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

Abstract 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. Methods: 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. Results: 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 (Q^2predict = 0.222; RMSE = 0.887, MAE = 0.684), compared to HBM (Q^2predict = 0.093; RMSE = 0.960, MAE = 0.726). Conclusion: 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. Keywords: Health belief, Experiential Avoidance, Health behavior, PTSD, Sociodemographic Variables