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Kamra M, Dhaliwal S, Li W, Acharya S, Wong A, Zhu A, Vemulakonda J, Wilson J, Gibb M, Maskerine C, Spilg E, Tanuseputro P, Myran DT, Solmi M, Sood MM. Physician Posttraumatic Stress Disorder During COVID-19: A Systematic Review and Meta-Analysis. JAMA Netw Open 2024; 7:e2423316. [PMID: 39046740 PMCID: PMC11270139 DOI: 10.1001/jamanetworkopen.2024.23316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Accepted: 05/22/2024] [Indexed: 07/25/2024] Open
Abstract
Importance The COVID-19 pandemic placed many physicians in situations of increased stress and challenging resource allocation decisions. Insight into the prevalence of posttraumatic stress disorder in physicians and its risk factors during the COVID-19 pandemic will guide interventions to prevent its development. Objective To determine the prevalence of posttraumatic stress disorder (PTSD) among physicians during the COVID-19 pandemic and examine variations based on factors, such as sex, age, medical specialty, and career stage. Data Sources A Preferred Reporting Items for Systematic Reviews and Meta-analyses-compliant systematic review was conducted, searching MEDLINE, Embase, and PsychInfo, from December 2019 to November 2022. Search terms included MeSH (medical subject heading) terms and keywords associated with physicians as the population and PTSD. Study Selection Peer-reviewed published studies reporting on PTSD as a probable diagnosis via validated questionnaires or clinician diagnosis were included. The studies were reviewed by 6 reviewers. Data Extraction and Synthesis A random-effects meta-analysis was used to pool estimates of PTSD prevalence and calculate odds ratios (ORs) for relevant physician characteristics. Main Outcomes and Measures The primary outcome of interest was the prevalence of PTSD in physicians, identified by standardized questionnaires. Results Fifty-seven studies with a total of 28 965 participants and 25 countries were included (of those that reported sex: 5917 of 11 239 [52.6%] were male and 5322 of 11 239 [47.4%] were female; of those that reported career stage: 4148 of 11 186 [37.1%] were medical trainees and 7038 of 11 186 [62.9%] were attending physicians). The estimated pooled prevalence of PTSD was 18.3% (95% CI, 15.2%-22.8%; I2 = 97%). Fourteen studies (22.8%) reported sex, and it was found that female physicians were more likely to develop PTSD (OR, 1.93; 95% CI, 1.56-2.39). Of the 10 studies (17.5%) reporting age, younger physicians reported less PTSD. Among the 13 studies (22.8%) reporting specialty, PTSD was most common among emergency department doctors. Among the 16 studies (28.1%) reporting career stage, trainees were more prone to developing PTSD than attendings (OR, 1.33; 95% CI, 1.12-1.57). Conclusions and Relevance In this meta-analysis examining PTSD during COVID-19, 18.3% of physicians reported symptoms consistent with PTSD, with a higher risk in female physicians, older physiciansy, and trainees, and with variation by specialty. Targeted interventions to support physician well-being during traumatic events like pandemics are required.
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Affiliation(s)
- Mihir Kamra
- McMaster University, Hamilton, Ontario, Canada
| | - Shan Dhaliwal
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Wenshan Li
- The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | | | - Adrian Wong
- McMaster University, Hamilton, Ontario, Canada
| | - Andy Zhu
- McMaster University, Hamilton, Ontario, Canada
| | | | - Janet Wilson
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Maya Gibb
- The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | | | - Edward Spilg
- The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Peter Tanuseputro
- The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada
- ICES, Ontario, Canada
- Bruyere Research Institute, Ottawa, Ontario, Canada
| | - Daniel T. Myran
- ICES, Ontario, Canada
- Bruyere Research Institute, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Marco Solmi
- The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
- Department of Psychiatry, University of Ottawa, Ottawa, Ontario, Canada
- Deptartment of Mental Health, The Ottawa Hospital, Ottawa, Ontario, Canada
- Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany
| | - Manish M. Sood
- The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada
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Tao R, Hsu M, Min K, Mo D, Geng F, Xia L, Liu T, Liu Y, Jiang F, Liu H, Tang YL. Alcohol misuse, health-related behaviors, and burnout among clinical therapists in China during the early Covid-19 pandemic: A Nationwide survey. Front Public Health 2023; 11:1084259. [PMID: 37089496 PMCID: PMC10118037 DOI: 10.3389/fpubh.2023.1084259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 03/20/2023] [Indexed: 04/25/2023] Open
Abstract
Objectives This study aimed to assess the extent of alcohol use and misuse among clinical therapists working in psychiatric hospitals in China during the early COVID-19 Pandemic, and to identify associated factors. Methods An anonymous nationwide survey was conducted in 41 tertiary psychiatric hospitals. We collected demographic data as well as alcohol use using the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) and burnout using the Maslach Burnout Inventory Human Services Survey. Results In total, 396 clinical therapists completed the survey, representing 89.0% of all potential participants we targeted. The mean age of participants was 33.8 years old, and more than three-quarters (77.5%) were female. Nearly two-fifths (39.1%) self-reported as current alcohol users. The overall prevalence of alcohol misuse was 6.6%. Nearly one-fifth (19.9%) reported symptoms of burnout with high emotional exhaustion in 46 (11.6%), and high depersonalization in 61 (15.4%). Multiple logistic regression showed alcohol use was associated with male gender (OR = 4.392; 95% CI =2.443-7.894), single marital status (OR = 1.652; 95% CI =0.970-2.814), smoking habit (OR = 3.847; 95%CI =1.160-12.758) and regular exercise (OR = 2.719; 95%CI =1.490-4.963). Alcohol misuse was associated with male gender (OR = 3.367; 95% CI =1.174-9.655), a lower education level (OR = 3.788; 95%CI =1.009-14.224), smoking habit (OR = 4.626; 95%CI =1.277-16.754) and high burnout (depersonalization, OR = 4.848; 95%CI =1.433-16.406). Conclusion During the COVID-19 pandemic, clinical therapists' alcohol consumption did not increase significantly. Male gender, cigarette smoking, and burnout are associated with an increased risk of alcohol misuse among clinical therapists. Targeted intervention is needed when developing strategies to reduce alcohol misuse and improve clinical therapists' wellness and mental health.
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Affiliation(s)
- Rui Tao
- Department of Substance-Related Disorders, Affiliated Psychological Hospital of Anhui Medical University, Hefei, China
- Department of Psychiatry, Chao hu Hospital of Anhui Medical University, Hefei, China
- Department of Psychiatry, School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, China
- Department of Substance-Related Disorders, Hefei Fourth People’s Hospital, Hefei, China
| | - Michael Hsu
- Addiction Psychiatry Fellowship Program, Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, GA, United States
| | - Kaiyuan Min
- State Key Laboratory of Medical Molecular Biology, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Daming Mo
- Department of Substance-Related Disorders, Affiliated Psychological Hospital of Anhui Medical University, Hefei, China
- Department of Psychiatry, Chao hu Hospital of Anhui Medical University, Hefei, China
- Department of Psychiatry, School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, China
- Department of Substance-Related Disorders, Hefei Fourth People’s Hospital, Hefei, China
| | - Feng Geng
- Department of Psychiatry, Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Lei Xia
- Department of Psychiatry, Chao hu Hospital of Anhui Medical University, Hefei, China
- Department of Psychiatry, School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, China
| | - Tingfang Liu
- Research Department, School of Health Policy and Management, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yuanli Liu
- Research Department, School of Health Policy and Management, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Feng Jiang
- Research Department, School of International and Public Affairs, Shanghai Jiao Tong University, Shanghai, China
- Research Department, Institute of Healthy Yangtze River Delta, Shanghai Jiao Tong University, Shanghai, China
| | - Huanzhong Liu
- Department of Psychiatry, Chao hu Hospital of Anhui Medical University, Hefei, China
- Department of Psychiatry, School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, China
- Department of Psychiatry, Anhui Psychiatric Center, Hefei, China
| | - Yi-lang Tang
- Addiction Psychiatry Fellowship Program, Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, GA, United States
- Mental Health Service Line, Atlanta Veterans Affairs Medical Center, Decatur, GA, United States
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Andhavarapu S, Yardi I, Bzhilyanskaya V, Lurie T, Bhinder M, Patel P, Pourmand A, Tran QK. Post-traumatic stress in healthcare workers during the COVID-19 pandemic: A systematic review and meta-analysis. Psychiatry Res 2022; 317:114890. [PMID: 36260970 PMCID: PMC9573911 DOI: 10.1016/j.psychres.2022.114890] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 10/02/2022] [Accepted: 10/06/2022] [Indexed: 01/05/2023]
Abstract
The SARS-CoV-2 (COVID-19) pandemic has increased healthcare worker (HCW) susceptibility to mental illness. We conducted a meta-analysis to investigate the prevalence and possible factors associated with post-traumatic stress disorder (PTSD) symptoms among HCW during the COVID-19 pandemic. We searched PubMed, SCOPUS and EMBASE databases up to May 4th, 2022. We performed random effects meta-analysis and moderator analyses for the prevalence of PTSD-relevant symptoms and severe PTSD symptoms. We identified 1276 studies, reviewed 209 full-text articles, and included 119 studies (117,143 participants) with a total of 121 data points in our final analysis. 34 studies (24,541 participants) reported prevalence of severe PTSD symptoms. Approximately 25.2% of participants were physicians, 42.8% nurses, 12.4% allied health professionals, 8.9% auxiliary health professionals, and 10.8% "other". The pooled prevalence of PTSD symptoms among HCWs was 34% (95% CI, 0.30-0.39, I2 >90%), and 14% for severe PTSD (95% CI, 0.11 - 0.17, I2 >90%). The introduction of COVID vaccines was associated with a sharp decline in the prevalence of PTSD, and new virus variants were associated with small increases in PTSD rates. It is important that policies work towards allocating adequate resources towards protecting the well-being of healthcare workers to minimize adverse consequences of PTSD.
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Affiliation(s)
- Sanketh Andhavarapu
- The Research Associate Program, Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Isha Yardi
- The Research Associate Program, Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Vera Bzhilyanskaya
- The Research Associate Program, Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Tucker Lurie
- The Research Associate Program, Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Mujtaba Bhinder
- The Research Associate Program, Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Priya Patel
- The Research Associate Program, Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Ali Pourmand
- Department of Emergency Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC, United States
| | - Quincy K Tran
- Department of Emergency Medicine, University of Maryland School of Medicine, 22 South Greene Street, Suite T3N45, Baltimore, MD 21043, United States; Program in Trauma, The R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD, United States.
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