Skip to main content

A closer look: obsessive-compulsive symptoms among intern nurses amidst COVID-19 pandemic



The distinctive circumstances and socio-cultural context in Egypt make it crucial to explore the psychological well-being of intern nurses amid the COVID-19 pandemic, with a specific focus on obsessive-compulsive symptoms. This study aimed to investigate the influence of fear of COVID-19 on obsessive-compulsive symptoms among intern nurses.


A cross-sectional survey involving 375 randomly recruited intern nurses was conducted. Data collected included the Fear of COVID-19 Scale and the Short Version of the Arabic Obsessive-Compulsive Scale.


A significant relationship was found between the fear of COVID-19 and the severity of obsessive-compulsive symptoms among the participants (r = 0.472, p = 0.000). A stepwise regression analysis indicated that the fear of COVID-19, living in urban regions, frequency of COVID-19 infection, and increased number of infected family members may contribute to the severity of Obsessive-Compulsive Symptoms with adjusted R2 value = 27.5%.


The findings suggest that the COVID-19 pandemic has had significant psychological impacts on newly qualified nurses during their internship training period, including the manifestation of mental health symptoms such as Obsessive-Compulsive Symptoms. It was observed that urban residents, intern nurses with recurrent COVID-19 infections, and those with more infected family members exhibited a higher severity of OCS. These findings underscore the need for further research to investigate additional factors that may influence OCS severity.

Peer Review reports


In December 2019, an unknown illness emerged in Wuhan City, China, later identified as COVID-19 caused by the SARS-CoV-2 virus [1]. COVID-19 quickly spread globally, posing a significant threat to human life and health due to its high contagiousness and severity [2]. It has resulted in numerous deaths worldwide, including in Egypt [3]. According to the World Health Organization's report in 2023, Egypt has experienced a significant impact from the ongoing COVID-19 pandemic, with 516,023 confirmed cases and 24,830 deaths recorded in the country [4]. In addition to its deadly effects, COVID-19 has severe psychological consequences, including stress, worry, obsessive thoughts, and depressive disorders [5, 6].

The COVID-19 pandemic has led to the widespread adoption of ritualized washing behaviors and avoidance measures endorsed by organizations like the WHO and implemented by governments [7]. This has unexpectedly caused individuals with modest levels of obsessive-compulsive symptoms (OCS) to exhibit thoughts and behaviors associated with clinical OCD, potentially contributing to a higher prevalence of OCD [8]. Distressing life events, such as the unexpected loss of a family member during the pandemic, have been found to correlate with increased OCS [9]. There is also evidence suggesting an increase in OCS, particularly in individuals with diagnosed OCD, specifically those with Contamination-related OCD or Cleaning-related OCS, during the COVID-19 pandemic [10, 11].

OCD is a chronic mental condition characterized by unwanted thoughts (obsessions) and repetitive behaviors (compulsions). While many individuals engage in repetitive actions in their daily lives, in individuals with OCD, these thoughts and behaviors are more frequent and severe, often significantly impacting their lives [12,13,14]. OCD ranks as the fourth most prevalent mental disorder globally [15]. The estimated lifetime prevalence of OCD is 2.3%, with a range of 1.1-3.3%. The prevalence of OCD varies based on factors such as age, location, and other factors [12, 16]. Individuals with OCD may exhibit various categories of symptoms, including fixation with contaminated cleaning practices, frequent checking, persistent unwanted or religious thoughts, repetitive hoarding, symmetry, and arranging. These symptoms and behaviors can be erratic, fluctuating over time, or changing their manifestations during the illness [6, 17,18,19].

The COVID-19 pandemic has had a significant negative impact on global mental health, including among intern nursing students [20]. Studies, particularly in the Arab-speaking countries and MENA region, have shown that a high percentage of medical and nursing students reported experiencing concurrent mental symptoms during the pandemic, with worry and stress being the most common [20, 21]. A study in Saudi Arabia found that OCD symptoms were prevalent in 3.4% of individuals in Asser province [22]. Meanwhile, a study among Iraqi undergraduate medical students during the COVID-19 pandemic found that 43% of the students had probable OCD symptoms [23]. Lastly, in Iran, a study found that 71% of COVID-19-recovered individuals exhibited OCD symptoms [24].

It is a complex condition that can be challenging to diagnose and understand due to symptom overlap with other mental illnesses and diseases. Additionally, individuals may deny or not acknowledge their symptoms and behaviors due to the stigma associated with such mental disorders. This emphasizes the importance of screening for OCD symptoms, particularly in high-risk populations such as intern nursing students [12]. Several researchers have noted that people with obsessive-compulsive symptoms tend to anticipate danger or adverse outcomes more than those without such symptoms, especially during stressful periods. These individuals tend to interpret danger based on the lack of evidence to the contrary rather than the presence of actual danger signals. They are more prone to avoiding risks compared to other groups. One of the most common symptoms of OCS is excessive cleaning, which attempts to control threats by minimizing the risk of harm and ensuring safety [8, 9].

