




































Humanitas: Indonesian Psychological Journal  

Vol. 20 (1), February 2023, 69-79 
ISSN:  2598-6368(online); 1693-7236(print)                                                                 

       humanitas@psy.uad.ac.id             http://journal1.uad.ac.id/index.php/Humanitas          https://doi.org/10.26555/humantias.v20i1.270   

Depression, anxiety, stress, and post-traumatic stress disorder among 

Iranian nursing caring for COVID-19 patients  

Bamdad Mirab Zadeh Ardekani1, Fatemeh Ghassem Boroujerdi2, Shirin Esmaili 

Dolabinjad2, Mitra Safa3, Farzaneh Haji Zadeh1 

1Massih Daneshvari Hospital, Shahid Beheshti University of Medical Sciences, Iran. 
2Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung 

Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Iran. 
3Clinical Tuberculosis and Epidemiology Research Center, National Research Institute of Tuberculosis and 

Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran. 

Corresponding Author: anahita86@yahoo.com 

 

Introduction 

The outbreak of COVID-19, in fast transmission, has become a global health emergency 

within just a few months (Wang et al., 2020). The sudden outbreak is transforming the 

psychological status and interpersonal relationships of millions worldwide (Asim et al., 

2020).  As the outbreak escalates, it will raise public health concerns (Sun et al., 2021)  and 

cause psychological distress and problems like anxiety, uncertainty, and stigmatization that 

can be prevented by medical and psychiatric treatment (Xiang et al., 2020). Wide-ranging, 

negative, and psychological outcomes, such as anger, confusion, and post-traumatic stress 

symptoms in the current situation, may be associated with extended quarantine, fear of 

infection, frustration, a lack of basic supplies, insufficient information, financial problems, 

and stigma (Santos, 2020). 

Moreover, confrontation with the acute situation of the COVID-19 pandemic has an 

inevitable impact on healthcare workers. Medical workers worldwide encounter enormous 

ART ICLE  INFO  

 

AB ST R ACT  

 

Article history 

Received November 24, 2022 

Revised February 22, 2023 

Accepted February 24, 2023 

 COVID-19 has put great physical and psychological pressure on 

medical staff worldwide, including Iran. As with any other disaster, it 

is worth paying attention to the risk of developing depression, anxiety, 

stress, and post-traumatic stress disorder (PTSD) among the 

healthcare team. This study aimed to determine the severity of 

depression, anxiety, stress, and PTSD status in healthcare staff 

involved in treating COVID-19 patients. 400 nurses and clinical 

assistants in a hospital occupied in treating COVID-19 were included 

in the study by the incidental sampling. The demographic information 

questionnaire, DASS-21, and Mississippi PTSD scales were applied 

to data collection. The mean score of PTSD in about half of the 

participants is severe. The mean score of re-experience sub-scale is 

higher than other sub-scales. Depression and stress are significantly 

higher in those infected with COVID-19. There is a significant 

difference between various age groups regarding the lack of 

depression. There is a significant difference in re-experience, 

alexithymia, and PTSD scores between participants with various 

marital statuses. Therefore, the existence of depression, stress, and 

PTSD among medical staff would be a major concern for the health 

ministry to protect the mental health of society members.  

    

 
Keywords 

COVID-19; 

depression; 

hospital nursing staff; 

stress; 

post-traumatic stress disorder. 

 

mailto:humanitas@psy.uad.ac.id
http://journal1.uad.ac.id/index.php/Humanitas
https://doi.org/10.26555/humantias.v20i1.270
mailto:anahita86@yahoo.com


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Ardekani et al. (Depression, anxiety, stress, and post-traumatic stress disorder among Iranian…) 

pressure, including a high risk of infection and inadequate protection from contamination, 

overwork, frustration, isolation, sad patients, a lack of contact with their families, and 

exhaustion (Kang et al., 2020).  Paramedics are more disposed to develop post-traumatic 

stress disorder (PTSD) symptoms than the general population (Kucmin et al., 2018). The 

development of PTSD, which results in chronic symptoms like intrusive memories, avoidance 

behaviors, irritability, and emotional numbing, is one of the main psychological consequences 

of the current pandemic (Sun et al., 2021). PTSD is a behavioral expression of 

neurobehavioral systems’ pathology shaped by individual, environmental, and cultural 

factors. Individuals who suffer from PTSD re-live distressing instances of the traumatic event 

with vivid emotional proximity and high, imperative intensity. 

