{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,3]],"date-time":"2026-11-03T14:54:12Z","timestamp":1793717652974,"version":"4.6.1"},"reference-count":76,"publisher":"BMJ","issue":"7","license":[{"start":{"date-parts":[[2023,7,20]],"date-time":"2023-07-20T00:00:00Z","timestamp":1689811200000},"content-version":"unspecified","delay-in-days":19,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2023,7,6]]},"published-print":{"date-parts":[[2023,7]]},"abstract":"<jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>The COVID-19 pandemic has had a significant impact on the burnout and mental health of medical staff. This meta-analysis aims to provide additional (and updated) evidence related to burnout and mental health problems among medical staff using a broader data pool.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Design<\/jats:title>\n                  <jats:p>Systematic review and meta-analysis.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Data sources<\/jats:title>\n                  <jats:p>PubMed, Embase, Cochrane Library, CNKI, Wanfang data and three preprint databases (SSRN, bioRxiv and medRxiv) were searched from 1 January 2020 to 17 May 2021.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Eligibility criteria<\/jats:title>\n                  <jats:p>We included observational studies investigating the prevalence of burnout and mental health problems among medical staff during the COVID-19 pandemic, including cross-sectional study, cohort study and case\u2013control study.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Data extraction and synthesis<\/jats:title>\n                  <jats:p>Two independent reviewers used a self-designed form to extract the primary data. The Joanna Briggs Institute quality appraisal tool was used to assess the quality of selected studies. Heterogeneity among studies was assessed by I<jats:sup>2<\/jats:sup> statistic. A random-effects model was used to pool the prevalence. Subgroup analysis was performed to explore between-group differences.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>250 studies were included, with a sample of 292\u2009230 participants from 46 countries. The pooled prevalence of burnout, anxiety, depression, insomnia, stress, post-traumatic stress disorder symptoms and somatic symptoms was 43.6% (95% CI 36.3% to 51.2%), 37.1% (95% CI 34.7% to 39.7%), 37.6% (95% CI 35.0% to 40.4%), 43.7% (95% CI 39.1% to 48.5%), 41.3% (95% CI 35.1% to 47.9%), 30.6% (95% CI 23.6% to 38.5%) and 25.0% (95% CI 16.7% to 35.6%), respectively. Subgroup analysis showed a higher prevalence of anxiety, depression and insomnia in frontline workers than in non-frontline workers, and a higher prevalence of anxiety in females than males. Mild cases accounted for the most significant proportion of the outcomes except for stress.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>This study highlights that identifying the risks of burnout and mental health problems and adopting preventive interventions are priorities for policymakers and medical staff to avoid long-term occupational, health and social impacts.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>PROSPERO registration number<\/jats:title>\n                  <jats:p>CRD42021254425.