Health crises, such as the COVID-19 pandemic, could potentially exacerbate OC symptoms in younger intern nurses who are already predisposed to such conditions. These external circumstances often act as catalysts for obsessive thoughts and compulsive behaviors. Young interns, who tend to overestimate threats, might harbor numerous concerns or obsessions related to harm, such as the fear of getting infected themselves, inadvertently spreading the virus, or causing harm to others. They might find themselves incessantly having ruminative thoughts and seeking reassurance by obsessively looking up news about COVID-19. Moreover, to alleviate their fear and anxiety, they might fall into the pattern of compulsive handwashing to manage their recurring intrusive obsessive thoughts [17, 19, 22].

Intern nurses in Egypt have played a crucial role in managing the increased number of patients during the COVID-19 pandemic [25]. Before the pandemic, Egyptian hospitals faced challenges such as a high patient load, limited resources, and a staff shortage. The demanding work hours assigned to interns can hurt their mental well-being, leading to increased levels of fear, anxiety, and OCS [26, 27]. The COVID-19 pandemic can further exacerbate these issues, which is particularly significant in Egypt, with its medium-income status and many patients in hospital settings. Thus, this study aimed to investigate the influence of fear of COVID-19 on obsessive-compulsive symptoms among intern nurses.

Research hypothesis

The researcher hypothesized that intern nurses with a severe level of fear towards COVID-19 would exhibit severe obsessive-compulsive symptoms.


Research design and setting

A cross-sectional survey targeted intern nurses from October 14th to December 20th, 2022. The survey encompassed four hospitals affiliated with Alexandria University. These included El-Shatby Hospital for Obstetricians and Gynecologists (A), Main University Hospital (B), El Hadara Orthopedic and Traumatology University Hospital (C), and Smouha University Hospital (D).

Target participants and sample size calculation

The objective of this study was to scrutinize a cohort of intern nurses who were trained across the four university hospitals. The records indicated 1,002 registered interns (A =498, B =561, C =258, and D = 183). To ascertain an appropriate representative sample size, the EPI INFO 7 software was utilized. The calculation was based on a 5% margin of error, a 95% confidence level, a 50% anticipated proportion, and a population size of 1,002. The software recommended a minimum sample size of 326 participants. However, to account for a potential 10% nonresponse rate, the total sample size was adjusted to 375 participants.

Inclusion and exclusion criteria

The eligibility criteria of this study included intern nurses who started their internship during the academic year 2022 and exhibited a readiness to participate. Moreover, it was a prerequisite that these participants did not have any diagnosed mental health disorders, were not consuming psychotropic medications, were not involved in ongoing psychotherapy, and had not engaged in the use of substances such as Alcohol, Amphetamines, or psychostimulant drugs.

Sampling and recruitment process

The study employed a stratified random sampling technique to select participants in proportion to the total number of intern nurses across four hospitals. The research team initially secured approval from the Internship Affairs Committee at the Faculty of Nursing to access the student registration list. This comprehensive list of the participants was then used as the basis for random selection using the Research Randomizer Generation software. Of the 390 invited participants, 9 refused to participate (A =2, B =3, C=1, and D=3), and 10 were ineligible (A =3, B =1, C=4, and D=2). This resulted in a final sample of 375 intern nurses (A =133, B =149, C=83, and D=44) whose responses were analyzed. This final sample was obtained through a rigorous random selection and adherence to the study's eligibility criteria (Fig. 1).

Fig. 1
figure 1

Recruitment flowchart

Study instruments

A sociodemographic profile for intern nurses

The research team formulated a data collection profile to gather specific information about the intern nurses. This information included their age, gender, place of residence, living arrangements, and frequency of COVID-19 infection. The profile also recorded the number of family members who had previously suffered from a COVID-19 infection. In addition, the data collection profile was designed to capture information on whether the intern nurses were simultaneously working other shifts in private hospitals during their internship training.

Fear of COVID-19 Scale (FCV-19S)

The FCV-19S is a seven-item instrument that utilizes a 5-point Likert scale, with responses ranging from 1 (strongly disagree) to 5 (strongly agree), to evaluate an individual’s fear of COVID-19 [28]. The total scores can vary from 7 to 35, with higher scores denoting severe fear. The scores are interpreted as follows: 7-15 indicates mild level, 16-25 indicates moderate, and 26-35 indicates severe level. FCV-19S showed a Cronbach's alpha of 0.82, reflecting high internal consistency [28]. The scale was translated into Arabic and then back-translated to ensure its applicability to Arabic-speaking populations. Bilingual Psychiatric Nursing and Mental Health experts reviewed the translated version. A confirmatory factor analysis was conducted to validate the content of the scale post-translation. In our study, the Arabic version of the FCV-19S demonstrated good internal consistency, as evidenced by a Cronbach's alpha of 0.87.

Short version of Arabic Obsessive-Compulsive Scale (AOCS)

The AOCS is a self-administered tool designed to evaluate symptoms of obsessive-compulsive symptoms [29]. The AOCS includes 25 statements, 20 of which are aimed at identifying OCD symptoms, while the remaining five serve as non-clinical fillers. Participants are asked to rate each item on a 4-point Likert scale, with responses ranging from "No" to "Always." The total score on the AOCS can range from 20 to 80, with a higher score indicating more severe obsessive-compulsive symptoms. The scores are categorized as follows: a score of 20-39 suggests mild OCD symptoms, a score of 40-59 indicates moderate symptoms, and a score of 60-80 signifies severe symptoms. The scale demonstrated a high level of internal consistency, as evidenced by a Cronbach's alpha value of 0.89 [30]. In addition, the AOCS displayed good internal consistency in this study, with a Cronbach's alpha of 0.84.


