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Uddin H, Hasan MK, Cuartas-Alvarez T, Castro-Delgado R. Effects of mass casualty incidents on anxiety, depression, and post-traumatic stress disorder among doctors and nurses: a systematic review. Public Health 2024; 234:132-142. [PMID: 39002283 DOI: 10.1016/j.puhe.2024.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 05/30/2024] [Accepted: 06/03/2024] [Indexed: 07/15/2024]
Abstract
OBJECTIVES Doctors and nurses suffer different mental health conditions following traumatic incidents. We systematically synthesized existing evidence on the prevalence of anxiety, depression, and post-traumatic stress disorder (PTSD) and their associated risk factors among doctors and nurses following mass casualty incidents (MCIs). STUDY DESIGN Systematic review. METHODS Seven databases were searched (2010-2022) with peer-reviewed articles in English using the predefined keywords. Two reviewers screened the titles, abstracts, and full texts using the eligibility criteria and extracted data independently. We used the National Institutes of Health Quality Assessment Tools (NIH-QAT) and the Critical Appraisal Skills Programme checklist (CASP) to measure the quality appraisal of the included studies. RESULTS A total of 5170 articles were retrieved, and 2512 articles were assessed by title and abstract (53 were eligible for full-text review). Finally, we included 19 studies. Most were assessed as of fair quality with a considerable risk of bias. PTSD was the highest-reported mental health condition. Nurses reported higher mental conditions, particularly PTSD. Two sets of risk factors (personal and workplace) are associated with anxiety, depression, and PTSD were found. CONCLUSIONS MCIs have a significant impact on the mental health outcomes of emergency health workers. Preventive measures should be designed considering the high-risk group, personal, and organizational risk factors of mental health outcomes.
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Affiliation(s)
- H Uddin
- Department of Medicine, University of Oviedo, Oviedo 33006, Spain; Department of Global Public Health, Karolinska Institutet, Solna 17177, Sweden; Department of Sociology, East West University, Dhaka 1212, Bangladesh; South Asian Institute for Social Transformation (SAIST), Dhaka 1205, Bangladesh.
| | - M K Hasan
- Institute of Disaster Management and Vulnerability Studies, University of Dhaka, Dhaka 1000, Bangladesh; School of Nursing and Midwifery, Griffith University, Gold Coast, Queensland, Australia
| | - T Cuartas-Alvarez
- Health Service of the Principality of Asturias (SAMU-Asturias), Health Research Institute of the Principality of Asturias (Research Group on Prehospital Care and Disasters, GIAPREDE), Oviedo 33001, Spain; RINVEMER-SEMES (Research Network on Prehospital Care-Spanish Society of Emergency Medicine), Madrid, Spain
| | - R Castro-Delgado
- Department of Medicine, University of Oviedo, Oviedo 33006, Spain; Health Service of the Principality of Asturias (SAMU-Asturias), Health Research Institute of the Principality of Asturias (Research Group on Prehospital Care and Disasters, GIAPREDE), Oviedo 33001, Spain; RINVEMER-SEMES (Research Network on Prehospital Care-Spanish Society of Emergency Medicine), Madrid, Spain.
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Matthews LR, Alden LE, Wagner S, Carey MG, Corneil W, Fyfe T, Randall C, Regehr C, White M, Buys N, White N, Fraess-Phillips A, Krutop E. PREVALENCE AND PREDICTORS OF POSTTRAUMATIC STRESS DISORDER, DEPRESSION, AND ANXIETY IN PERSONNEL WORKING IN EMERGENCY DEPARTMENT SETTINGS: A SYSTEMATIC REVIEW. J Emerg Med 2022; 62:617-635. [PMID: 35379514 DOI: 10.1016/j.jemermed.2021.09.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 08/15/2021] [Accepted: 09/11/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Professionals working in the emergency department (ED) are regularly exposed to traumatic events. Rates of posttraumatic mental health conditions vary widely in the literature and there is no agreement that rates in ED staff are elevated relative to other populations. OBJECTIVE We conducted a systematic review of international literature reporting prevalence of posttraumatic stress disorder (PTSD), depression, and anxiety in ED personnel to determine whether prevalence is elevated compared to the general community, and to evaluate convergent evidence across the literature for predictive factors. To our knowledge, there is no comprehensive review on this topic in the literature at this time. METHODS Seven databases were searched for studies reporting rates of PTSD, depression, and anxiety in ED personnel. Two independent researchers screened studies and assessed quality using Munn's Prevalence Critical Appraisal Instrument. Best-evidence synthesis determined whether conditions demonstrated elevated prevalence compared to the general population of Canada, a conservative benchmark. RESULTS Twenty-four studies from 12 countries and a combined sample size of 4768 were included. PTSD rates ranged from 0% to 23.6% (mean 10.47%), depression ranged from 0.7% to 77.1% (mean 24.8%), and anxiety rates ranged from 2.4% to 14.6% (mean 9.29%). Each condition was elevated compared to the general population. Sociodemographic variables were not consistent predictors. Elevated PTSD seemed most strongly related to workplace exposure and maladaptive coping. CONCLUSIONS ED professionals have an elevated risk of experiencing PTSD, depression, and anxiety. Identification of organizational and workplace predictors are needed to inform interventions that will reduce risk and provide optimal treatment and management of PTSD, depression, and anxiety in ED settings.
