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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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Negri L, Bassi M, Accardi R, Delle Fave A. Post-traumatic stress symptoms and benefit finding: a longitudinal study among Italian health workers during the COVID-19 pandemic. Soc Psychiatry Psychiatr Epidemiol 2023; 58:1549-1559. [PMID: 37029827 PMCID: PMC10082687 DOI: 10.1007/s00127-023-02475-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 03/30/2023] [Indexed: 04/09/2023]
Abstract
PURPOSE Research has highlighted that the exposure of healthcare professionals to the COVID-19 pandemic for over two years can lead to the development and persistence of symptoms characteristic of Post-Traumatic Stress Disorder (PTSD), with serious consequences on both the individual well-being and the quality of care provided. The present study was aimed at investigating the role of benefit finding in moderating post-traumatic stress symptoms (PTSS) over time. METHODS The longitudinal study, conducted between April and October 2020, involved 226 Italian health workers (44.7% nurses and midwives, 35% doctors, 20.3% technical and rehabilitation professionals), who filled out an online survey at the beginning of the study (T1), after three months (T2), and after six months (T3). Participants (77.4% women; mean age = 41.93, SD = 12.06) completed the PTSD Checklist for DSM-5 (PCL-5) and Benefit Finding, a 17-item questionnaire measuring the perceived level of positive consequences derived from stressful experiences. A hierarchical regression analysis highlighted the moderating effect of benefit finding (T2) on the association between PTSS values at T1 and T3. RESULTS A buffering effect was observed, with higher benefit finding levels reducing the magnitude of the bivariate association between PTSS assessed at the beginning and at the end of the study. CONCLUSION Findings suggest the potential mental health related benefits of interventions allowing health professionals to identify positive aspects in the experience of working under prolonged emergency circumstances, such as the pandemic ones.
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Affiliation(s)
- Luca Negri
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Via F. Sforza 35, 20122, Milan, Italy.
| | - Marta Bassi
- Department of Biomedical and Clinical Sciences, Università degli Studi di Milano, Milan, Italy
| | - Roberto Accardi
- Health Professions Directorate, Fondazione I.R.C.C.S. Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Antonella Delle Fave
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Via F. Sforza 35, 20122, Milan, Italy
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Gong Y, Guo Z, Lu H, Wang X, Zhang Y, Ren L, Zhu X. Network analysis of acute stress reaction in a sample of Chinese male military college students. Front Psychiatry 2023; 14:1082549. [PMID: 37621968 PMCID: PMC10444979 DOI: 10.3389/fpsyt.2023.1082549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 07/24/2023] [Indexed: 08/26/2023] Open
Abstract
Background Acute stress reaction (ASR) following a stressful event is associated with stress-related mental disorders. However, no studies have investigated the relationships between ASR symptom clusters. The present study aimed to provide a fine-grained understanding of the complex relationships among symptom clusters and identify the central symptom clusters of ASR using network analysis. Methods The Acute Stress Reaction Scale (ASRS) was used to investigate the network structure of ASR in 1792 Chinese male military college students who were about to participate in an important physical fitness test. We calculated the weights of the edges connecting different symptom clusters and the central indices of 25 symptom clusters in the final network. Results There were five strongest edges with significantly higher weights than most other edge weights, including the edges between "Less communication" and "Isolated from others." The symptom clusters of "Somatic symptoms," "Hypoprosexia," and "Anxiety" were found to be the central nodes with the highest expected influences (primary centrality index). Conclusion The present study explored the network structure of ASR, revealed complex connections between symptom clusters, and identified central clusters. These findings have important clinical implications, and it is suggested that the three central symptom clusters may be potential targets for effective interventions for ASR.
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Affiliation(s)
- Yue Gong
- School of Psychology, Shaanxi Normal University, Xi’an, China
| | - Zhihua Guo
- Department of Military Medical Psychology, Air Force Medical University, Xi’an, China
| | - Hongliang Lu
- Department of Military Medical Psychology, Air Force Medical University, Xi’an, China
| | - Xinlu Wang
- Department of Military Medical Psychology, Air Force Medical University, Xi’an, China
| | - Yajuan Zhang
- Department of Military Medical Psychology, Air Force Medical University, Xi’an, China
| | - Lei Ren
- Military Psychology Section, Logistics University of PAP, Tianjin, China
- Military Mental Health Services and Research Center, Tianjin, China
| | - Xia Zhu
- Department of Military Medical Psychology, Air Force Medical University, Xi’an, China
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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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Greco E, Graziano EA, Stella GP, Mastrodascio M, Cedrone F. The impact of leadership on perceived work-related stress in healthcare facilities organisations. JOURNAL OF ORGANIZATIONAL CHANGE MANAGEMENT 2022. [DOI: 10.1108/jocm-07-2021-0201] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
PurposeEmployees in the private, public, and third sectors have experienced an increase in stress over the years. Amongst the sectors, people working in hospitals and other healthcare facilities were put under severe stress during the COVID-19 pandemic. Indeed, the World Health Organisation has clearly stated that defending people's mental health at this particular time of restless pandemic growth is an absolute necessity. The purpose of this article is to assess the perceived work-related stress (WRS) of healthcare workers (HCWs) as a result of the spread of COVID-19, as well as how a leadership role can help to reduce WRS.Design/methodology/approachBased on a multiple case study approach applied to two Italian health-care facilities, the questionnaire results were subjected to a regression analysis.FindingsThe results show an association in HCWs between the perception of supportive leadership and the perception of negative psychosocial risks whose exposure can lead to manifestation of WRS during COVID-19 pandemic.Originality/valueThe study addresses the role that the perception of supportive leadership can play in reducing exposure to occupational psychosocial risks in a sample of healthcare professionals.