Ethical approval

The research was conducted by the Declaration of Helsinki (DoH-Oct2008) guidelines and regulations. Ethical approval was secured from the Research Ethics Committee (REC) at the Faculty of Nursing, El Mansoura University. The Vice Dean of Students' Affairs Faculty of Nursing in Alexandria, Egypt, officially granted permission to conduct the study. The contact details of the intern nurses were obtained from the University's Internship affairs unit. Informed consent was obtained from each participant, who was thoroughly briefed about the study's purpose and assured of their anonymity and the confidentiality of their personal information. Participants were also informed of their right to withdraw from the study at any time without any repercussions, emphasizing that their participation was entirely voluntary.

Pilot study and tool validity

The researchers developed a sociodemographic profile of intern nurses to gather relevant information. To ensure the content validity of the Fear of COVID-19 Scale (FCV-19S) in Arabic, it was translated into Arabic, then back-translated, and subjected to confirmatory factor analysis. The results of the analysis indicated that the Chi-Square Test of Model Fit was p=0.10, the Comparative Fit Index (CFI) was 0.92, the Tucker-Lewis Index (TLI) was 0.93, and the Root Mean Square Error of Approximation (RMSEA) was 0.07. Furthermore, the Arabic Obsessive-Compulsive Scale (AOCS) was adopted and employed in the study. A preliminary study was conducted with 40 intern nurses who were not part of the final sample. This initial study aimed to evaluate the clarity and applicability of the research tools and identify any potential challenges in gathering data. The findings from this pilot study confirmed that the research instruments were accurate, understandable, and suitable for use. Also, the pilot results found that 15% of the participants exhibited a higher OC symptom.

Data collection

After excluding the participants from the pilot study, a representative sample was selected using a simple random method, following a stratified sampling procedure from the four target hospitals. Interviews were then conducted by a trained psychiatrist using structured questionnaires to gather the necessary data. This was to ensure that the participants did not have any psychiatric disorders, were not taking psychiatric medications or undergoing psychotherapy, and had no history of substance use. Participants were required to provide written informed consent before independently completing the questionnaires. These interviews, each lasting about 10-15 minutes, were conducted individually in a private room in each hospital to ensure privacy. Participants were assured of their anonymity and confidentiality. Participation was entirely voluntary, with no rewards or penalties involved. Intern nurses were informed that they could withdraw without facing any repercussions. To ensure the accuracy and completeness of the data, the researchers meticulously reviewed the responses to the research tool provided by the participants.

Statistical processing and analysis

The data analysis was conducted using the SPSS program, version 26.0. Initially, the data was coded, cleaned, and checked for normal distribution using the Shapiro-Wilk test. Descriptive statistics were then used to summarize the qualitative data, presenting frequencies and percentages. Descriptive statistics such as mean and standard deviation (SD) were calculated for the quantitative data. The internal consistency of the research instruments, FCV-19S and AOCS, was assessed using Cronbach's alpha. To explore the relationship between the fear of COVID-19 and obsessive-compulsive symptoms, the Pearson correlation coefficient was calculated. Additionally, a linear regression analysis was employed to evaluate the extent to which the fear of COVID-19 explains the variance in obsessive-compulsive symptoms while considering other potential influencing factors.


Table 1 presents the sociodemographic characteristics of 375 intern nurses. The age groups range from 24 to over 26 years old. Most intern nurses were female (61.07%), resided in urban areas (57.86%), and 83.73% lived with their families. Regarding their history with COVID-19, 14.93% have not been infected, 80.26% have been infected once, 3.20% twice, and 1.61% more than twice. Regarding family members previously Infected with COVID-19, 73.06% had between 1 and 3 family members infected, 22.40% had between 4 and 5, and 4.54% had more than 5—lastly, most intern nurses (90.66%) work in other private hospitals during their internship training.

Table 1 Distribution of the participants regarding their sociodemographic data

Figure 2 reveals that most participants (54.2%) reported mild symptoms of OCD. A significant portion (38.3%) reported moderate symptoms. A small percentage (7.5%) reported severe symptoms on the AOCS. The average score on the AOCS scale was 25.81 SD (10.07), suggesting a moderate level of overall symptom severity. The figure also shows that a substantial portion of participants (58.8%) reported moderate fear of COVID-19. A smaller percentage (9.8%) reported severe fear of COVID-19. The average score was 17.96 (5.10), indicating a moderate level of fear related to COVID-19.

Fig. 2
figure 2

Distribution of the participants according to fear of COVID-19 and OCS severity (n=375). AOCS: Short Version of Arabic Obsessive-Compulsive Scale. FCV-19S: Fear of COVID-19 Scale

Table 2 displays the Pearson correlation coefficient between FCV-19S and AOCS, with r = 0.472 and a p-value of 0.000. These results indicate a moderate statistically significant positive correlation between the participants' fear of COVID-19 and OCS.

