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While some of the high rates of post-traumatic stress (PTSD) seen in healthcare workers during the pandemic are specifically COVID-19-related, a more significant number of cases were linked to trauma that occurred earlier in their lives, researchers at the University of Oxford have found.

Female healthcare worker wearing a face mask sitting against a wall looking exhausted © Shutterstock

Led by Associate Professor of Experimental Psychology Jennifer Wild, the study – published in the British Journal of Clinical Psychology – assessed 103 frontline healthcare staff working directly with COVID-19 patients with clinical interviews,  considered the gold-standard approach to diagnosing mental health problems. 

Previous research conducted during the pandemic has reported high rates of PTSD, depression and other mental health symptoms amongst healthcare workers. However, that research has typically failed to assess if earlier trauma was linked to symptoms or when the symptoms began, making it difficult to conclude whether the high rates of symptoms were due to the pandemic.  Previous research has also relied on self-report measures of symptoms, a less accurate method of diagnosing mental health problems. 

The Oxford study significantly advances prior research as the researchers conducted in-depth diagnostic interviews. Researchers found that trauma linked to PTSD was more likely to relate to occupational or personal trauma that had occurred before the pandemic. Other key findings include:

  • Rates of PTSD were high at 44%, as were rates of depression at 39%.
  • 76% of healthcare staff reported trauma that was unrelated to the pandemic
  • However, 24% of healthcare workers reported a trauma that was related to their work during the COVID-19 pandemic.

There was an even split between occupational versus personal trauma linked to PTSD, where 52% of staff diagnosed with PTSD reported occupational trauma and 48% reported trauma that occurred in their personal lives as the index event associated with symptoms.

Associate Professor Wild said:

These are important findings. They highlight the need to assess the trauma associated with PTSD symptoms as well as when the symptoms began. Only then can we be sure which trauma is linked to PTSD symptoms.

‘This research helps to clarify the PTSD picture among healthcare workers. In the 76% of staff who had PTSD that was unrelated to the pandemic, it is likely that the stressful nature of working during the pandemic exacerbated symptoms or made it harder to recover from them.  There was a significant minority, 24%, who did develop PTSD due to COVID-19 trauma.


Whilst PTSD was more likely to have pre-dated the pandemic, major depressive disorder was more likely to develop during the pandemic.

Dr Aimee McKinnon, EP clinical research psychologist, assessed many of the healthcare workers. She said: ‘The pandemic has drawn our attention to high rates of trauma and depression in healthcare workers.  Our findings suggest that much of this difficulty was pre-existing and unrelated to the pandemic. This warrants specific focus in service planning to best understand and support the needs of the healthcare workers who look after us.’

Funders for this study are: University of Oxford COVID Research Response Fund; The Wellcome Trust; and Oxford Health NIHR Biomedical Research Centre.

About the paper

Jennifer Wild, Aimee McKinnon, Abbie Wilkins and Haddi Browne. Posttraumatic Stress Disorder and Major Depression among Frontline Healthcare Staff working during the COVID-19 Pandemic. British Journal of Clinical Psychology. 29 Oct 2021.

Read the paper