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/bmjopen-2022-061945","type":"journal-article","created":{"date-parts":[[2023,7,20]],"date-time":"2023-07-20T12:45:37Z","timestamp":1689857137000},"page":"e061945","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":50,"title":["Prevalence of burnout and mental health problems among medical staff during the COVID-19 pandemic: a systematic review and meta-analysis"],"prefix":"10.1136","volume":"13","author":[{"given":"Hongjin","family":"Zhu","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology, Women and Children\u2019s Hospital of Chongqing Medical University, Chongqing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaoyun","family":"Yang","sequence":"additional","affiliation":[{"name":"Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4100-1267","authenticated-orcid":false,"given":"Shiqi","family":"Xie","sequence":"additional","affiliation":[{"name":"School of Nursing, Chongqing Medical University, Chongqing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3612-1264","authenticated-orcid":false,"given":"Jianrong","family":"Zhou","sequence":"additional","affiliation":[{"name":"School of Nursing, Chongqing Medical University, Chongqing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2023,7,20]]},"reference":[{"key":"2025101812575250000_13.7.e061945.1","unstructured":"WHO . Statement on the second meeting of the International health regulations (2005) emergency committee regarding the outbreak of novel Coronavirus (2019-nCoV). 2020. Available: https:\/\/www.who.int\/news\/item\/30-01-2020-statement-on-the-second-meeting-of-the-international-health-regulations-(2005)-emergency-committee-regarding-the-outbreak-of-novel-coronavirus-(2019-ncov)"},{"key":"2025101812575250000_13.7.e061945.2","unstructured":"WHO . WHO Coronavirus (COVID-19) dashboard. Available: https:\/\/covid19.who.int [Accessed 19 Feb 2023]."},{"key":"2025101812575250000_13.7.e061945.3","doi-asserted-by":"publisher","DOI":"10.1177\/070674370705200406"},{"key":"2025101812575250000_13.7.e061945.4","doi-asserted-by":"publisher","DOI":"10.1001\/archinternmed.2009.384"},{"key":"2025101812575250000_13.7.e061945.5","doi-asserted-by":"publisher","DOI":"10.3201\/eid2105.141988"},{"key":"2025101812575250000_13.7.e061945.6","doi-asserted-by":"crossref","first-page":"217","DOI":"10.1097\/jnr.0000000000000116","article-title":"Living under the constant threat of ebola: a phenomenological study of survivors and family caregivers during an ebola outbreak","volume":"23","author":"Matua","year":"2015","journal-title":"J Nurs Res"},{"key":"2025101812575250000_13.7.e061945.7","doi-asserted-by":"crossref","unstructured":"Song W , Huang D , Yu J . How does centralized isolation treatment strategy affect the medical staff's mental health during the COVID-19 pandemic? Front Public Health 2022;10. doi:10.3389\/fpubh.2022.1055564","DOI":"10.3389\/fpubh.2022.1055564"},{"key":"2025101812575250000_13.7.e061945.8","doi-asserted-by":"crossref","first-page":"2651","DOI":"10.1017\/S0033291720004717","article-title":"The impacts of COVID-19 outbreak on mental health in general population in different areas in China","volume":"52","author":"Ran","year":"2022","journal-title":"Psychol Med"},{"key":"2025101812575250000_13.7.e061945.9","doi-asserted-by":"crossref","first-page":"S18","DOI":"10.1016\/j.jadohealth.2021.03.020","article-title":"COVID-19, mental health, and young people's engagement","volume":"72","author":"El Omrani","year":"2023","journal-title":"J Adolesc Health"},{"key":"2025101812575250000_13.7.e061945.10","doi-asserted-by":"crossref","unstructured":"Wilder-Smith A , Freedman DO . Isolation, quarantine, social distancing and community containment: pivotal role for old-style public health measures in the novel Coronavirus (2019-nCoV) outbreak. J Travel Med 2020;27. doi:10.1093\/jtm\/taaa020","DOI":"10.1093\/jtm\/taaa020"},{"key":"2025101812575250000_13.7.e061945.11","doi-asserted-by":"crossref","first-page":"288","DOI":"10.1186\/s12889-022-12644-9","article-title":"The