Table 2 The correlation coefficient between the fear of COVID-19 and Obsessive-compulsive symptoms severity among the participants (n=375)

Table 3 reveals that there was no significant difference in OCD symptoms based on age (F=3.578, p=0.126), gender (t=0.502, p=0.325), or living arrangement (F=1.372, P=0.255). However, a significant difference was observed in OCD symptoms based on residence, with urban residents scoring higher on the AOCS scale than rural residents (t=6.335, p=0.012). The frequency of COVID-19 infection also showed a significant correlation with OCD symptoms (F=2.588, P=0.053), as did the number of infected family members (F=3.472, P=0.017). Interestingly, working in other private hospitals during internship training did not significantly affect OCD symptoms (t=4.369, p=0.258).

Table 3 The relationship between sociodemographic variables and OC symptoms severity among the participants (n=375)

Table 4 presents a stepwise regression model examining the impact of fear of COVID-19 and other covariates on OCD severity. In the first step, 'FCV-19S' explained 16.5% of the variance in OCD severity, with a significant impact (p < 0.001). In the second step, 'Residence' is added to the model, increasing the explained variance to 18.9%, with both variables showing a significant impact. The third step introduces 'Frequency of COVID-19 infection', increasing the explained variance to 23.2%. Finally, in the fourth step, 'No. of infected family members’ was added, resulting in a total variance of 27.5% explained by the model. All variables in the final model have a significant impact (p < 0.05).

Table 4 A hierarchical regression analysis between OCD Symptoms Severity, fear of COVID-19, and other covariates (n=375)


The COVID-19 pandemic has made hospital clinical placements challenging and frightening for intern nurses, who fear incubating the virus and spreading it to their loved ones and colleagues [31]. Intern nurses have been deployed to COVID-19 departments, taking on roles typically filled by registered nurses. Traumatic experiences or stressful life events are risk factors for obsessive-compulsive and related disorders [32]. The COVID-19 pandemic, with its serious health risks and unpredictability, may exacerbate pre-existing symptoms and trigger new ones in those predisposed to OCD [10, 33]. This study aimed to investigate the influence of COVID-19 fear on obsessive-compulsive symptoms among intern nurses.

The study found that many participants exhibited a modest COVID-19 fear. This could be attributed to these intern nurses' often being asked to work in high-risk areas such as isolation units, emergency departments, and intensive care units where COVID-19 patients were treated. This could increase anxiety among intern nursing students due to misconceptions or a lack of understanding about diseases and infection control procedures relevant to their clinical practice. As a result, students may become more fearful, and diseases may spread more rapidly. The lack of safety precautions in hospitals and the intern nurses' insufficient experience in a COVID-19 environment could further exacerbate these fears [34, 35].

Several studies have highlighted the challenges faced by nursing interns during the COVID-19 pandemic. Key issues include a lack of knowledge and skills, concerns about family, disorientation, and stress from various factors such as fear of making mistakes, handling emergencies, and dealing with death [36, 37]. Mostafa and Abu Zead (2021) found that most nursing interns initially showed reluctance to work in isolation units and care for COVID-19 patients due to fear of infection [38]. Aslan and Pekince (2021) [39] and Rana et al. (2022) [31] found that 61.1% and 68.1% of students had a moderate fear of contracting the infection, respectively.

The current study indicates that most participants displayed mild to moderate levels of OCD, with an average score of 25.81 on the AOCS scale, suggesting a moderate level of overall symptom severity. This could be related to those intern nurses beginning their clinical practice amidst the COVID-19 pandemic. They were faced with a multitude of challenges, such as executing complex and demanding nursing procedures, operating in high-stress and infection-prone settings, managing patients with diverse diagnoses, including those in terminal stages, and dealing with anxious family members. These stressors could adversely affect their cognitive patterns, triggering stress-related schemas in these young students and potentially leading to an escalation in obsessive-compulsive symptoms. This aligns with other studies conducted in Egypt. For instance, a study conducted in Cairo found an incidence of OCD of 2.5% among 1,000 undergraduates attending a university clinic [40]. Another study revealed that the prevalence of Obsessive-Compulsive Symptoms (OCS) is 38.7% in secondary schools [41]. In a study conducted by Taher et al. (2021) in Iraq, it was reported that a significant number, 1153 (70.1%), reported experiencing mental symptoms, with worry and stress being the most common, affecting 674 (25.9%) and 617 (23.7%) of the students respectively. Interestingly, 707 (43%) of the students exhibited potential OCD symptoms that warrant further investigation. The most common symptom was unpleasant thoughts, experienced by 51.8% of the students. Surprisingly, the scores for washing and contamination were relatively low at 14% and 19.4%, respectively, while the least common symptom was the repetition of specific numbers, reported by only 8% of the students [23].

A study by Wang et al. (2023) involving 496 nurses in China found that the mean score of obsessive-compulsive symptoms was 47.21, with 94% of participants scoring above the median of 36, indicating a higher prevalence of OCD symptoms [42]. Ergenc et al. (2020) found that healthcare workers in the COVID-19 section had significantly higher rates of anxiety, depression, and obsessive-compulsive disorders compared to the control group [43]. The pandemic has led to an increase in OCD washing symptoms [44] and a greater incidence of OCD symptoms among healthcare workers compared to the public [45]. A longitudinal study by Pan et al. (2021) found that the pandemic did not appear to worsen the high levels of symptoms in those with severe or persistent mental health disorders. However, those with no or less severe mental health disorders experienced higher levels of depressive symptoms, anxiety, worry, and loneliness [46]. A rapid scoping review by Grant et al. (2022) found that a significant proportion of people with OCD experienced symptoms of worsening during the pandemic, particularly during initial restrictions. They also raised important questions about how exposure-based therapy should be modified during pandemics, how to reduce the risk of OCD aggravation in vulnerable people because of public health messaging, and whether COVID-19 infection is associated with OCD symptoms [11].

