Journal of Practical & Professional Nursing Category: Clinical Type: Short Review

The Prevalence of Post-Traumatic Stress Disorder (PTSD) among Emergency Front-Line Nurse during the COVID-19 Outbreak: A Cross Sectional Study in Wuhan, China

Chen M1*, Sun H1, Tian Yu2* and Liu L3*

1 Department of nursing, ZhongNan Hospital of Wuhan University, Wuhan, China
2 Department of emergency, ZhongNan Hospital of Wuhan University, Wuhan, China
3 Department of radiotherapy and chemotherapy of head and neck, ZhongNan Hospital of Wuhan University, Wuhan, China

*Corresponding Author(s):
Chen M
Department Of Nursing, ZhongNan Hospital Of Wuhan University, Wuhan, China
Tel:+027 67812888,

Received Date: Jan 27, 2021
Accepted Date: Jan 29, 2021
Published Date: Feb 05, 2021


Background: A novel corona virus in Wuhan has broken in China during a short period of time. Faced with this situation, front-line healthcare workers were exposed to stress heavily. Post-traumatic stress disorder (PTSD) is one of the anxiety disorders which occurs in response of facing outbreak events and accidents accompanied by fears, frustration and terror. The aim of this study was to investigate the prevalence of PTSD among emergency front-line nurses going through the COVID-19 break.

Materials and methods: In this cross-sectional study, all participants were front-line nurses working in Emergency Department of ZhongNan Hospital of Wuhan University and 142 front-line nurses were included through census method. The participant responded to questionnaire online individually via phone and data were collected after questionnaire completed. The questionnaire consists of 2 parts, one part capture demographics, like ages, education level, and gender. While the second part was PTSD Checklist -Civilian (PCL-C) Version, which was used to investigate the extent of PTSD in this study. Data were analyzed using SPSS version 22.

Result: This cross-sectional study included a total of 142 front-line nurses. The mean (SD) total score of PTSD was 35.81(14.42).The prevalence of PTSD was 35.21%. In the classification of age, nurses with 20-30-yearold had the maximum frequency (50.00%), and the score of PTSD among older was higher than younger. A large scale of front-line nurses in this study (81.69%,n=116)acquired bachelor’s degree. Different job title also show the difference PTSD score during the COVID-19 outbreak. Besides, in the classification of job title, the intermediate nurse has the highest PTSD score(35.81±14.42).

Conclusion: The result of this study indicates the prevalence of PTSD among front-line nurses during the acute phase of the COVID-19 outbreak. Therefore, some supportive and effective strategies are indeed to be taken among front-line nurses, in order to prevent and manage this disorder effectively, which probably can release their stress and improve their performance.


Front-line Nurses; Post-Traumatic Stress Disorders; The COVID-19


The outbreak of a novel corona virus (COVID-19) in Wuhan is bring in rapidly evolving situation at the end of 2019 ,which was parallels with the 2003 outbreak of severe acute respiratory syndrome (SARS) caused by another corona virus with confirmed infection in China[1] . By Apr 5, 2020, there were 82966 confirmed cases of the COVID-19 in China [2]. Wuhan, with population of over ten million in the affected area, had 50008 people got infected and 2570 people lost their life in this epidemic till Apr 5, 2020. Many healthcare workers also lost their life in this disaster. Local residents have been comparing the situation to “the end of the world”, hospitals are overwhelmed and there were concerns about medical supplies shortages [3]. Panic in Wuhan” is a common refrain[4]  .Individuals severely exposed to disasters, both residents and nurses and they experienced both physical sufferings and great psychological distress with the increasing number of infected cases and deaths at the first breaking stage. As we know, accidents, particularly artificial disasters, may develop PTSD or other mental disorders[5-6] . Fear and anxiety usually appear immediately after the disaster and disappear within a short period of time, but the depression and psychophysical symptoms persist for a longer period of time [7] . When healthcare workers were taking care of COVID-19 patients, they not only had intense pressure from their workload, but also experienced stigma, fear, and frustration. Front-line nurses in emergency are vulnerable to the emotional impact of corona virus in this framework [8]. 