In addition, a high percentage of PTSD symptoms (29.5%) has been found in the Italian 

population during the COVID-19 pandemic (Forte et al., 2020). A study in Wuhan, the first 

region of China, which has been affected by the COVID-19 pandemic, reported 5% of PTSD 

symptoms (Sun et al., 2021). A similar prevalence rate of PTSD also was reported in the 

Italian population (Favieri et al., 2020). Moreover, depression, anxiety, and stress symptoms 

were reported as high as 50.7%, 44.7%, and 73.4% among Chinese healthcare workers during 

the COVID-19 pandemic (Elbay et al., 2020). 

The current study is important and needed to describe the mental health problems of 

healthcare workers treating infected patients with COVID-19 in Iran, especially the data 

regarding the distress caused by infectious disease outbreaks in the healthcare team. This 

study aimed to investigate depression, anxiety, stress, and PTSD in the staff of one of the 

primary hospitals for treating COVID-19. The first hypothesis of the current research 

included the different levels of depression, anxiety, stress, and PTSD in hospital staff with 

and without a history of being infected by COVID-19.  The second hypothesis is demographic 

characteristics impact depression, anxiety, stress, and PTSD among hospital staff. 

Method 

Research Design 

A quantitative method with comparative and correlational designs was applied in this study. 

The investigation was carried out following the latest version of the Declaration of Helsinki 

and was approved by an appropriate ethical committee, with the approval number 

IR.SBMU.NRITLD.REC.1399.147.  Informed consent from the participants was obtained 

after the procedures were fully explained. 

The questionnaires used for the current study were sent online to the study population, 

and those who met the inclusion criteria completed them. Data collection was from the middle 

of March 2020 until the middle of June 2020. 

Participants  

Four hundred nurses and clinical assistants were chosen with incidental sampling 

participating in this study during the Spring and Summer of 2020. The inclusion criteria were 

verbal informed consent and being a nurse or clinical assistant at COVID-19 wards. In 

contrast, the exclusion criteria were reluctance to continue participating in the research or 

quitting the job in the hospital. 

According to Table 1, most of the sample group were female (68.6%), married (55.2%), 

did not have children (62.3%), and had an academic education (77.1%) up to Ph.D. The mean 

age was 36.36±7.87 years old. The majority of participants were nurses (69.3%) and were not 



Humanitas: Indonesian Psychological Journal 71 

 

                                         Ardekani et al. (Depression, anxiety, stress and post-traumatic stress disorder among Iranian…)   

infected by COVID-19, and did not show COVID-19 symptoms with negative COVID-19 

test results for themselves or their families (86.7%).  

 

Table 1  

Demographic Data 

Variable Percentage 

Gender                                Male 

                                            Female 

31.4 

68.6 

Marital status                      Single 

                                            Married 

                                            Widowed  

                                            Divorced 

40.3 

55.2 

1.5  

3.0 

Number of children             0  

                                            1-2 

                                            3≤ 

62.3 

34.4 

3.3 

Educational level                High school diploma 

                                            Academic education 

22.9 

77.1 

Job title                               Nurse 

                                            Clinical assistant 

69.3 

30.7 

History of being infected    Self and family member 

by Covid-19                        None 

13.3 

86.7 

Instruments  

The demographic information questionnaire, DASS-21, and Mississippi PTSD scale were 

used in this study. The demographic questionnaire has been applied to identifying gender, 

age, marital status, number of children, educational level, occupation, and also a history of 

being infected by COVID-19 in themselves and their immediate family members.  

The DASS-21 is the short form of the DASS-42, produced by Lovibond and Lovibond 

(1995), as a self-report scale designed to measure the negative emotional states of depression, 

anxiety, and stress, each with seven questions, over the past week in adults. The answers are 

in four options: never, sometimes, often, and always. The scoring is between 0 to 3. The sum 

of scores is calculated and multiplied by two and then interpreted by the following Table 2. 
 

Table 2 

Categorization Based on Score of the DASS 21  

Range Depression Anxiety Stress 

Normal 0 – 9 0 – 7 0 – 14 

Mild  10 – 13 8 – 9 15 – 18 

Moderate 14 – 20 10 – 14 19 – 25 

Severe 21 – 27 15 – 19 26 – 33 

Extremely severe 28+ 20+ 34+ 

The correlation of the DASS with the Beck Depression Inventory (BDI) in a sample 

with 717 students was high (r = .4) (Lovibond & Lovibond, 1995). In a sample of 1794, this 

scale was compared with two others scales about depression and anxiety. The Cronbach 

alpha was .95, .9, .93, and .97 for depression, anxiety, stress, and the total score, respectively 

(Henry & Crawford, 2005).  The validity and reliability of this scale are confirmed in the 

Iranian sample, with the Cronbach alpha reported to be .94, .92, and .82 for depression, 

anxiety, and stress, respectively (Moradi Panah, 2005). 