impact of COVID-19 and associated measures on health, police, and non-government organisation service utilisation related to violence against women and children","volume":"22","author":"Butler","year":"2022","journal-title":"BMC Public Health"},{"key":"2025101812575250000_13.7.e061945.12","doi-asserted-by":"crossref","unstructured":"Wang C , Pan R , Wan X , 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. Int J Environ Res Public Health 2020;17. doi:10.3390\/ijerph17051729","DOI":"10.3390\/ijerph17051729"},{"key":"2025101812575250000_13.7.e061945.13","doi-asserted-by":"crossref","unstructured":"Lai J , Ma S , Wang Y , et al . Factors associated with mental health outcomes among health care workers exposed to Coronavirus disease 2019. JAMA Netw Open 2020;3. doi:10.1001\/jamanetworkopen.2020.3976","DOI":"10.1001\/jamanetworkopen.2020.3976"},{"key":"2025101812575250000_13.7.e061945.14","doi-asserted-by":"crossref","unstructured":"Oteir AO , Nazzal MS , Jaber AF , et al . Depression, anxiety and insomnia among frontline Healthcare workers amid the Coronavirus pandemic (COVID-19) in Jordan: a cross-sectional study. BMJ Open 2022;12. doi:10.1136\/bmjopen-2021-050078","DOI":"10.1136\/bmjopen-2021-050078"},{"key":"2025101812575250000_13.7.e061945.15","doi-asserted-by":"crossref","unstructured":"Lu M-Y , Ahorsu DK , Kukreti S , et al . The prevalence of post-traumatic stress disorder symptoms, sleep problems, and psychological distress among COVID-19 frontline Healthcare workers in Taiwan. Front Psychiatry 2021;12. doi:10.3389\/fpsyt.2021.705657","DOI":"10.3389\/fpsyt.2021.705657"},{"key":"2025101812575250000_13.7.e061945.16","doi-asserted-by":"crossref","unstructured":"Burns ES , Pathmarajah P , Muralidharan V . Physical and psychological impacts of Handwashing and personal protective equipment usage in the COVID-19 pandemic: a UK based cross-sectional analysis of Healthcare workers. Dermatol Ther 2021;34. doi:10.1111\/dth.14885","DOI":"10.1111\/dth.14885"},{"key":"2025101812575250000_13.7.e061945.17","doi-asserted-by":"crossref","unstructured":"Barello S , Palamenghi L , Graffigna G . Burnout and somatic symptoms among frontline Healthcare professionals at the peak of the Italian COVID-19 pandemic. Psychiatry Res 2020;290. doi:10.1016\/j.psychres.2020.113129","DOI":"10.1016\/j.psychres.2020.113129"},{"key":"2025101812575250000_13.7.e061945.18","doi-asserted-by":"publisher","DOI":"10.1016\/j.bbi.2020.04.049"},{"key":"2025101812575250000_13.7.e061945.19","doi-asserted-by":"crossref","unstructured":"Qureshi I , Gogoi M , Wobi F , et al . Healthcare workers from diverse ethnicities and their perceptions of risk and experiences of risk management during the COVID-19 pandemic: qualitative insights from the United Kingdom-reach study. Front Med (Lausanne) 2022;9. doi:10.3389\/fmed.2022.930904","DOI":"10.3389\/fmed.2022.930904"},{"key":"2025101812575250000_13.7.e061945.20","doi-asserted-by":"crossref","first-page":"942046","DOI":"10.3389\/fpubh.2022.942046","article-title":"Personal protective equipment-associated headaches in health care workers during COVID-19: a systematic review and meta-analysis","volume":"10","author":"Sahebi","year":"2022","journal-title":"Front Public Health"},{"key":"2025101812575250000_13.7.e061945.21","doi-asserted-by":"crossref","unstructured":"Grailey K , Lound A , Brett S . Lived experiences of Healthcare workers on the front line during the COVID-19 pandemic: a qualitative interview study. BMJ Open 2021;11. doi:10.1136\/bmjopen-2021-053680","DOI":"10.1136\/bmjopen-2021-053680"},{"key":"2025101812575250000_13.7.e061945.22","doi-asserted-by":"crossref","DOI":"10.3390\/healthcare9010090","article-title":"Burnout