PTSD is an anxiety disorder which occurs in response to experiencing accidents and events accompanied by fear, frustration, and terror [9-12]. Some studies indicated that PTSD can develop in those who witness disastrous events in the workplace not only this affected person [13-18]. Considering the special situation and complexity of COVID-19, which are associated with unpredictable infections and taking care of critically patients and witnessing the death of patients, who were infected, create highly stressful conditions for front-line nurses who are directly in contact with patients. This can cause development of job-related psychological problems such as PTSD symptoms [19-21]. The impact of this epidemic on front-line nurses’ mental health has few been studied. There is also an urgent need to understand the possible psychological impacts of the COVID-19.Thus the aim  of this study is to investigate the prevalence of PTSD among healthcare workers going through the infectious disease.


a. Participant and questionnaire

All front-line nurses in this cross-sectional study are provided by the Emergency Department of Zhongnan Hospital of Wuhan University, and 150 questionnaire were distribute totally to those nurses who went through the COVID-19.Finally,142 questionnaires(94.67%)met the criteria. Every participant completed questionnaires online by their own phone and data were collected after questionnaires completed. Besides, researchers interviewed each participant and explained the purpose, significance, and relevant instructions before administering the questionnaire. Every participant in this project signed a detailed informed consent form. Further, in order to help participants confide in the study, they were requested not to write their personal information and name on the questionnaires. The questionnaire includes two parts. The first part is consisted of demographic characteristics such as age, educational level, job title, working hours per day, marital status, and work experience? experience of disasters. The second part is PCL-C which was utilized in this study to investigate the prevalence of PTSD. 


PTSD was evaluated in our population using a Chinese-language version of the PTSD Checklist – Civilian Version (PCL-C).The PCL-C includes 17 items that reflect Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) criteria [22]. Participants were asked about how bothered they were by each item over the COVID-19 break time on a 5-point Like scale with regard to their most significant life event stressor. Total scores on the PCL-C range from 17 to 85. We used a PCL-C score of 38 or higher to indicate presence of PTSD in our population. The coefficient of concordance of PCL-C in our population is 0.88-0.94 [23-24] .

Statistical Analysis

We first examined characteristics using number (n) and percentages (%) for categorical variables and mean and standard deviation (SD) for continuous variables. For categorical values, p-values were calculated using the Chi-square test. For continuous variables, p-values were calculated using analysis of variance (ANOVAs). The P values less than 0.05 was considered statistically significant. SPSS Statistics 22.0 was used to performed all statistics analyses.


A total of 142 front-line nurse going through the COVID-19 in Zhongnan Hospital of Wuhan University were included in this study. The demographic characteristics and total scores for PTSD of this study are presented in (Table 1).The majority of front-line nurses in this study (81.69%,n=116) acquired bachelor’s degree. Female nurse consist heavily part of the population (90.14%) and the mean age of women was 32.77 years (SD=7.19).And only 38 participants (26.76%) mentioned experience of disasters in their past work experiences. In this study, the mean (SD) total score of PTSD was 35.81(14.42)in front-line nurse. The prevalence of PTSD was 35.21%.The score was 35.89(14.22) and 35.14(16.74) in female and male, which does not show significantly difference. The mean score in aged over 40 years old was 40.37, which higher than others (p-value=0.012).In the classification of job title, intermediate nurse got the highest score(41.00) than other titles(p-value=0.033). 