The Mississippi Scale for Combat-Related Post-traumatic Stress Disorder is a 39-item 

self-report scale. It is scored as Likert type, which includes 1-5 scores for each question; 

some are scored reversely. The total score would be from 0 to 195. Scores up to 65, between 



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Ardekani et al. (Depression, anxiety, stress, and post-traumatic stress disorder among Iranian…) 

65 to 130, and above 130 reflect the mild, moderate, and severe symptoms of PTSD, 

respectively. It includes four sub-scale: re-experience, interpersonal relationship problems, 

alexithymia, and lack of depression. The test's sensitivity and specificity were .93 and .89, 

respectively, when it was used to differentiate between a post-traumatic stress disorder 

(PTSD) group and two non-PTSD comparison groups (Keane et al., 1988). The scale was 

validated in the Iranian sample, with the reliability from internal correlation being .92 and 

the test-retest coefficient being .91 (Goodarzi, 2003). 

Data Analysis 

Descriptive analysis, ANOVA, Chi-square, and independent t-tests were applied to data 

analysis. All data were analyzed by SPSS-22.  

Results 

Table 3 shows the mean score of depression in participants with COVID-19 is significantly 

higher than participants with no history of infection with COVID-19 (p < .01).  Even though 

the mean score of depression in participants with a history of infection with COVID-19 and 

without it, is in a normal range. However, there is no significant difference in the anxiety 

score of participants with a history of infection of COVID-19 and without it. The score of 

anxiety in both groups is in the normal range. The mean stress score in participants with 

COVID-19 is significantly higher than that of participants with no history of infection with 

COVID-19, even though the mean score of the stress of both groups is in the normal range.  
 

Table 3    

The t-test of the DASS Score 

DASS scales History of COVID-19 Mean ± SD t p 

Depression Infecting with COVID-19 8.00 ± 4.44  2.852 .014 

 No history 3.90 ± 4.08   

Anxiety Infecting with COVID-19 5.72 ± 3.00 1.861 .081 

 No history 3.81 ± 3.90   

Stress Infecting with COVID-19 10.18 ± 3.54 3.260 .004 

 No history 6.14 ± 5.02   

Moreover, Table 4 shows the mean score of depression and the mean score of stress are 

significantly higher in those whose family member had been infected with COVID-19 (p < 

.01). However, there is no significant difference in the anxiety score of participants with a 

history of infection with COVID-19 in themselves or family members and without it.  
 

Table 4   

DASS Score Based on History of COVID-19 

p F Mean ± SD History of COVID-19  

.013 4.58 7.66 ± 4.36 Self Depression 

  8.40 ± 5.02 Family member  

  3.90 ± 4.08 None  

.266 1.35 6.33 ± 1.96 Self Anxiety 

  5.00 ± 4.06 Family member  

  3.81 ± 3.90 None  

.045 3.25 9.83 ± 3.43  Self Stress 

  10.60 ± 4.03 Family member  

  6.14 ± 5.02 None  



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According to Table 5, about half of the sample group members had severe PTSD 

symptoms. However, there is no significant difference in the severity of PTSD between 

participants with and without a history of COVID-19 infection. 

Table 5 

PTSD Severity 

Table 6 shows the independent t-test of PTSD scores in total and each sub-scale. The 

results indicate no significant difference in PTSD in total and each sub-scale between people 

with and without a history of being infected by COVID-19, in themselves, or their immediate 

family members.  

 

Table 6 

Scores of the PTSD Sub-scales Based on History of Covid-19 

Sub-scales                       t p 

Re-experience - .592 .562 

Interpersonal relationship problems .170 .868 

Alexithymia -1.137 .271 

Lack of depression .644 .531 

PTSD - .300 .760 

According to Table 7, there is a significant difference in anxiety between various age 

groups (p < .05). Even though all participants are in the normal range of anxiety, participants 

in age groups of 20-30 years old suffered less anxiety than other age groups. Also, people in 

the age group of 51 to 60 years old had higher anxiety compared to others. In one of the 

PTSD sub-scales, namely lack of depression, there is a significant difference in various age 

groups, with participants in the age groups of 20-30 and 31-40 having the highest and lowest 

scores, respectively. 

