Mental Health under Pressure: PTSD Risk Among Healthcare Workers in Ekiti State, Nigeria - The Role of Health Beliefs and Experiential Avoidance

Background Healthcare workers (HCWs) in Ekiti State, Nigeria, faced significant psychological stress during the early phase of the COVID-19 pandemic. However, limited evidence exists on how health behavior, experiential avoidance, and the Health Belief Model (HBM) jointly shape posttraumatic stress disorder (PTSD) symptoms, especially through moderated mediation mechanisms.

A cross-sectional survey of 475 HCWs (171 males, 304 females) was conducted using snowball sampling across two urban local governments. Instruments included the HBM Scale, Health Behavior Questionnaire, Acceptance and Action Questionnaire-II (AAQ-II), and the PTSD Checklist (Civilian Version). Data were analyzed using SPSS v22 and SmartPLS.

Health behavior significantly predicted HBM scores (β = 0.156, p = 0.005) but not PTSD symptoms directly (β = 0.097, p = 0.101). Experiential avoidance predicted both HBM (β = –0.143, p = 0.003) and PTSD (β = 0.392, p < 0.001). HBM partially mediated the effects of health behavior (β = –0.022, p = 0.043) and experiential avoidance (β = 0.019, p = 0.045) on PTSD. Conditional indirect effects showed that these mediation pathways were moderated by age (β = 0.028, p = 0.019), years of practice (β = 0.024, p = 0.025), professional designation (β = –0.014, p = 0.036), and experiential avoidance (β = 0.020, p = 0.041). Predictive assessment confirmed strong model performance, especially for PTSD symptoms (Q²predict = 0.222; RMSE = 0.887, MAE = 0.684), compared to HBM (Q²predict = 0.093; RMSE = 0.960, MAE = 0.726).

The HBM played a dual role—both buffering and amplifying the effects of behavior and avoidance on PTSD—depending on demographic and psychological context. The model demonstrates both explanatory and predictive value, reinforcing the need for belief-sensitive, tailored interventions to reduce PTSD risk in resource-constrained healthcare environments. Competing Interest Statement The authors have declared no competing interest. Clinical Protocols https://zenodo.org/uploads/15817238 Funding Statement This study did not receive any funding Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The study used human data collected directly from participants in the Oru Refugee Camp, Nigeria, under approved ethical protocols. Ethical approval for this study was granted by the Ekiti State University Ethical Review and Research Committee, coordinated through the Office of Research, Development, and Innovation (ORDI) I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes Data Availability A de-identified version of the data produced in the present study is available online at Zenodo: https://zenodo.org/uploads/15817238.