prevalence and its associated factors among Malaysian Healthcare workers during COVID-19 pandemic: an embedded mixed-method study","volume":"9","author":"Roslan","year":"2021","journal-title":"Healthcare (Basel)"},{"key":"2025101812575250000_13.7.e061945.23","doi-asserted-by":"publisher","DOI":"10.1111\/jonm.13359"},{"key":"2025101812575250000_13.7.e061945.24","doi-asserted-by":"crossref","unstructured":"Alrawashdeh HM , Al-Tammemi AB , Alzawahreh MK , et al . Occupational burnout and job satisfaction among physicians in times of COVID-19 crisis: a CONVERGENT parallel mixed-method study. BMC Public Health 2021;21. doi:10.1186\/s12889-021-10897-4","DOI":"10.1186\/s12889-021-10897-4"},{"key":"2025101812575250000_13.7.e061945.25","doi-asserted-by":"crossref","first-page":"284","DOI":"10.3389\/fpsyg.2019.00284","article-title":"The relationship between burnout, depression, and anxiety: a systematic review and meta-analysis","volume":"10","author":"Koutsimani","year":"2019","journal-title":"Front Psychol"},{"key":"2025101812575250000_13.7.e061945.26","doi-asserted-by":"crossref","unstructured":"Salvagioni DAJ , Melanda FN , Mesas AE , et al . Physical, psychological and occupational consequences of job burnout: a systematic review of prospective studies. PLoS One 2017;12. doi:10.1371\/journal.pone.0185781","DOI":"10.1371\/journal.pone.0185781"},{"key":"2025101812575250000_13.7.e061945.27","doi-asserted-by":"crossref","unstructured":"Sun J , Sarfraz M , Ivascu L , et al . How did work-related depression, anxiety, and stress hamper Healthcare employee performance during COVID-19? the mediating role of job burnout and mental health. Int J Environ Res Public Health 2022;19. doi:10.3390\/ijerph191610359","DOI":"10.3390\/ijerph191610359"},{"key":"2025101812575250000_13.7.e061945.28","doi-asserted-by":"crossref","first-page":"219","DOI":"10.1037\/prj0000480","article-title":"COVID-related work changes, burnout, and turnover intentions in mental health providers: a moderated mediation analysis","volume":"44","author":"Sklar","year":"2021","journal-title":"Psychiatr Rehabil J"},{"key":"2025101812575250000_13.7.e061945.29","doi-asserted-by":"crossref","first-page":"795","DOI":"10.1111\/jrh.12659","article-title":"Anxiety, depression, stress, burnout, and professional quality of life among the hospital workforce during a global health pandemic","volume":"38","author":"Kelly","year":"2022","journal-title":"J Rural Health"},{"key":"2025101812575250000_13.7.e061945.30","doi-asserted-by":"crossref","unstructured":"Hao Q , Wang D , Xie M , et al . Prevalence and risk factors of mental health problems among Healthcare workers during the COVID-19 pandemic: a systematic review and meta-analysis. Front Psychiatry 2021;12. doi:10.3389\/fpsyt.2021.567381","DOI":"10.3389\/fpsyt.2021.567381"},{"key":"2025101812575250000_13.7.e061945.31","doi-asserted-by":"crossref","unstructured":"Saragih ID , Tonapa SI , Saragih IS , et al . Global prevalence of mental health problems among Healthcare workers during the COVID-19 pandemic: a systematic review and meta-analysis. Int J Nurs Stud 2021;121. doi:10.1016\/j.ijnurstu.2021.104002","DOI":"10.1016\/j.ijnurstu.2021.104002"},{"key":"2025101812575250000_13.7.e061945.32","doi-asserted-by":"crossref","unstructured":"Aymerich C , Pedruzo B , P\u00e9rez JL , et al . COVID-19 pandemic effects on health worker's mental health: systematic review and meta-analysis. Eur Psychiatry 2022;65. doi:10.1192\/j.eurpsy.2022.1","DOI":"10.1192\/j.eurpsy.2022.1"},{"key":"2025101812575250000_13.7.e061945.33","doi-asserted-by":"publisher","DOI":"10.1111\/jan.15175"},{"key":"2025101812575250000_13.7.e061945.34","doi-asserted-by":"crossref","unstructured":"Rapisarda