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Affiliation(s)
- Lynda R Matthews
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, New South Wales, Australia
| | - Lynn E Alden
- Department of Psychology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Shannon Wagner
- College of Arts, Social and Health Sciences, University of Northern British Columbia, Prince George, British Columbia, Canada
| | - Mary G Carey
- School of Nursing, University of Rochester, Rochester, New York
| | - Wayne Corneil
- Interdisciplinary School of Health Sciences and Telfer School of Management, University of Ottawa, Ottawa, Ontario, Canada
| | - Trina Fyfe
- Northern Medical Program, University of Northern British Columbia, Prince George, British Columbia, Canada
| | - Christine Randall
- School of Allied Health Sciences, Health Group, Menzies Health Institute of Queensland, Griffith University, Gold Coast Campus, Southport, Queensland, Australia
| | | | - Marc White
- Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada
| | - Nicholas Buys
- Menzies Health Institute of Queensland, Griffith University, Gold Coast Campus, Southport, Queensland, Australia
| | - Nicole White
- University of Northern British Columbia, Prince George, British Columbia, Canada
| | - Alex Fraess-Phillips
- School of Health Sciences, University of Northern British Columbia, Prince George, British Columbia, Canada
| | - Elyssa Krutop
- Aligned Kamloops, Kamloops, British Columbia, Canada
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Hilaire Schneider C, Saint-Cast A, Michelland L, de Stefano C, Radou L, Chouied T, Savary D, Gueye P, Jehel L, Lapostolle F. [Psychological effects of emergency calls management on medical dispatcher assistants in a SAMU-Center 15]. Encephale 2020; 47:388-394. [PMID: 33190817 DOI: 10.1016/j.encep.2020.06.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 06/08/2020] [Accepted: 06/19/2020] [Indexed: 11/29/2022]
Abstract
INTRODUCTION In France, the emergency call center is called SAMU (service d'aide médicale d'urgence). The Medical Dispatcher Assistant (MDA) is the first responder and is exposed to first calls of distress and has a high risk of stress disorder. AIM Psychological impact of emergency calls on MDA. METHOD National multicenter prospective study from January to August 2018 by electronic surveys, including all MDA of 13 SAMU, subdivided in 5 sections: population characteristics, PCL-5 scale (DSM-5) assessing post-traumatic stress disorder (PTSD), ProQOL assessing professional quality of life, call categories and an MDA's emotional perception, and work impacts on an MDA's quality of life. Univariate descriptive statistical analysis of the group with PCL-5≥34 (=complete PTSD group) and with PCL-5<34 (=group without complete PTSD). RESULTS Of 400 MDA asked to be interviewed, 283 (71 %) replied of whom 72 % (205) were women and 28 % (79) men. Age groups: 9 % (25) for 18-25 yrs, 39 % (110) for 26-35 yrs, 31 % (89) 36-45 yrs, 15 % (43) 46-55 yrs and 6 % (16) for more than 56 yrs. All MDA reported having been exposed to death experience. For 46 % (129) the most recent traumatic event occurred within the last 7 months. 78 % (219) have reported intense fear, feeling helpless, or even sensed horror when answering the calls. 97 % (273) could talk about it with colleagues but only 64 % (180) with family. 72 % (203) felt lack of recognition at work. 78 % (220) had no knowledge about psycho-traumatic disorder. While 11 % (30) suffered symptoms suggestive of a complete PTSD, 15 % (42) an incomplete PTSD, 3 % (8) suffer burnout and 4 % (11) compassion fatigue, none reported secondary traumatic stress. The only significant difference (P<0.05) between the two groups characteristics was on the education level. 74 % (22) of the MDA with a complete PTSD had a High School diploma or less. MDA with symptoms suggestive of complete PTSD developed significantly (P<0.001) more stress reduction strategies (alcohol, drugs, medication) (13 % vs 2 %), had more food disorders (80.5 % vs 38 %), more sleeping problems (75.5 % vs 21 %), more anxiety (67 % vs 17 %), and more sick leaves (13 % vs 4 %) than the group without complete PTSD. CONCLUSION Part of the surveyed MDAs showed symptoms suggestive of PTSD. The study highlights that MDAs is a vulnerable population, and PTSD prevention techniques should be systematically implemented for them. The study also highlights that a higher education level prevents the psycho traumatic process with its accompanying disorders.
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Affiliation(s)
- C Hilaire Schneider
- SAMU 93, UF recherche, enseignement, qualité, université Paris 13, Sorbonne-Paris cité, Inserm U942, hôpital Avicenne, AP-HP, 125, rue de Stalingrad, 93009 Bobigny, France.
| | - A Saint-Cast
- SAMU 93, UF recherche, enseignement, qualité, université Paris 13, Sorbonne-Paris cité, Inserm U942, hôpital Avicenne, AP-HP, 125, rue de Stalingrad, 93009 Bobigny, France
| | - L Michelland
- SAMU 93, UF recherche, enseignement, qualité, université Paris 13, Sorbonne-Paris cité, Inserm U942, hôpital Avicenne, AP-HP, 125, rue de Stalingrad, 93009 Bobigny, France; Hôpital Saint-Louis, Inserm 1153, AP-HP, Paris, France
| | - C de Stefano
- SAMU 93, UF recherche, enseignement, qualité, université Paris 13, Sorbonne-Paris cité, Inserm U942, hôpital Avicenne, AP-HP, 125, rue de Stalingrad, 93009 Bobigny, France; Service de psychiatrie de l'enfant et de l'adolescent et psychiatrie générale, hôpital Avicenne, université Sorbonne-Paris 13, Paris Cité, laboratoire UTRPP (EA4403), AP-HP, Paris, France
| | - L Radou
- SAMU 72, CH de Le Mans, 194, avenue Rubillard, 72037 Le Mans cedex 9, France
| | - T Chouied
- SAMU 54, Emergency Department, University Hospital of Nancy, Nancy, France; Faculté de médecine, centre d'investigations cliniques plurithématique 1433, institut Lorrain-du cœur et des vaisseaux, France groupe choc, Inserm U1116, Université de Lorraine, 54500 Vandoeuvre-les-Nancy, France
| | - D Savary
- Centre hospitalier universitaire d'Angers, 4, rue Larrey, 49933 Angers, France
| | - P Gueye
- SAMU 972, CHU de Martinique, 97200 Fort-de-France, Martinique
| | - L Jehel
- Département de psychiatrie et psychologie médicale, CHU de Martinique, 97200 Fort-de-France, Martinique; Université des Antilles, CESP-Inserm U1178 équipe IPSOM, 97261 Fort-de-France cedex, Martinique
| | - F Lapostolle
- SAMU 93, UF recherche, enseignement, qualité, université Paris 13, Sorbonne-Paris cité, Inserm U942, hôpital Avicenne, AP-HP, 125, rue de Stalingrad, 93009 Bobigny, France
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Campillo-Cruz M, González-Gutiérrez JL, Ardoy-Cuadros J, Fernández-Muñoz JJ. The Development and Exploratory Psychometric Properties of the Traumatic and Routine Stressors Scale on Emergency Nurses (TRSS-EN). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17061963. [PMID: 32192115 PMCID: PMC7143067 DOI: 10.3390/ijerph17061963] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 03/13/2020] [Accepted: 03/15/2020] [Indexed: 01/05/2023]
Abstract
Emergency nurses are exposed to traumatic events and routine stressors, both of which can lead to the development of PTSD (Post Traumatic Stress Disorder) symptomatology. However, there are currently no instruments designed to assess the impact and frequency of such sources of stress in nurses. The Traumatic and Routine Stressors Scale on Emergency Nurses (TRSS-EN) was built for this purpose. A sample of 147 emergency nurses from three hospitals in Madrid (Spain) completed this 13-item scale. The analyses showed a factorial structure composed of two factors. The first is characterized by items regarding traumatic and stressful events and procedures of severe magnitude (traumatic stressors), and the second by items related to stressful events and procedures of moderate magnitude (routine stressors) but hypothesized to possess a substantial traumatic potential. Analyses provided evidence of both adequate internal consistency (Cronbach’s α = 0.92; first factor α = 0.91 and second factor α = 0.86) and test–retest reliability. In addition, concurrent validity also proved to be satisfactory. In short, TRSS-EN seems to be a reliable and valid tool in a healthcare emergency nursing setting for screening the frequency and impact of exposure to everyday work-related traumatic stressors, either event-related or routine.
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Impact of Stressful Events on Motivations, Self-Efficacy, and Development of Post-Traumatic Symptoms among Youth Volunteers in Emergency Medical Services. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16091613. [PMID: 31071966 PMCID: PMC6540098 DOI: 10.3390/ijerph16091613] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 05/04/2019] [Accepted: 05/06/2019] [Indexed: 11/17/2022]
Abstract
During the last decades, Israeli emergency medical services (EMS) personnel has been exposed to different potentially traumatic events, including mass terror attacks. The aims of the present study were to identify how potentially traumatic events affect young volunteers in their motivation to volunteer and their perceived self-efficacy while being at risk of developing post-traumatic symptoms. The final sample included 236 Magen David Adom (MDA, the "Israeli Red Cross") youth volunteers. The study evaluated their motivational factors for volunteering, perceived self-efficacy, participation in potentially traumatic events, and post-traumatic symptoms. Over two-thirds of the volunteers participated in a traumatic event on duty. Volunteers who were involved in potentially stressful events scored higher levels of post-traumatic symptoms, though still very low and subclinical. Nonetheless, participating in stressful events contributed to an increased sense of self-efficacy. No difference in post-traumatic symptom levels was observed between volunteers who partook in mass casualty incidents and those who did not. The results demonstrate that MDA youth volunteers may mostly benefit from participating in situations requiring the administration of emergency medicine, even stressful ones. They may help to find ways to empower the volunteers and increase their resilience.
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Naylor K, Torres A, Gałązkowski R, Torres K. Self-reported occupational blood exposure among paramedics in Poland: a pilot study. INTERNATIONAL JOURNAL OF OCCUPATIONAL SAFETY AND ERGONOMICS 2018. [PMID: 29521581 DOI: 10.1080/10803548.2018.1450717] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Introduction. Paramedics are at risk of occupational blood exposure, increased by the immediacy of provided treatment. However, the issue has not been acknowledged to date by any research in Europe. Methods. This research aimed at assessing occupational blood exposure among paramedics in Poland. Respondents represented 21 Polish medical institutions. Their participation was voluntary and anonymous. Paramedics were provided with a self-directed job-specific questionnaire adapted to Polish conditions from an original US version. Results. 118 paramedics participated in the study from institutions constituting the National Emergency Medical System in Poland; including ambulance crews, Helicopter Emergency Medical Services and emergency department employees. Occupational exposure was reported by 18.64% of respondents and the main route of exposure was needlestick events. Conclusions. There is a further need to improve education among paramedics concerning the threat of being infected with blood-borne pathogens through all existing routes. Our findings point to the problem as being hidden and considered a shameful issue.
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Affiliation(s)
- Katarzyna Naylor
- a Department of Didactics and Medical Simulation, Medical University of Lublin , Poland
| | - Anna Torres
- b Laboratory of Biostructure, Medical University of Lublin , Poland
| | | | - Kamil Torres
- a Department of Didactics and Medical Simulation, Medical University of Lublin , Poland
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Carmassi C, Gesi C, Corsi M, Cremone IM, Bertelloni CA, Massimetti E, Olivieri MC, Conversano C, Santini M, Dell'Osso L. Exploring PTSD in emergency operators of a major University Hospital in Italy: a preliminary report on the role of gender, age, and education. Ann Gen Psychiatry 2018; 17:17. [PMID: 29755579 PMCID: PMC5935923 DOI: 10.1186/s12991-018-0184-4] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Accepted: 04/09/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Emergency services personnel face frequent exposure to potentially traumatic events, with the potential for chronic symptomatic distress. The DSM-5 recently recognized a particular risk for post-traumatic stress disorder (PTSD) among first responders (criterion A4) but data are still scarce on prevalence rates and correlates. OBJECTIVE The aim of the present study was to explore the possible role of age, gender, and education training in a sample of emergency personnel diagnosed with DSM-5 PTSD. METHODS The Trauma and Loss Spectrum-Self-Report (TALS-SR) and the Work and Social Adjustment Scale (WSAS) were administered to 42 between nurses and health care assistants, employed at the emergency room of a major University Hospital (Pisa) in Italy. RESULTS 21.4% of the sample reported DSM-5 PTSD with significantly higher scores in the TALS-SR domain exploring the acute reaction to trauma and losses among health care assistants, older, and non-graduated subjects. A significant correlation between the number of the TALS-SR symptoms endorsed, corresponding to DSM-5 PTSD diagnostic criteria emerged in health care assistants. CONCLUSIONS Despite further studies are needed in larger samples, our data suggest a high risk for PTSD and post-traumatic stress spectrum symptoms in nurses and health care workers operating in an emergency department, particularly among health care assistants, women, older, and non-graduated operators.
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Affiliation(s)
- Claudia Carmassi
- 1Section of Psychiatry, Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, 56100 Pisa, Italy
| | - Camilla Gesi
- 1Section of Psychiatry, Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, 56100 Pisa, Italy
| | - Martina Corsi
- 1Section of Psychiatry, Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, 56100 Pisa, Italy
| | - Ivan M Cremone
- 1Section of Psychiatry, Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, 56100 Pisa, Italy
| | - Carlo A Bertelloni
- 1Section of Psychiatry, Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, 56100 Pisa, Italy
| | - Enrico Massimetti
- 1Section of Psychiatry, Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, 56100 Pisa, Italy
| | | | - Ciro Conversano
- 1Section of Psychiatry, Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, 56100 Pisa, Italy
| | - Massimo Santini
- Emergency Medicine and Emergency Room Unit, AOUP, Pisa, Italy
| | - Liliana Dell'Osso
- 1Section of Psychiatry, Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, 56100 Pisa, Italy
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Carmassi C, Gesi C, Simoncini M, Favilla L, Massimetti G, Olivieri MC, Conversano C, Santini M, Dell'Osso L. DSM-5 PTSD and posttraumatic stress spectrum in Italian emergency personnel: correlations with work and social adjustment. Neuropsychiatr Dis Treat 2016; 12:375-81. [PMID: 26937192 PMCID: PMC4762463 DOI: 10.2147/ndt.s97171] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5) has recently recognized a particular risk for posttraumatic stress disorder (PTSD) among first responders (criterion A4), acknowledging emergency units as stressful places of employment. Little data is yet available on DSM-5 among emergency health operators. The aim of this study was to assess DSM-5 symptomatological PTSD and posttraumatic stress spectrum, as well as their impact on work and social functioning, in the emergency staff of a major university hospital in Italy. One hundred and ten subjects (doctors, nurses, and health-care assistants) were recruited at the Emergency Unit of the Azienda Ospedaliero-Universitaria Pisana (Italy) and assessed by the Trauma and Loss Spectrum-Self Report (TALS-SR) and Work and Social Adjustment Scale (WSAS). A 15.7% DSM-5 symptomatological PTSD prevalence rate was found. Nongraduated persons reported significantly higher TALS-SR Domain IV (reaction to loss or traumatic events) scores and a significantly higher proportion of individuals presenting at least one maladaptive behavior (TALS-SR Domain VII), with respect to graduate ones. Women reported significantly higher WSAS scores. Significant correlations emerged between PTSD symptoms and WSAS total scores among health-care assistants, nongraduates and women. Our results showed emergency workers to be at risk for posttraumatic stress spectrum and related work and social impairment, particularly among women and nongraduated subjects.
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Affiliation(s)
- Claudia Carmassi
- Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, Pisa, Italy
| | - Camilla Gesi
- Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, Pisa, Italy
| | - Marly Simoncini
- Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, Pisa, Italy
| | - Luca Favilla
- Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, Pisa, Italy
| | - Gabriele Massimetti
- Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, Pisa, Italy
| | - Maria Cristina Olivieri
- Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, Pisa, Italy
| | - Ciro Conversano
- Emergency Medicine and Emergency Room Unit, Azienda Ospedaliero-Universitaria Pisana (AOUP), Pisa, Italy
| | - Massimo Santini
- Emergency Medicine and Emergency Room Unit, Azienda Ospedaliero-Universitaria Pisana (AOUP), Pisa, Italy
| | - Liliana Dell'Osso
- Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, Pisa, Italy
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Sheen K, Slade P, Spiby H. An integrative review of the impact of indirect trauma exposure in health professionals and potential issues of salience for midwives. J Adv Nurs 2013; 70:729-43. [DOI: 10.1111/jan.12274] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2013] [Indexed: 11/29/2022]
Affiliation(s)
- Kayleigh Sheen
- Institute of Psychology; Health and Society; University of Liverpool; UK
| | - Pauline Slade
- Institute of Psychology; Health and Society; University of Liverpool; UK
| | - Helen Spiby
- School of Health Sciences; Queen's Medical Centre; Nottingham UK
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