scholar]

[pone.0255340.ref031] 31.Bøen H, Dalgard OS, Bjertness E. The importance of social support in the associations between psychological distress and somatic health problems and socio-economic factors among older adults living at home: a cross sectional study. BMC geriatrics. 2012;12(1):1–12. doi: 10.1186/1471-2318-12-27 [DOI] [PMC free article] [PubMed] [Google Scholar]

[pone.0255340.ref032] 32.Luceño-Moreno L, Talavera-Velasco B, García-Albuerne Y, Martín-García J. Symptoms of posttraumatic stress, anxiety, depression, levels of resilience and burnout in Spanish health personnel during the COVID-19 pandemic. International journal of environmental research and public health. 2020;17(15):5514. doi: 10.3390/ijerph17155514 [DOI] [PMC free article] [PubMed] [Google Scholar]

[pone.0255340.ref033] 33.Lee SM, Kang WS, Cho A-R, Kim T, Park JK. Psychological impact of the 2015 MERS outbreak on hospital workers and quarantined hemodialysis patients. Comprehensive psychiatry. 2018;87:123–7. doi: 10.1016/j.comppsych.2018.10.003 [DOI] [PMC free article] [PubMed] [Google Scholar]

[pone.0255340.ref034] 34.Shacham M, Hamama-Raz Y, Kolerman R, Mijiritsky O, Ben-Ezra M, Mijiritsky E. COVID-19 factors and psychological factors associated with elevated psychological distress among dentists and dental hygienists in Israel. International Journal of Environmental Research and Public Health. 2020;17(8):2900. doi: 10.3390/ijerph17082900 [DOI] [PMC free article] [PubMed] [Google Scholar]

[pone.0255340.ref035] 35.Chan AO, Huak CY. Psychological impact of the 2003 severe acute respiratory syndrome outbreak on health care workers in a medium size regional general hospital in Singapore. Occupational Medicine. 2004;54(3):190–6. doi: 10.1093/occmed/kqh027 [DOI] [PMC free article] [PubMed] [Google Scholar]

[pone.0255340.ref036] 36.Liu N, Zhang F, Wei C, Jia Y, Shang Z, Sun L, et al. Prevalence and predictors of PTSS during COVID-19 outbreak in China hardest-hit areas: Gender differences matter. Psychiatry research. 2020:112921. doi: 10.1016/j.psychres.2020.112921 [DOI] [PMC free article] [PubMed] [Google Scholar]

[pone.0255340.ref037] 37.Carmassi C, Foghi C, Dell’Oste V, Cordone A, Bertelloni CA, Bui E, et al. PTSD symptoms in healthcare workers facing the three coronavirus outbreaks: What can we expect after the COVID-19 pandemic. Psychiatry research. 2020:113312. doi: 10.1016/j.psychres.2020.113312 [DOI] [PMC free article] [PubMed] [Google Scholar]

[pone.0255340.ref038] 38.Krishnamoorthy Y, Nagarajan R, Saya GK, Menon V. Prevalence of psychological morbidities among general population, healthcare workers and COVID-19 patients amidst the COVID-19 pandemic: A systematic review and meta-analysis. Psychiatry research. 2020;293:113382. doi: 10.1016/j.psychres.2020.113382 [DOI] [PMC free article] [PubMed] [Google Scholar]

[pone.0255340.ref039] 39.Bai Y, Lin C-C, Lin C-Y, Chen J-Y, Chue C-M, Chou P. Survey of stress reactions among health care workers involved with the SARS outbreak. Psychiatric Services. 2004;55(9):1055–7. doi: 10.1176/appi.ps.55.9.1055 [DOI] [PubMed] [Google Scholar]

[pone.0255340.ref040] 40.Cabello IR, Echavez JFM, Serrano-Ripoll MJ, Fraile-Navarro D, de Roque MAF, Moreno GP, et al. Impact of viral epidemic outbreaks on mental health of healthcare workers: a rapid systematic review. medRxiv. 2020. doi: 10.1016/j.jad.2020.08.034 [DOI] [PMC free article] [PubMed] [Google Scholar]

[pone.0255340.ref041] 41.Nobles J, Martin F, Dawson S, Moran P, Savovic J. The potential impact of COVID-19 on mental health outcomes and the implications for service solutions. Royaume Uni, Centre for Academic Mental Health of the University of Bristol …; 2020.

[pone.0255340.ref042] 42.Gold J. The COVID-19 crisis too few are talking about: health care workers’ mental health. StatReports April. 2020;3. [Google Scholar]

[pone.0255340.ref043] 43.Zhang W-r, Wang K, Yin L, Zhao W-f, Xue Q, Peng M, et al. Mental health and psychosocial problems of medical health workers during the COVID-19 epidemic in China. Psychotherapy and psychosomatics. 2020:1–9. doi: 10.1159/000507639 [DOI] [PMC free article] [PubMed] [Google Scholar]

[pone.0255340.ref044] 44.Deacon H, Boulle A. Commentary: Factors affecting HIV/AIDS-related stigma and discrimination by medical professionals. International journal of epidemiology. 2007;36(1):185–6. doi: 10.1093/ije/dyl255 [DOI] [PubMed] [Google Scholar]

[pone.0255340.ref045] 45.O’Donnell AT, Corrigan F, Gallagher S. The impact of anticipated stigma on psychological and physical health problems in the unemployed group. Frontiers in psychology. 2015;6:1263. doi: 10.3389/fpsyg.2015.01263 [DOI] [PMC free article] [PubMed] [Google Scholar]