The present study has identified a significant connection between the fear of getting infected with COVID-19 and the occurrence of obsessive-compulsive symptoms among nursing interns. The adjusted R-squared value of 0.165 indicates that fear can explain 16.5% of the variance in OCS. This outcome can be understood in the context of Hobfoll (2001) theory, which posits that prolonged stress and fear can lead to a depletion of resources [47]. The fear associated with the pandemic acts as a significant barrier to effective coping mechanisms, potentially exacerbating OC symptoms. The fear and anxiety triggered by the COVID-19 crisis can amplify existing fears of contamination in some interns, leading to an increase in OC symptoms and compulsive behaviors. For these interns, the coronavirus can become a pervasive thought, with fears of touching contaminated surfaces or coming too close to others. The fear of COVID-19 may also make them more compliant with pandemic restrictions, such as social isolation, which could further negatively impact their OC symptoms.

However, these findings were inconsistent with a study by Ji et al. (2020) that examined the impact of fear of adverse events on Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) scores in a COVID-19 fear-inducing environment. They found that the prevalence of possible OCD was significantly higher during the early stages of the pandemic. Still, there was a significant decrease in Y-BOCS score, anxiety level, quarantine level, and intensity of fear of COVID-19 during the middle and late stages of the pandemic. Participants with probable OCD reported higher levels of fear than those with a lower Y-BOCS score (<16), indicating that an interaction between the environment (COVID-19 pandemic) and psychology (fear and anxiety) may be involved in OCD. This suggests that fear of adverse events may play a role in the etiology of OCD [48]. A rapid scoping review by Grant et al. (2022) found that a significant proportion of people with OCD experienced symptoms worsening during the pandemic, particularly during initial restrictions. They also raised important questions about how exposure-based therapy should be modified during pandemics, how to reduce the risk of OCD aggravation in vulnerable people because of public health messaging, and whether COVID-19 infection is associated with OCD symptoms [11].

The study found that intern nurses residing in urban areas demonstrated a higher prevalence of Obsessive-Compulsive (OC) symptoms compared to those living in rural areas. However, this finding is contradicted by Cao et al. (2020), who suggested that urban living could cause worries and stress among university students [49]. The increased fear of COVID-19 in urban areas is thought to be due to greater exposure to media, supported by Garfin et al. (2020), who suggested that repeated exposure to media content related to the outbreak can result in heightened stress responses, thereby affecting both physical and mental health [50]. On the other hand, the robust social networks, community cohesion, and strong family support systems prevalent in rural areas may protect against worries throughout demanding times by providing emotional support, practical help, and reassurance to intern nurses experiencing COVID-19 fear and obsessive-compulsive symptoms. Family members can help interns cope with challenges, reduce stress, and alleviate anxiety. Additionally, family members can play a crucial role in helping interns make informed decisions about their work and take appropriate precautions to protect themselves from COVID-19. Ultimately, family support can help nursing interns feel more confident and secure in their role, positively impacting their overall performance and patient care. This is supported by earlier studies, which suggested that residing with parents and having the family's backing can shield against the fear of external stressors [51, 52].

The research findings indicate a notable link between repeated COVID-19 infections and the intensity of OCS. This suggests that individuals who have experienced multiple bouts of COVID-19 may be more susceptible to severe OCD symptoms. This could be due to the repeated stress and anxiety associated with recurrent infections, which may exacerbate OCD symptoms. Similarly, an increased number of infected family members was also found to influence OCD symptoms significantly. This could be attributed to the added emotional stress and worry about the health and well-being of loved ones, which could exacerbate OCD symptoms. The subjects in the study conducted by Dehghani et al. (2023) had an average score on the obsessive-compulsive disorder scale of 32.90, SD= 19.87, while the average score for fear of coronavirus was 16.82, SD=5.79. Among the dimensions of OCD, contamination had the highest score of 9.04, SD=5.46, while stealing had the lowest score of 0.10, SD=0.49. Individuals with a history of infection had a significantly higher mean fear of COVID-19 than those without (P = 0.002). As the fear of coronavirus scale score increased, the score of obsessive-compulsive disorders also increased, except for the stealing dimension (P < 0.001) [53]. These studies highlight the significant impact of the COVID-19 pandemic on mental health, particularly among intern nurses. They underscore the need for targeted interventions and support systems to help these individuals cope with the ongoing crisis.

Limitations of the study

While the study provides valuable awareness of the relationship between the fear of COVID-19 and the severity of obsessive-compulsive symptoms among intern nurses, there are several potential limitations to consider. The reliance on self-reported data could introduce bias, as participants may not accurately recall or may underreport or overreport their symptoms. As a cross-sectional study, it provides a snapshot at a single point in time and does not allow for examining changes over time or determining causality. There may also be unmeasured confounding variables that could influence the observed relationship, such as personal resilience, pre-existing mental health conditions such as anxiety or depression, history of traumatic events, social support systems, coping mechanisms, and personality traits. The study's cultural context may limit the findings' generalizability to other cultural settings.

