Younes et al. BioPsychoSocial Medicine (2024) 18:4 https://doi.org/10.1186/s13030-024-00300-0 RESEARCH Open Access © The Author(s) 2024. 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 http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativeco mmons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. BioPsychoSocial Medicine Moderating effect of work fatigue on the association between resilience and posttraumatic stress symptoms: a cross-sectional multi-country study among pharmacists during the COVID-19 pandemic Samar Younes 1,2 , Souheil Hallit 3,4 , Irfan Mohammed 5 , Sarah El Khatib 2,6 , Anna Brytek‑Matera 7 , Shadrach Chinecherem Eze 8 , Kenneth Egwu 9 , Rawshan Jabeen 10 , Nebojša Pavlović 11 , Pascale Salameh 2,12,13,14 , Michelle Cherfane 2,12 , Marwan Akel 1,2 , Chadia Haddad 2,12,15,16 , Randa Choueiry 17 , Feten Fekih‑Romdhane 18,19† and Katia Iskandar 1,2,20,21*† Abstract Introduction In the context of the COVID‑19 pandemic, pharmacists, despite their vital contributions, have faced significant challenges that have impacted their mental well‑being, potentially leading to the development of Post‑ Traumatic Stress symptoms (PTSS). The aim of this study was to investigate the role of work‑related fatigue as a poten‑ tial moderator in the relationship between pharmacists’ resilience and their likelihood of experiencing PTSS dur‑ ing the COVID‑19 pandemic. Methods A cross‑sectional survey was conducted online in eight countries from January to December 2021, includ‑ ing Brazil, Lebanon, Nigeria, Pakistan, Poland, Serbia, and Tunisia. The mediation analysis was conducted using PRO‑ CESS MACRO (an SPSS add‑on) v3.4 model 1, taking work fatigue as a moderator in the association between resilience and PTSS. Results A total of 442 pharmacists were enrolled in this study (mean age = 33.91 ± 10.36 years) with 59.5% of them being females. The results were adjusted over country, gender, working in contact with COVID‑19, working patients, working mandatory hours, working voluntary hours, age, household crowding index and number of months engaged in COVID‑19. The interactions resilience by physical (Beta = 0.02; p = .029), mental (Beta = 0.02; p = .040) and emotional (Beta = 0.03; p = .008) work fatigue were significantly associated with PTSS; for pharmacists with low to moderate levels of physical (Beta = − 0.33; p < .001 and Beta = − 0.21; p = .001), mental (Beta = − 0.29; p < .001 and Beta = − 0.18; p = .006) and emotional (Beta = − 0.31; p < .001 and Beta = − 0.17; p = .008) work fatigue, higher resilience was significantly † Feten Fekih‑Romdhane and Katia Iskandar are last coauthors. *Correspondence: Katia Iskandar katia_iskandar@hotmail.com Full list of author information is available at the end of the article