 

Table 7 

Difference of PTSD and DASS Sub-scales Based on Age Groups 

Sub-scales Ages Mean ± SD F p 

Depression  

 

 

 

20-30 years old 

31-40 years old 

41-50 years old 

51-60 years old 

2.90 ± 3.79 

4.43 ± 3.56 

5.60 ± 5.24 

11 

2.336 

 

 

.081 

 

 

Anxiety  

 

 

 

20-30 years old 

31-40 years old 

41-50 years old 

51-60 years old 

2.36 ± 2.66 

4.50 ± 3.55 

4.25 ± 4.08 

11 

3.185 .029 

Stress 20-30 years old 

31-40 years old 

41-50 years old 

51-60 years old 

4.72  ± 4.99 

8.00 ± 4.80 

6.55 ± 5.12 

10 

2.002 .122 

 

History of COVID-19 

 

The severity of PTSD (%) 
ꭕ2 p 

Mild Moderate Severe 

Yes 23.5 16.5 60.0 1.57 .45 

No  14.5 31.5 54.0 

Total  19.0 24.0 57.0 



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Table 7 

Continued 

Sub-scales Ages Mean ± SD F p 

Re-experience 

 

20-30 years old 

31-40 years old 

41-50 years old 

51-60 years old 

43.04 ± 4.35 

42.13 ± 5.64 

43.05 ± 3.80 

39.00 ± 1.00 

.402 .752 

Interpersonal relationship 

problems 

  

20-30 years old 

31-40 years old 

41-50 years old 

51-60 years old 

32.36 ± 4.12 

30.83 ± 3.71 

31.15 ± 2.85 

28.00 ± .10 

 

 

1.075 

 

 

.365 

Alexithymia 

   

 

20-30 years old 

31-40 years old 

41-50 years old 

51-60 years old 

40.13 ± 5.02 

38.60 ± 4.90 

39.30 ± 4.90 

36.00 ± .50 

 

.553 

 

.648 

Lack of depression 

   

 

20-30 years old 

31-40 years old 

41-50 years old 

51-60 years old 

40.13 ± 3.31 

37.16 ± 4.84 

39.50 ± 3.42 

38 ± .20 

 

2.621 

 

.050 

PTSD 

   

 

20-30 years old 

31-40 years old 

41-50 years old 

51-60 years old 

155.68 ± 13.32 

148.73 ± 15.23 

153 ± 12.24 

141 ± 1.1 

 

1.311 

 

.278 

Table 8 shows a significant difference in depression between participants with various 

marital statuses (p < .01). The mean score of depression is significantly higher in divorced 

participants than in other ones. A significant difference in PTSD score and the sub-scales 

score, namely re-experience and alexithymia, is also found based on marital status. Married 

people had the highest score in re-experience, alexithymia, and PTSD scores. However, the 

findings of this study show no difference in depression, anxiety, stress, and PTSD based on 

gender, number of children, educational level, and job status 

 

Table 8 

Difference between PTSD and DASS Based on Marital Status 

Sub-scales Marital status Mean ± SD F p 

Depression 

 

 

 

Single 

Married 

Widowed 

Divorced 

4.11 ± 4.5 

3.56 ± 3.46 

1 

13.5 ± 3.53 

4.240 .009 

Anxiety  

 

 

 

Single 

Married 

Widowed 

Divorced 

3.19 ± 3.24 

4.05 ± 3.46 

1 

9.50 ± 7.77 

2.340 .081 

Stress 

 

Single 

Married 

Widowed 

Divorced 

5.85 ± 4.84 

5.95 ± 4.74 

3.00 ± 2.82 

14.00 ± 4.88 

1.990 .123 

Re-experience  

 

Single 

Married 

Widowed 

Divorced 

42.33 ± 3.82 

43.75 ± 3.96 

40.00 ± 2.30 

30.00 ± 13.43 

6.517 .001 

Interpersonal relationship 

problems  

 

Single 

Married 

Widow 

Divorced 

31.44 ± 4.11 

31.48 ± 3.33 

32.00 ± 1.20 

28.50 ± 2.12 

.434 .729 



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Table 8 

Continued 

Sub-scales Marital status Mean ± SD F p 

Alexithymia Single 

Married 

Widow 

    Divorced 

38.77 ± 4.53 

40.40 ± 4.03 

39.00 ± 3.50 

28.00 ± 11.31 

5.173 .003 

Lack of depression          

 

Single 

Married 

Widow 

Divorced 

39.14 ± 4.12 

38.08 ± 3.82 

42.00 ± 2.40 

31.50 ± 7.77 

2.588 .061 

PTSD  

   