Demographic Information


PTSD score  ?mean(SD)



Age range,y ≤29















Gender Male










Martial status Single















Educational Level Polytechnic School










Working,y ≤5















Job title Registered nurse





Primary nurse





Intermediate nurse





Deputy senior





Working time,h ?6















Disaster experience Yes










Table 1: Demographic characteristics of front-line nurses and total scores for PTSD,n=142


Few studies on the prevalence of PTSD among front-line nurses during the COVID-19 break have been reported to date. Therefore, we conducted an online study to examine the prevalence of PTSD among emergence department in the Zhongnan Hospital of Wuhan University nurses contacted the COVID-19 patients directly, in order know about their stress and to help the better fight the epidemic disaster. In this cross sectional study, 35.21% of emergency front-line nurses experienced PTSD, which is lower than the results of the studies by band Iranmanesh in Iran [25] .This discrepancy can be due to the different target group in the present study, which investigated front-line nurses currently going through the COVID-19. Actually, over 40000 medical staffs have been sent from other provinces to Wuhan to care for patients who are infected and those with suspected infection, 16 Fangcang Hospital were built in only 15 days, Leishen Shan and Huoshen Shan Hospital also finished in a shocking speed, all those steps can strengthen logistics support, and help reduce the pressure on health-care personnel [26]  .Besides, a range of guidelines and expert consensus have been developed by health authorities and academic association in China [27] to help front-line nurses conduct right and precise clinical decision.Actually,hospitals in Hubei lacked of medical supplies in early stage, which may affect nurses’ mental state and this situation went better after other provinces send medical teams and medical supplies to Hubei provinces. All steps above help nurses to adjust their mental stress and avoid some negative mood like depress and anxiety. 

Although the mental health service system in China has been greatly improved after several major disasters, especially the Wenchuan earthquake and the National Health Commission of China released the notification of basic principles for emergency psychological crisis interventions for the COVID-19 on Jan 26, 2020 [28]. Mental health care for the front-line nurses going through the COVID-19 epidemic still has been under-addressed. The Chinese authorities should announced relevant policies and actuating principles aimed at isolated patients or citizens. Unfortunately, few psychological polices are published to mention about nurses or other health workers. As the fight to COVID-19 continues, we hope this study will help researchers from various fields to have a better understanding about the prevalence of front-line nurses towards the COVID-19 and then help the local authority to provide multifaceted guidance aiming at promote health workers mental state effectively.

Competing Interests

We declare no competing interests.




The authors' thank Research Group: Department of Emergency in Zhongnan Hospital Wuhan University.