[pone.0255340.ref046] 46.Cook JM, McCarthy E, Thorp SR. Older adults with PTSD: Brief state of research and evidence-based psychotherapy case illustration. The American Journal of Geriatric Psychiatry. 2017;25(5):522–30. doi: 10.1016/j.jagp.2016.12.016 [DOI] [PubMed] [Google Scholar]

[pone.0255340.ref047] 47.Pless Kaiser A, Cook JM, Glick DM, Moye J. Posttraumatic stress disorder in older adults: a conceptual review. Clinical gerontologist. 2019;42(4):359–76. doi: 10.1080/07317115.2018.1539801 [DOI] [PMC free article] [PubMed] [Google Scholar]

[pone.0255340.ref048] 48.d’Ettorre G, Ceccarelli G, Santinelli L, Vassalini P, Innocenti GP, Alessandri F, et al. Post-Traumatic Stress Symptoms in Healthcare Workers Dealing with the COVID-19 Pandemic: A Systematic Review. International Journal of Environmental Research and Public Health. 2021;18(2):601. doi: 10.3390/ijerph18020601 [DOI] [PMC free article] [PubMed] [Google Scholar]

[pone.0255340.ref049] 49.Naushad VA, Bierens JJ, Nishan KP, Firjeeth CP, Mohammad OH, Maliyakkal AM, et al. A systematic review of the impact of disaster on the mental health of medical responders. Prehospital and disaster medicine. 2019;34(6):632–43. doi: 10.1017/S1049023X19004874 [DOI] [PubMed] [Google Scholar]

[pone.0255340.ref050] 50.Brummett BH, Mark DB, Siegler IC, Williams RB, Babyak MA, Clapp-Channing NE, et al. Perceived social support as a predictor of mortality in coronary patients: effects of smoking, sedentary behavior, and depressive symptoms. Psychosomatic medicine. 2005;67(1):40–5. doi: 10.1097/01.psy.0000149257.74854.b7 [DOI] [PubMed] [Google Scholar]

[pone.0255340.ref051] 51.North CS, Nixon SJ, Shariat S, Mallonee S, McMillen JC, Spitznagel EL, et al. Psychiatric disorders among survivors of the Oklahoma City bombing. The Science of Mental Health: Stress and the Brain: Taylor and Francis; 2013. p. 159–67. [DOI] [PubMed] [Google Scholar]

[pone.0255340.ref052] 52.Brewin CR, Andrews B, Valentine JD. Meta-analysis of risk factors for posttraumatic stress disorder in trauma-exposed adults. Journal of consulting and clinical psychology. 2000;68(5):748. doi: 10.1037//0022-006x.68.5.748 [DOI] [PubMed] [Google Scholar]

[pone.0255340.ref053] 53.Tsujiuchi T, Yamaguchi M, Masuda K, Tsuchida M, Inomata T, Kumano H, et al. High prevalence of post-traumatic stress symptoms in relation to social factors in affected population one year after the Fukushima nuclear disaster. PloS one. 2016;11(3):e0151807. doi: 10.1371/journal.pone.0151807 [DOI] [PMC free article] [PubMed] [Google Scholar]

[pone.0255340.ref054] 54.Tham KY, Tan YH, Loh OH, Tan WL, Ong MK, Tang HK. Psychological morbidity among emergency department doctors and nurses after the SARS outbreak. Hong Kong Journal of Emergency Medicine. 2005;12(4):215–23. [PubMed] [Google Scholar]

PERMALINK

Prevalence of post-traumatic stress disorder on health professionals in the era of COVID-19 pandemic, Northwest Ethiopia, 2020: A multi-centered cross-sectional study

Sintayehu Asnakew

Getasew Legas

Tewachew Muche Liyeh

Amsalu Belete

Kalkidan Haile

Getachew Yideg Yitbarek

Wubet Alebachew Bayih

Dejen Getaneh Feleke

Binyam Minuye Birhane

Haile Amha

Shegaye Shumet

Ermias Sisay Chanie

Roles

Abstract

Objective

Methods

Results

Conclusions

Introduction

Materials and methods

Study setting and period

Sample size determination

Sampling technique, study participants, and participating hospitals

Study variables

Data sources, measurement and operational definitions

Perceived stigma

History of mental illness

History of medical illness

Families with medical illness

Data processing and analysis

Ethical consideration

Patient and public involvement

Results

Table 1. Sociodemographic characteristics of health professionals working in South Gondar zone hospitals, Ethiopia, 2020(n = 396).

Clinical factors of the respondents

Table 2. Clinical factors of health care providers working in South Gondar zone hospitals, Amhara, Ethiopia, 2020.

Psychosocial and material factors

Prevalence of post-traumatic stress disorder (PTSD)

The severity of post-traumatic stress disorder

Fig 1. Severity of post-traumatic stress disorder on health care providers in South Gondar zone hospitals, Amhara, Ethiopia, 2020.

Factors associated with post-traumatic stress disorder

Table 3. Bivariate analysis showing factors associated with PTSD on health care providers in South Gondar hospitals, Ethiopia, 2020.

Table 4. Multivariable analysis showing factors associated with PTSD on health care providers in South Gondar hospitals, Ethiopia, 2020.

Discussions

Limitations

Conclusions

Supporting information

Acknowledgments

Data Availability

Funding Statement

References

Decision Letter 0

Frank T Spradley

Roles

Author response to Decision Letter 0

Decision Letter 1

Frank T Spradley

Roles

Author response to Decision Letter 1

Decision Letter 2

Frank T Spradley

Roles

Author response to Decision Letter 2

Decision Letter 3

Frank T Spradley

Roles

Acceptance letter

Frank T Spradley

Roles

Associated Data

Supplementary Materials

Data Availability Statement

ACTIONS

PERMALINK

RESOURCES

Similar articles

Cited by other articles

Links to NCBI Databases