The Biological and Psychological Profiles of Hospital Healthcare Professionals During a Stressful Wartime

Background

Hospital healthcare professionals working during military conflicts experience extreme psychological pressure, yet the accompanying inflammatory responses in such real-world high-stress settings remain poorly characterized. In October 2023, during nationwide missile attacks in Israel, hospital staff had to continue routine clinical duties.

Objective

To examine the association between biological and psychological profiles of healthcare professionals during a stressful wartime.

Design

A prospective cohort study.

Participants

Ninety healthy hospital employees from central Israel volunteered to participate.

Main Measures

Psychological distress was measured using the Patient Health Questionnaire-4 (PHQ-4), and perceived stress was assessed using the Perceived Stress Scale-4 (PSS-4). Serum concentrations of interleukin-1 (IL-1), interleukin-6 (IL-6), and tumor necrosis factor-α (TNF-α) were quantified using ELISA assays. Associations between psychological measures and cytokine levels were evaluated using linear regression analyses.

Key Results

Multiple linear regression analysis showed that psychological distress was associated with IL-1 production (p = 0.0265; 95% CI, 0.009543–0.1502), whereas no significant associations were observed for IL-6 (p = 0.4624; 95% CI, 0.08931–0.04098) or TNF (p = 0.5235; 95% CI, −0.9145 to 1.783). Multiple linear regression analysis showed that mental stress was associated with IL-1 production (p = 0.003; 95% CI, 0.04567–0.1486), whereas no significant associations were observed for IL-6 (p = 0.7084; 95% CI, −0.05985 to 0.04087) or TNF (p = 0.9761; 95% CI, −1.058 to 1.027).

Conclusions

These findings demonstrate that psychological distress and mental stress experienced by healthcare professionals during wartime are accompanied by measurable increases in circulating cytokines. Inflammation may serve as an objective biomarker of psychological burden in extreme conditions and could inform future strategies to monitor and support the mental health of hospital healthcare professionals during crises.