Conclusion and recommendations

The study's findings suggest that the COVID-19 pandemic has had significant psychological impacts on new nurses during their internship training period, including the manifestation of mental health symptoms such as obsessive-compulsive symptoms. It was observed that urban residents, intern nurses with recurrent COVID-19 infections, and those with more infected family members exhibited a higher severity of OCS. A notable correlation was found between the fear of COVID-19 and the severity of OCS among the intern nurses, indicating that fear of the virus may exacerbate OCS. However, it is essential to note that there are likely other contributing factors that need to be accounted for in this model that may also influence the severity of OCS. These findings underscore the need for further research to investigate additional factors that may influence OCS severity.

Nursing implications

The research underscores the importance of providing new interns with mental health support in internship training units. This could include counseling, stress management workshops, peer support groups, and telepsychiatry consultations. Training programs that arm nurses with effective coping strategies could enhance mental health outcomes and overall well-being. This is particularly crucial for those residing in urban areas, individuals infected multiple times, and their family members.

Availability of data and materials

No datasets were generated or analysed during the current study.


  1. Phan LT, Nguyen TV, Luong QC, Nguyen TV, Nguyen HT, Le HQ, et al. Importation and human-to-human transmission of a novel coronavirus in Vietnam. N Engl J Med. 2020;382(9):872–4.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Li Z, Ge J, Yang M, Feng J, Qiao M, Jiang R, et al. Vicarious traumatization in the general public, members, and non-members of medical teams aiding in COVID-19 control. Brain Behav Immun. 2020;88:916–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Schaalan M, Abou Warda AE, Osman SM, Fathy S, Sarhan RM, Boshra MS, et al. The impact of sociodemographic, nutritional, and Health Factors on the Incidence and Complications of COVID-19 in Egypt: A Cross-Sectional Study. Viruses. 2022;14(3):448.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Word Health Organization Egypt: WHO Coronavirus Disease (COVID-19) Dashboard with Vaccination. 2023. Available at:

  5. Gao J, Zheng P, Jia Y, Chen H, Mao Y, Chen S, et al. Mental health problems and social media exposure during COVID-19 Outbreak. PLoS One. 2020;15(4):e0231924.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Huang L, Lei W, Xu F, Liu H, Yu L. Emotional responses and coping strategies in nurses and nursing students during Covid-19 outbreak: a comparative study. PLoS One. 2020;15(8):e0237303.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Demaria F, Pontillo M, Di Vincenzo C, Di Luzio M, Vicari S. Hand washing: when ritual behavior protects! Obsessive-compulsive symptoms in young people during the COVID-19 pandemic: a narrative review. J Clin Med. 2022;11(11):3191.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Sulkowski ML, Mariaskin A, Storch EA. Obsessive-compulsive spectrum disorder symptoms in college students. J Am Coll Health. 2011;59(5):342–8.

    Article  PubMed  Google Scholar 

  9. Krebs GC, Hannigan LJ, Gregory AM, Rijsdijk FV, Maughan B, Eley TC. Are punitive parenting and stressful life events environmental risk factors for obsessive-compulsive symptoms in youth? Longitudinal twin studies. Eur Psychiatry. 2019;56(1):35–42.

    Article  CAS  PubMed  Google Scholar 

  10. Fontenelle LF, Miguel EC. The impact of coronavirus (COVID-19) in the diagnosis and treatment of obsessive-compulsive disorder. Depress Anxiety. 2020;37(6):510.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Grant JE, Drummond L, Nicholson TR, Fagan H, Baldwin DS, Fineberg NA, et al. Obsessive-compulsive symptoms and the Covid-19 pandemic: a rapid scoping review. Neurosci Biobehav Rev. 2022;132:1086–98.

    Article  CAS  PubMed  Google Scholar 

  12. American Psychiatric Association, Obsessive-Compulsive Disorder (OCD), last updated July 2017.

  13. Fenske JN, Petersen K. Obsessive-compulsive disorder: diagnosis and management. Are Fam Phys. 2015;92(10):896–903.

    Google Scholar 

  14. Torres AR, Fontenelle LF, Shavitt RG, Hoexter MQ, Pittenger C, Miguel EC. Epidemiology, comorbidity, and burden of OCD. In Obsessive-compulsive disorder: phenomenology, pathophysiology, and treatment. Oxford University Press, Oxford; 2017.

  15. Asghar MA, Rehman AA, Shafiq Y, Siddiq A, Zehravi M, Khan K, et al. Relationship of obsessive-compulsive disorders with religion and psychosocial attitude among local medical college students of Karachi: an epidemiological study. JPMA 2020;70(1563).

  16. Raynal P, Melioli T, Chabrol H. Personality disorder traits in young adults with subclinical obsessive-compulsive symptoms: not just traits related to obsessive-compulsive personality. Bull Menninger Clin. 2019;83(4):433–52.

    Article  PubMed  Google Scholar 

  17. Assareh M, Rakhshani T, Kashfi M, Ayazi M. Status of obsessive-compulsive disorder among Iranian college students in Kermanshah, Iran. J Hum Environ Health Promot. 2016;1(4):213–9.