 

Single 

Married 

Widow 

Divorced 

151.70 ± 13.47 

153.72 ± 10.95 

153.00 ± 4.50 

118.50 ± 34.64 

4.833 .004 

Discussion 

The findings of the current study show the mean score of PTSD in about half of the members 

of the sample group is severe. Just 19% of them had mild PTSD, and 24% had moderate 

symptoms of PTSD. No difference in PTSD between hospital staff with and without a history 

of COVID-19; therefore, the first hypothesis is rejected. These findings show the serious 

development of PTSD in a life-threatening pandemic, whether or not the participants have 

been infected. Because the depth of catastrophic direct encountering with patients with 

COVID-19 would be so unknown and stressful, which seems that affect everyone similarly 

and especially cause multiple remembering of the unpleasant situations in mind.  

Some studies have shown that medical staff exposed to H7N9 patients and disaster 

relief medical staff have the highest score in re-experiencing dimension (Tang et al., 2017), 

which is compatible with our findings when considering the psychological status of people 

when confronted with a large epidemic.  Other studies reported that the incidence 

of PTSD in nurses caring for COVID-19 patients was 16.83% (Y.-X. Wang et al., 2020).  A 

study in Singapore hospitals between February and March 2020 found many healthcare 

workers had anxiety (14.5%), depression (8.9%), and PTSD (7.7%) (Tan et al., 

2020). Furthermore, another study among pulmonary patients with and without cancer found 

PTSD level is influenced by hopeless and ambiguous views about the future of the disease 

(Safa et al., 2014). So, according to the results of the current study about the existence of 

PTSD symptoms in nursing staff – which are mostly congruent with other research which has 

been described – it is important to pay attention to PTSD symptoms in the healthcare team of 

COVID-19.  

The first hypothesis stating the difference among hospital staff based on a history of 

COVID-19 was confirmed in the domain of depression and stress. Accordingly, although the 

mean score of depression in both groups of participants is in the normal range, depression in 

the participant with a history of COVID-19 is significantly higher. Moreover, depression was 

significantly higher in those whose family members had been infected with COVID-19. In 

addition, although stress in all participants is in the normal range, it is significantly higher in 

the group of participants with a history of COVID-19 than in the other group. Especially it is 

also higher in those whose family members have been infected with COVID-19. It shows the 

burden of COVID-19 on family members of hospital staff because of the mental pressure they 

felt in encountering the disease and fearing transferring it to their family members and feeling 

guilty about it. Some studies show that 64.7% of physicians had depressive symptoms, 51.6% 

had anxiety, and 41.2% had stress during the early COVID-19 pandemic in Turkey, using 



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DASS-21. Among China healthcare workers, 50.4% reported symptoms of depression, 44.6% 

anxiety, and 71.5% reported distress during the COVID-19 pandemic (Elbay et al., 2020). 

The current study's second hypothesis, including the impact of demographic data on 

depression, anxiety stress, and PTSD, is confirmed in the domain of age and marital status. 

In the PTSD sub-scale, persons in their twenties have the lowest score of lack of depression, 

but in the fourth decade, they have the highest lack of depression. It may result from rising 

positive emotions at the beginning of adulthood, which would be reduced in the next decade 

due to more social occupation, especially when encountering a crisis. On the other hand, the 

highest score of PTSD score and its two sub-scales, namely re-experience and alexithymia in 

married people, is controversial in the current study.  Indeed, marriage does not necessarily 

increase mental health and the quality of relationships, but it would be the better determinative 

factor. Also, the number of children did not correlate with depression, anxiety, stress, and 

PTSD in the current study. It shows that the pressure of being encountered with a life-

threatening virus would not be reduced or increased by familial support, especially at the 

beginning of the virus pandemic. Some other factors may play a role in this regard. The 

familial affiliations would exacerbate the anxiety because of worry about the family members. 

This kind of anxiety would be reduced in single and childless people. On the contrary, a 

previous study found predictors of PTSD symptoms during infectious diseases prevalence, 

such as SARS and H1N1, including gender, age, degree of exposure to the infectious disease, 

the experience of being infected, and having family, friends, or acquaintances that have been 

infected (Xu et al., 2011). 