F , Vallarino M , Cavallini E , et al . The early impact of the COVID-19 emergency on mental health workers: a survey in Lombardy, Italy. Int J Environ Res Public Health 2020;17. doi:10.3390\/ijerph17228615","DOI":"10.3390\/ijerph17228615"},{"key":"2025101812575250000_13.7.e061945.35","doi-asserted-by":"crossref","unstructured":"Matsuo T , Kobayashi D , Taki F , et al . Prevalence of health care worker burnout during the Coronavirus disease 2019 (COVID-19) pandemic in Japan. JAMA Netw Open 2020;3. doi:10.1001\/jamanetworkopen.2020.17271","DOI":"10.1001\/jamanetworkopen.2020.17271"},{"key":"2025101812575250000_13.7.e061945.36","unstructured":"FUCfE-b N . The Joanna Briggs Institute critical appraisal tools. Available: http:\/\/ebn.nursing.fudan.edu.cn\/school\/quality [Accessed 17 Aug 2021]."},{"key":"2025101812575250000_13.7.e061945.37","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.327.7414.557"},{"key":"2025101812575250000_13.7.e061945.38","doi-asserted-by":"publisher","DOI":"10.1016\/j.cct.2015.09.002"},{"key":"2025101812575250000_13.7.e061945.39","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.315.7109.629"},{"key":"2025101812575250000_13.7.e061945.40","doi-asserted-by":"crossref","first-page":"178","DOI":"10.1159\/000513733","article-title":"What we have learned from two decades of epidemics and Pandemics: a systematic review and meta-analysis of the psychological burden of frontline healthcare workers","volume":"90","author":"Busch","year":"2021","journal-title":"Psychother Psychosom"},{"key":"2025101812575250000_13.7.e061945.41","doi-asserted-by":"crossref","unstructured":"Chen Y , Zhang L , Qi H , et al . Relationship between negative emotions and job burnout in medical staff during the prevention and control of the COVID-19 epidemic: the mediating role of psychological resilience. Front Psychiatry 2022;13. doi:10.3389\/fpsyt.2022.857134","DOI":"10.3389\/fpsyt.2022.857134"},{"key":"2025101812575250000_13.7.e061945.42","doi-asserted-by":"crossref","DOI":"10.3390\/ijerph18084361","article-title":"SARS\/MERS\/SARS-Cov-2 outbreaks and burnout syndrome among Healthcare workers. an umbrella systematic review","volume":"18","author":"Magnavita","year":"2021","journal-title":"Int J Environ Res Public Health"},{"key":"2025101812575250000_13.7.e061945.43","doi-asserted-by":"crossref","unstructured":"Mart\u00ednez-Cuazitl A , Mart\u00ednez-Salazar IN , Maza-De La Torre G , et al . Burnout syndrome in a military tertiary hospital staff during the COVID-19 contingency. Int J Environ Res Public Health 2022;19. doi:10.3390\/ijerph19042229","DOI":"10.3390\/ijerph19042229"},{"key":"2025101812575250000_13.7.e061945.44","doi-asserted-by":"crossref","first-page":"616369","DOI":"10.3389\/fpsyg.2021.616369","article-title":"Burnout and its relationship with depressive symptoms in medical staff during the COVID-19 epidemic in China","volume":"12","author":"Huo","year":"2021","journal-title":"Front Psychol"},{"key":"2025101812575250000_13.7.e061945.45","doi-asserted-by":"publisher","DOI":"10.1007\/s00420-021-01695-x"},{"key":"2025101812575250000_13.7.e061945.46","doi-asserted-by":"crossref","first-page":"590190","DOI":"10.3389\/fpubh.2020.590190","article-title":"Prevalence, associated factors, and consequences of burnout among Egyptian physicians during COVID-19 pandemic","volume":"8","author":"Abdelhafiz","year":"2020","journal-title":"Front Public Health"},{"key":"2025101812575250000_13.7.e061945.47","doi-asserted-by":"publisher","DOI":"10.3201\/eid1212.060584"},{"key":"2025101812575250000_13.7.e061945.48","doi-asserted-by":"crossref","unstructured":"Chigwedere