  18. Leininger M, Taylor Dyches T, Prater MA, Heath MA. Teaching students with obsessive-compulsive disorder. Interv Sch Clin. 2010;45(4):221–31.

    Article  Google Scholar 

  19. M Ebrahim S, Diab Abd-el Wahab S, A Shokr E, A Radwan H. Effectiveness of mindfulness skills on self-efficacy and suicidal ideation among first-year nursing students with obsessive-compulsive symptoms during COVID-19 pandemic. Int Egypt J Nurs Sci Res. 2022;3(1):221-39.

  20. Chaabane S, Chaabna K, Bhagat S, Abraham A, Doraiswamy S, Mamtani R, et al. Perceived stress, stressors, and coping strategies among nursing students in the Middle East and North Africa: an overview of systematic reviews. Syst Rev. 2021;10(1):1–17.

    Article  Google Scholar 

  21. Elhadi M, Buzreg A, Bouhuwaish A, Khaled A, Alhadi A, Msherghi A, et al. The psychological impact of the civil war and COVID-19 on Libyan medical students: a cross-sectional study. Front Psychol. 2020;11:570435.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Al-Abbasi AH, Al-Khafaji AK, Al-Mamoori FA. Prevalence of obsessive-compulsive disorder symptoms among individuals in Asser province, Saudi Arabia: a cross-sectional study. Middle East Curr Psychiatry. 2023;30(1):1–7.

    Google Scholar 

  23. Taher TMJ, Al-faithful SAL, Abutiheen AA, Ghazi HF, Abood NS. Prevalence of obsessive-compulsive disorder (OCD) among Iraqi undergraduate medical students in time of COVID-19 pandemic. Middle East Curr Psychiatry. 2021;28(1):1–8.

    Article  Google Scholar 

  24. Shafighi AH, Atashzadeh-Shoorideh F, Ebadi A, Ghadirian F. Prevalence and predictors of COVID-centred obsessive-compulsive disorder among Iranian COVID-19 recovered individuals: a Bayesian analysis. BMC Psychiatry. 2023;23(1):1–9.

    Article  Google Scholar 

  25. El-Sayed Mahfouz HH, Araby Ebraheem SM, Saad NF, Mohamed SS, Sabry SS, Mahmoud AA. Effect of Educational Program About COVID-19 on Intern-Nurses' Performance and Work Engagement. Egypt J Nurs Health Sci. 2022;3(1):167–203.

  26. Kasemy ZA, Abd-Ellatif EE, Abdel Latif AA, Bahgat NM, Shereda HMA, Shattla SI, et al. Prevalence of Workaholism among Egyptian healthcare workers with an Assessment of its relation to the Quality of Life. Mental Health Burnout Front Public Health. 2020;8:581373.

    Article  PubMed  Google Scholar 

  27. Hussien RM, Shahin MAH, Ibrahim ME. Professional identity, wellness, and future hope among nurse interns in Egypt. Front Nurs. 2021;8(3):279–90.

    Article  Google Scholar 

  28. Ahorsu DK, Lin CY, Imani V, Saffari M, Griffiths MD, Pakpour AH. The fear of COVID-19 scale development and initial validation. Int J Ment Health Addict. 2020;1–9.

  29. Abdel-Khalek AM. The development and validation of the Arabic Obsessive-Compulsive Scale. Eur J Psychol Assess. 1998;14(2):146–58.

    Article  Google Scholar 

  30. Abdel-Khalek AM, Lester D. Reliability of the Arabic obsessive-compulsive scale in Kuwaiti and American students. Psychol Rep. 1998;83(3_suppl):1470–1470.

    Article  CAS  PubMed  Google Scholar 

  31. Rana N, Kalal N, Sharma SK. Fear and Challenges of Nursing Students Being in Hospital for Clinical Posting During the COVID-19 Pandemic: An Exploratory Survey. Front Psychol. 2022;13:867606.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Razzaque MA, Hussain S, Qadir G, Azad Y, Wahid A. Stress and its Influencing Factors among Intern Nurses during the Pandemic Outbreak of Covid-19. J Aziz Fatimah Med Dental Coll. 2022;4(2).

  33. Feizollahzadeh H, Hassankhani H, Barsaei M. Disturbances of nursing students in an internship during emerging disease COVID‐19 pandemic: a qualitative study. Nursing Open. 2023.

  34. Gül U, Altuntaş D, Efe E. A year and a half later: Clinical experiences of intern nursing students in the COVID-19 Pandemic: a constructivist grounded theory. Nurse Educ Pract. 2022;63:103381.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Meșterelu I, Rîmbu R, Blaga P, Stefan S. Obsessive-compulsive symptoms and reactions to the COVID-19 pandemic. Psychiatry Res. 2021;302:114021.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  36. Feizollahzadeh H, Hassankhani H, Barsaei M. Disturbances of nursing students in an internship during emerging disease COVID-19 pandemic: a qualitative study. Nurs Open. 2023.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Ghanbari V, Darvishi N, Kalhory P, Hadadian F, Rostamniya L, Abdi A, et al. Experienced challenges by internship nursing students during clinical training during the COVID-19 Pandemic Era: a qualitative content analysis. Educ Res Med Sci. 2022;11(2).