Depression was higher in divorced participants. It reflects the mental burden of divorce 

even when confronted with a completely different issue, like a disease. A previous study has 

demonstrated that marriage or having children may improve mental health (Association, 

2013; Sadock et al., 2017). This study found that higher scores of DASS-21 existed among 

single healthcare workers, whereas having a child was associated with lower DASS-21 

scores. In addition, those living with their spouse and children had lower scale scores than 

those who lived alone during the COVID-19 pandemic.  A previous study found being single 

increased the odds of depression in hospital staff, even three years after the SARS outbreak 

(Elbay et al., 2020).  

In this study, all participants have a medium range of anxiety; younger participants 

suffered less anxiety than older age groups. On the contrary, people in the age group of 51 to 

60 years old had higher anxiety compared to others. It implies that younger participants 

manage anxiety better than other age groups with the power of youth. Other studies have 

shown that young individuals show higher rates of depression due to isolation during COVID-

19 (Renaud-Charest et al., 2021). Another study found higher scores of DASS-21 existed 

among young healthcare workers (Elbay et al., 2020). Women and frontline workers in China 

had a higher risk of developing psychiatric problems during the COVID-19 pandemic (Elbay 

et al., 2020).  

Also, the current study shows that males and females are equal in confronting the life-

threatening pandemic in showing PTSD symptoms. These findings do not align with some 

other studies that females were prone to develop higher levels of PTSD both in COVID-19 

and H1N1 outbreaks (Sun et al., 2021; Xu et al., 2011). Moreover, as reported by some other 

studies, females are about twice as likely to develop PTSD symptoms (D. E. A. Christiansen, 

2012). It would result from the fact that females usually experience higher levels of associated 

risk factors, like depression, physical anxiety sensitivity, and helplessness (D. M. 

Christiansen & Hansen, 2015). The relative equality of females and males in confronting the 

stressful situation in the current study shows inconsistency with other results in this regard. It 



Humanitas: Indonesian Psychological Journal 77 

 

                                         Ardekani et al. (Depression, anxiety, stress and post-traumatic stress disorder among Iranian…)   

may describe that Iranian women in our society have become more compatible during the 

past years due to many problems in the country like war, earthquake, and economic crisis. 

Neither education nor job status significantly impacted depression, anxiety, stress, and 

PTSD. One possible reason might be that the sample group was in a relatively similar 

situation, which made them less affected by education and job status. But some other studies 

have shown that nurses exposed to COVID-19 with high job satisfaction have lower PTSD 

scores, necessitating reducing the PTSD level by trying to improve job satisfaction (Y.-X. 

Wang et al., 2020). Higher scores of depression, anxiety, and stress in healthcare workers of 

COVID-19 existed among those with less work experience or who worked in the frontline 

(Elbay et al., 2020). Higher DAS-21 scores between them were associated with increased 

working hours, increased number of COVID-19 patients cared for, receiving lower support 

from peers and supervisors, and feelings of incompetence about COVID-19 tasks (Elbay et 

al., 2020).  

The current research involved nurses and clinical assistants from a hospital due to the 

limited time and access to the sample group. So, it is suggested that future researchers include 

more variety of hospitals whose staff deal with COVID-19 departments directly to obtain 

more precise results. Because of the emergency conditions of the pandemic, data gathering 

was done online, which would affect the research results. But in some cases where there was 

a need for a psychiatrist or psychologist in COVID-19 treatment wards, they had shown up 

in the wards to provide sufficient information about the online questionnaires. Besides, the 

probable psychological stress of the respondents to the questionnaires would affect the 

responses. Therefore, it is suggested that future researchers have follow-up research and 

investigate the role of depression, anxiety, and stress among hospital staff during a pandemic 

such as COVID-19 to provide optimum psychological services for study participants. 

Conclusion 

The hospital staff who had been occupied with treating patients with COVID-19 have 

symptoms of PTSD, whether having a history of COVID-19 or not. Moreover, those who 

had been infected with COVID-19, even themselves or family members, had higher 

depression and stress than those who did not have COVID-19 infection. Marital status and 

age are two demographic characteristics that have a significant impact. Being married is a 

determinant factor of a higher PTSD score and its two sub-scales, namely re-experience and 

alexithymia. On the other hand, being divorced predicts a higher depression. Young people 

have the lowest anxiety, whereas older people have the highest anxiety. 

Acknowledgment 

The authors appreciate all co-workers in Massih Daneshvari Hospital who participated in 

this study. 

Declarations  

Author contribution. All authors contribute evenly to the study and writing the article.  

Funding statement. This research received no specific grant from funding agencies in the 

public, commercial, or not-for-profit sectors. 

Conflict of interest. None declared 

Additional information. No additional information is available for this paper. 

 

 



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