OC , Sadath A , Kabir Z , et al . The impact of epidemics and pandemics on the mental health of healthcare workers: a systematic review. Int J Environ Res Public Health 2021;18: . doi:10.3390\/ijerph18136695","DOI":"10.3390\/ijerph18136695"},{"key":"2025101812575250000_13.7.e061945.49","doi-asserted-by":"publisher","DOI":"10.5498\/wjp.v12.i5.739"},{"key":"2025101812575250000_13.7.e061945.50","doi-asserted-by":"crossref","first-page":"323","DOI":"10.1016\/j.jad.2022.02.045","article-title":"The pooled prevalence of the mental problems of Chinese medical staff during the COVID-19 outbreak: a meta-analysis","volume":"303","author":"Hu","year":"2022","journal-title":"J Affect Disord"},{"key":"2025101812575250000_13.7.e061945.51","doi-asserted-by":"publisher","DOI":"10.5271\/sjweh.1054"},{"key":"2025101812575250000_13.7.e061945.52","doi-asserted-by":"crossref","unstructured":"Alshekaili M , Hassan W , Al Said N , et al . Factors associated with mental health outcomes across Healthcare settings in Oman during COVID-19: frontline versus non-frontline Healthcare workers. BMJ Open 2020;10. doi:10.1136\/bmjopen-2020-042030","DOI":"10.2139\/ssrn.3624265"},{"key":"2025101812575250000_13.7.e061945.53","doi-asserted-by":"crossref","unstructured":"Chersich MF , Gray G , Fairlie L , et al . COVID-19 in Africa: care and protection for frontline Healthcare workers. Global Health 2020;16. doi:10.1186\/s12992-020-00574-3","DOI":"10.1186\/s12992-020-00574-3"},{"key":"2025101812575250000_13.7.e061945.54","doi-asserted-by":"crossref","unstructured":"Kisely S , Warren N , McMahon L , et al . Occurrence, prevention, and management of the psychological effects of emerging virus outbreaks on Healthcare workers: rapid review and meta-analysis. BMJ 2020;369. doi:10.1136\/bmj.m1642","DOI":"10.1136\/bmj.m1642"},{"key":"2025101812575250000_13.7.e061945.55","doi-asserted-by":"crossref","first-page":"269","DOI":"10.1016\/j.shaw.2022.06.003","article-title":"Influencing factors of high PTSD among medical staff during COVID-19: evidences from both meta-analysis and subgroup analysis","volume":"13","author":"Qi","year":"2022","journal-title":"Saf Health Work"},{"key":"2025101812575250000_13.7.e061945.56","doi-asserted-by":"crossref","unstructured":"Nguyen C , Young FG , McElroy D , et al . Personal protective equipment and adverse dermatological reactions among Healthcare workers: survey observations from the COVID-19 pandemic. Medicine (Baltimore) 2022;101. doi:10.1097\/MD.0000000000029003","DOI":"10.1097\/MD.0000000000029003"},{"key":"2025101812575250000_13.7.e061945.57","doi-asserted-by":"crossref","unstructured":"Robert R , Kentish-Barnes N , Boyer A , et al . Ethical dilemmas due to the COVID-19 pandemic. Ann Intensive Care 2020;10. doi:10.1186\/s13613-020-00702-7","DOI":"10.1186\/s13613-020-00702-7"},{"key":"2025101812575250000_13.7.e061945.58","doi-asserted-by":"publisher","DOI":"10.1093\/occmed\/kqaa052"},{"key":"2025101812575250000_13.7.e061945.59","doi-asserted-by":"crossref","unstructured":"Zhang C , Yang L , Liu S , et al . Survey of insomnia and related social psychological factors among medical staff involved in the 2019 novel Coronavirus disease outbreak. Front Psychiatry 2020;11. doi:10.3389\/fpsyt.2020.00306","DOI":"10.3389\/fpsyt.2020.00306"},{"key":"2025101812575250000_13.7.e061945.60","doi-asserted-by":"crossref","unstructured":"Christiansen DM , Berke ET . Gender- and sex-based contributors to sex differences in PTSD. Curr Psychiatry Rep 