  38. Gamal Mostafa M, Mamdouh Abu Zead M. Lived experience of recovered COVID-19 nursing intern students: a qualitative study. Egypt J Health Care. 2021;12(1):1798–809.

  39. Aslan H, Pekince H. Nursing students’ views on the COVID-19 pandemic and their perceived stress levels. Perspect Psychiatr Care. 2021;57(2):695–701.

    Article  PubMed  Google Scholar 

  40. Okasha A. OCD in Egyptian adolescents: The effect of culture and religion. Psychiatric Times. 2004;21(5):1–5.

    Google Scholar 

  41. Rady A, Salama H, Wagdy M, Ketat A. Obsessive-compulsive phenomenology in a sample of Egyptian adolescent population. Eur J Psychiatry. 2013;27(2):89–96.

    Article  Google Scholar 

  42. Wang D, Lin B, Liang H, Deng Y, Zhang L. Mediating role of psychological flexibility in the effect of obsessive-compulsive symptoms on sleep quality among nurses during the COVID-19 pandemic. Curr Psychol. 2023;1–10.

  43. Ergenc H, Ergenc Z, Usanmaz M, Tor IH, Usanmaz H, Akcay EU. Investigating Anxiety, Depression, and obsessive-compulsive disorders (OCD) among healthcare workers in the COVID-19 unit and the control group. Medicine. 2020;9(4):1072–5.

    Article  Google Scholar 

  44. Cox RC, Olatunji BO. Linking insomnia and OCD symptoms during the coronavirus pandemic: examining prospective associations. J Anxiety Disorder. 2021;77:102341.

    Article  Google Scholar 

  45. Zhang W Rui, Wang K, Yin L, Zhao W Feng, Xue Q, Peng M, et al. Mental health and psychosocial problems of medical health workers during the COVID-19 epidemic in China. Psychother Psychosom. 2020;89(4):242–50.

  46. Pan KY, Kok AAL, Eikelenboom M, Horsfall M, Jörg F, Luteijn RA, et al. The mental health impact of the COVID-19 pandemic on people with and without depressive, anxiety, or obsessive-compulsive disorders: a longitudinal study of three Dutch case-control cohorts. Lancet Psychiatry. 2021;8(2):121–9.

    Article  PubMed  Google Scholar 

  47. Hobfoll SE. The influence of culture, community, and the nested self in the stress process: advancing conservation of resources theory. Appl Psychol. 2001;50(3):337–421.

    Article  Google Scholar 

  48. Ji G, Wei W, Yue KC, Li H, Shi LJ, Ma JD, et al. Effects of the COVID-19 pandemic on obsessive-compulsive symptoms among university students: prospective cohort survey study. J Med Internet Res. 2020;22(9).

  49. Cao W, Fang Z, Hou G, Han M, Xu X, Dong J, et al. The psychological impact of the COVID-19 epidemic on college students in China. Psychiatry Res. 2020;287:112934.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  50. Garfin DR, Silver RC, Holman EA. The novel coronavirus (COVID-2019) outbreak: Amplification of public health consequences by media exposure. Health Psychol. 2020;39(5):355.

    Article  PubMed  PubMed Central  Google Scholar 

  51. Prime H, Wade M, Browne DT. Risk and resilience in family well-being during the COVID-19 pandemic. Am Psychol Assoc. 2020;75(5):631–43.

    Article  Google Scholar 

  52. Kontoangelos K, Economou M, Papageorgiou C. Mental health effects of COVID-19 pandemia: a review of clinical and psychological traits. Psychiatry Investig 2020;17(6):491.

  53. Dehghani M, Hakimi H, Talebi M, Rezaee H, Mousazadeh N, Ahmadinia H, et al. The relationship between fear of Covid-19 and obsessive–compulsive disorder. BMC Psychol. 2023;11(1):1–7.

    Article  Google Scholar 

Download references


The authors would like to extend their sincere appreciation and gratitude to all the clients who willingly participated in this study.


Open access funding provided by The Science, Technology & Innovation Funding Authority (STDF) in cooperation with The Egyptian Knowledge Bank (EKB).

Author information

Authors and Affiliations



ME and MH conducted the initial study plan, conceptualization, and methodology. ST, EE, and HS contributed to the conceptualization, preparation, methodology, formal analysis, and data analysis. The final manuscript underwent a thorough review process involving all authors and was approved.

Corresponding author

Correspondence to Mona Metwally El-Sayed.

Ethics declarations

Ethics approval and consent to participate

The research adhered to the guidelines and regulations outlined in the Declaration of Helsinki (DoH-Oct2008). The Faculty of Nursing's Research Ethical Committee (REC) at El-Mansoura University approved data collection in this study (IRB000148389/91/9/2022). Participants were required to sign an informed consent form, which included an explanation of the research and an assessment of their understanding. They were informed that their participation was voluntary and that they could withdraw their consent without any adverse effects. Rigorous steps were taken to ensure the privacy and confidentiality of the data collected.

Consent for publication

Not Applicable.

Competing interests

The authors declare no competing interests.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

El-Sayed, M.M., Elhay, E.S.A., Hawash, M.M. et al. A closer look: obsessive-compulsive symptoms among intern nurses amidst COVID-19 pandemic. BMC Nurs 23, 214 (2024).

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: