Network analysis of the comorbidity between post-traumatic stress, depression and anxiety symptoms among frontline healthcare workers during the COVID-19 pandemic

Abstract

Background: Coronavirus disease 2019 pandemic pointed out significant mental symptoms of frontline healthcare workers (HCWs). Objective: We aimed to estimate the prevalence and comorbidity of post-traumatic stress symptoms (PTSS), depression and anxiety symptoms in HCWs from Fangcang shelter hospitals during the pandemic. Design: Demographic information, post-traumatic stress disorder checklist for DSM-5 (PCL-5), Patient Health Questionnaire (PHQ-9) and Generalized Anxiety Disorder Questionnaire (GAD-7) were obtained online based on stratified random sampling design during April 2022, with 284 eligible responses. Method: Hierarchical regression analyses were applied to investigate independent variables associated with psychological status outcomes (PHQ-9, GAD-7 and PCL-5), and the network analyses were applied to explore the comorbidity using all items of PCL-5, PHQ-9 and GAD-7. Results: (1) 10.56%, 13.03% and 8.10% of HCWs reported PTSS, depression and anxiety symptoms. Fifty-three (18.66%) HCWs experienced at least one mental health disorder, among which 26.42–37.74% HCWs had comorbidity of two or three mental disorders; (2) several influence factors of mental health were identified, including medical professions, working hours, contacted patients ( p < 0.05); (3) prominent bridge symptoms between PTSS and depression were sleep problems, suicide ideation, concentration difficulties and recklessness. Comorbidity between PTSS and anxiety was thought to mainly stem from negative affect, such as afraid, anxious, annoyed and worrying. Depressed mood and worry might be good targets during treatment of comorbidity of depression and anxiety. Conclusion: Our data suggest mild level of PTSS, depression and anxiety symptoms among HCWs during the pandemic and might give novel insights into assessment and intervention of comorbidity.