2020;22. doi:10.1007\/s11920-020-1140-y","DOI":"10.1007\/s11920-020-1140-y"},{"key":"2025101812575250000_13.7.e061945.61","doi-asserted-by":"publisher","DOI":"10.4037\/ajcc2014747"},{"key":"2025101812575250000_13.7.e061945.62","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1186\/s12991-018-0184-4","article-title":"Exploring PTSD in emergency operators of a major University hospital in Italy: a preliminary report on the role of gender, age, and education","volume":"17","author":"Carmassi","year":"2018","journal-title":"Ann Gen Psychiatry"},{"key":"2025101812575250000_13.7.e061945.63","doi-asserted-by":"publisher","DOI":"10.1016\/j.bbi.2020.03.028"},{"key":"2025101812575250000_13.7.e061945.64","doi-asserted-by":"crossref","first-page":"243","DOI":"10.1159\/000077743","article-title":"Positive coping Up- and down-regulates in vitro cytokine productions from T cells dependent on stress levels","volume":"73","author":"Sakami","year":"2004","journal-title":"Psychother Psychosom"},{"key":"2025101812575250000_13.7.e061945.65","doi-asserted-by":"crossref","unstructured":"Wright KB . Researching Internet-based populations: advantages and disadvantages of online survey research, online questionnaire Authoring software packages, and web survey services. J Comput Mediat Commun 2017;10. doi:10.1111\/j.1083-6101.2005.tb00259.x","DOI":"10.1111\/j.1083-6101.2005.tb00259.x"},{"key":"2025101812575250000_13.7.e061945.66","doi-asserted-by":"publisher","DOI":"10.1177\/070674370905400504"},{"key":"2025101812575250000_13.7.e061945.67","unstructured":"D\u2019Ettorre G , Pellicani V , Ceccarelli G . Post-traumatic stress disorder symptoms in Healthcare workers: a ten-year systematic review. Acta Biomed 2020;91. doi:10.23750\/abm.v91i12-S.9459"},{"key":"2025101812575250000_13.7.e061945.68","doi-asserted-by":"publisher","DOI":"10.1176\/appi.psy.12.6.371"},{"key":"2025101812575250000_13.7.e061945.69","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.166.10.1092"},{"key":"2025101812575250000_13.7.e061945.70","doi-asserted-by":"publisher","DOI":"10.1001\/archpsyc.1965.01720310065008"},{"key":"2025101812575250000_13.7.e061945.71","doi-asserted-by":"publisher","DOI":"10.1046\/j.1525-1497.2001.016009606.x"},{"key":"2025101812575250000_13.7.e061945.72","doi-asserted-by":"crossref","unstructured":"Lovibond S , Lovibond P , Lovibond S , et al . Manual for the depression anxiety stress scales 2nd ed. Psychology Foundation of Australia, 1995.","DOI":"10.1037\/t01004-000"},{"key":"2025101812575250000_13.7.e061945.73","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-0447.1983.tb09716.x"},{"key":"2025101812575250000_13.7.e061945.74","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-3999(02)00604-9"},{"key":"2025101812575250000_13.7.e061945.75","doi-asserted-by":"publisher","DOI":"10.1016\/S1389-9457(00)00065-4"},{"key":"2025101812575250000_13.7.e061945.76","doi-asserted-by":"crossref","first-page":"1955","DOI":"10.1017\/S0033291720001622","article-title":"Tackling the mental health burden of frontline healthcare staff in the COVID-19 pandemic: China\u2019s experiences","volume":"51","author":"Zhou","year":"2021","journal-title":"Psychol Med"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2022-061945","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,18]],"date-time":"2025-10-18T19:58:10Z","timestamp":1760817490000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2022-061945"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,7]]},"references-count":76,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2023,7,20]]},"published-print":{"date-parts":[[2023,7]]}},"alternative-id":["10.1136\/bmjopen-2022-061945"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2022-061945","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,7]]}}}