  1. Xiang YT, Yu X, Ungvari GS, Correll CU, Chiu HFK, et al. ( 2014) Outcomes of SARS survivors in China: not only physical and psychiatric co-morbidities. East Asian Arch Psychiatry: 24: 37-38.
  2. National Health Commission of the People Republic of China by 24:00 on 5 April the latest situation of new coronavirus pneumonia.
  3. Lima,CKT, Carvalho PMM, Lima IAAS, Nunes JVAO, Saraiva JS, et al. (2020) The emotional impact of Coronavirus 2019-nCoV (new Coronavirus disease). Psychiatry Res 287: 112915.
  4. Rubin GJ, Wessely S (2020) Coronavirus: The psychological effects of quarantining a
  5. Farooqui M, Quadri SA, Suriya SS, Khan MA, Ovais M, et al. (2017) Posttraumatic stress disorder: a serious post-earthquake complication. Trends Psychiatry Psychother 39: 135-143.
  6. Neria Y, Di Grande L, Adams BG (2011) Posttraumatic stress disorder following the September 11, 2001, terrorist attacks: a review of the literature among highly exposed populations. Am Psychol 66: 429-446.
  7. Shioyama A, Uemoto M, Shinfuku N, Ide H, Seki W, et al. (2000) The mental health of school children after the Great Hanshin-Awaji Earthquake: II. Longitudinal analysis. Seishin Shinkeigaku 102: 481-497.
  8. Xiang YT, Yang Y, Li W, Zhang L, Zhang Q (2020) Timely mental health care for the 2019 novel coronavirus outbreak is urgently needed. Lancet Psychiatry 7: 228-229.
  9. Mealer M, Jones J, Meek P (2017) Factors affecting resilience and development of posttraumatic stress disorder in critical care nurses. Am J Crit Care 26: 184-192.
  10. Zerach G, Shalev TB (2015) The relations between violence exposure,posttraumatic stress symptoms, secondary traumatization , vicarious post traumatic growth and illness attribution among psychiatric nurses. Arch Psychiatr Nurs 29: 135-142.
  11. Jayatunge RM, Pokorski M (2019) Post-traumatic Stress Disorder: A Review of Therapeutic Role of Meditation Interventions. Adv Exp Med Biol 1113: 53-59.
  12. Lancaster CL, Teeters JB, Gros DF, Back SE (2016) Posttraumatic Stress Disorder: Overview of Evidence-Based Assessment and Treatment. J Clin Med 5: 105.
  13. Laposa JM, Alden LE, Fullerton LM (2003) Work stress and posttraumatic stress disorder in ED nurses/personnel. J Emerg Nurs 29: 23-28.
  14. Khamisa N, Oldenburg B, Peltzer K, Ilic D (2015) Work related stress, burnout, job satisfaction and general health of nurses. Int J Environ Res Public Health 12: 652-666.
  15. Javidi H, Yadollahie M (2012) Post-traumatic Stress Disorder. Int J Occup Environ Med 3: 2-9.
  16. Shamia NA, Thabet AA, Vostanis P (2015) Exposure to war traumatic experiences, post- traumatic stress disorder and post-traumatic growth among nurses in Gaza. J Psychiatr Ment Health Nurs 22: 749-755.
  17. Kolkow TT, Spira JL, Morse JS, Grieger TA (2007) Post-traumatic stress disorder and depression in health care providers returning from deployment to Iraq and Afghanistan. Mil Med. 172: 451-455.
  18. Shih RA, Schell TL, Hambarsoomian K, Belzberg H, Marshall GN, et al. (2010) Prevalence of posttraumatic stress disorder and major depression after trauma center hospitalization. J Trauma 69: 1560-1566.
  19. Mealer M, Burnham EL, Goode CJ, Rothbaum B, Moss M, et al. (2009) The prevalence and impact of post-traumatic stress disorder and burnout syndrome in nurses. Depress Anxiety 26: 1118-1126.
  20. Mealer M, Jones J (2013) Posttraumatic stress disorder in the nursing population: a concept analysis. Nurs Forum. 48: 279-288.
  21. Beck CT, Gable RK (2012) A mixed methods study of secondary traumatic stress in labor and delivery nurses. J Obstet Gynecol Neonatal Nurs 41: 747-60.
  22. Weathers F, Huska J, Keane T (1991) PCL-C for DSM-IV. In: Division NCfP-BS, ed. Boston.
  23. Yang X Y,Yang HA,Liu QG (2007) The research on the reliability and validity of PCL-C and influence factors. China Journal of Health Psychology 15: 6-9.
  24. Wang XM, Liu J, Wang Q (2013) The revision of Chinese version of PTSD Checklist- civilian(PCL-C)and preliminary application in cancer inpatients. Medical Information 26: 62-63.
  25. Iranmanesh S, Tirgari B, Bardsiri HS (2013) Post-traumatic stress disorder among paramedic and hospital emergency personnel in south-east Iran. World J Emerg Med 4: 26-31.
  26. National Health Commission of the Peoples Republic of China. The guideline of Psychological crisis intervention for 2019-nCoV
  27. Liu S, Yang LL, Zhang CX, Xiang YT, Liu Z, et al. (2020) online mental health services in china during the COVID-19 outbreak. Lancet Psychiatry 7: 17-18.
  28. National Health Commission of China Principles for emergency psychological crisis intervention for the new corona virus pneumonia in Chinese.

Citation: Chen M, Sun H, Tian Yu, Liu L (2021) The Prevalence of Post-Traumatic Stress Disorder (PTSD) among Emergency Front-Line Nurse during the COVID-19 Outbreak: A Cross Sectional Study in Wuhan, China. J Pract Prof Nurs 4: 022.

Copyright: © 2021  Chen M, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Herald Scholarly Open Access is a leading, internationally publishing house in the fields of Sciences. Our mission is to provide an access to knowledge globally.

© 2024, Copyrights Herald Scholarly Open Access. All Rights Reserved!