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Cockerham M, Beier ME, Branson S, Boss L. Nurse Adaptability and Post-traumatic Stress Disorder Symptoms During the COVID-19 Pandemic: The Effects of Family and Perceived Organizational Support. Front Psychol 2022; 12:749763. [PMID: 35317265 PMCID: PMC8934423 DOI: 10.3389/fpsyg.2021.749763] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 12/17/2021] [Indexed: 12/28/2022] Open
Abstract
Objective To examine the effect of family and perceived organizational support on the relationship between nurse adaptability and their experience with COVID-related PTSD (post-traumatic stress disorder) symptoms in frontline nurses working on COVID-19 units. Background Proximity to and survival of life-threatening events contribute to a diagnosis of PTSD, which is characterized by avoidance of reminders of trauma, intrusive thoughts, flashbacks of events, sleep disturbances, and hypervigilance. Using the job-demands and resource model, we examined the effect of adaptability, family support, and perceived organizational support on PTSD symptoms for nurses during the COVID-19 pandemic. Specifically, we tested whether perceptions of environmental supports-i.e., family and organizational support-moderated the relationship between nurse adaptability and COVID-related PTSD symptoms. Methods A sample of frontline nurses working on COVID-19 units during the COVID-19 pandemic in Texas (N = 277) participated in this cross-sectional, observational study. Frontline Nurses reported demographic information and completed surveys designed to measure adaptability, perceived organizational support, family support, and COVID-related PTSD symptoms. Results Adaptability was significantly positively correlated (medium effects) to perceived organizational and family support (r = 0.51 and 0.56, respectively, p < 0.01). Adaptability and perceived organizational support were also negatively correlated with COVID-related PTSD symptoms (medium effects). Adaptability was negatively correlated with COVID-related PTSD symptoms, supporting Hypothesis 1 (r = -0.43, p < 0.01). Perceived organizational support was also significantly negatively correlated with COVID-19-related PTSD symptoms (r = -0.30, p < 0.01). Family support was not significantly correlated with COVID-related PTSD but was positively related to experiencing COVID-related PTSD after other variables were accounted for. Conclusion Findings suggest that individual adaptability and organizational support may reduce PTSD severity in frontline nurses working during a crisis; however, family support may increase PTSD symptoms. We provide suggestions for strengthening individual adaptability and healthcare leadership including remaining highly engaged to show support by providing rapid communication, remaining calm during difficult circumstances, and maintaining a consistent, physical presence during difficult times. Moreover, our results suggest additional support for nurses with families to adapt to crisis.
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Affiliation(s)
- Mona Cockerham
- School of Nursing, Sam Houston State University, The Woodlands, TX, United States
| | - Margaret E. Beier
- Department of Psychological Sciences, Rice University, Houston, TX, United States
| | - Sandy Branson
- Cizik School of Nursing, The University of Texas Health Science Center, UT-Health, Houston, TX, United States
| | - Lisa Boss
- Cizik School of Nursing, The University of Texas Health Science Center, UT-Health, Houston, TX, United States
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Nicolaou C, Menikou J, Lamnisos D, Lubenko J, Presti G, Squatrito V, Constantinou M, Papacostas S, Aydın G, Chong YY, Chien WT, Cheng HY, Ruiz FJ, Segura-Vargas MA, Garcia-Martin MB, Obando-Posada DP, Vasiliou VS, McHugh L, Höfer S, Baban A, Neto DD, da Silva AN, Monestès JL, Alvarez-Galvez J, Paez-Blarrina M, Montesinos F, Valdivia-Salas S, Ori D, Kleszcz B, Lappalainen R, Ivanović I, Gosar D, Dionne F, Merwin RM, Kassianos AP, Karekla M, Gloster AT. Mental Health Status of Healthcare Workers During the COVID-19 Outbreak. EUROPEAN JOURNAL OF PSYCHOLOGY OPEN 2021. [DOI: 10.1024/2673-8627/a000010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Abstract. Background: The COVID-19 pandemic is a massive health crisis that has exerted enormous physical and psychological pressure. Mental healthcare for healthcare workers (HCWs) should receive serious consideration. This study served to determine the mental-health outcomes of 1,556 HCWs from 45 countries who participated in the COVID-19 IMPACT project, and to examine the predictors of the outcomes during the first pandemic wave. Methods: Outcomes assessed were self-reported perceived stress, depression symptom, and sleep changes. The predictors examined included sociodemographic factors and perceived social support. Results: The results demonstrated that half of the HCWs had moderate levels of perceived stress and symptoms of depression. Half of the HCWs ( n = 800, 51.4%) had similar sleeping patterns since the pandemic started, and one in four slept more or slept less. HCWs reported less perceived stress and depression symptoms and higher levels of perceived social support than the general population who participated in the same project. Predictors associated with higher perceived stress and symptoms of depression among HCWs included female sex, not having children, living with parents, lower educational level, and lower social support. Discussion: The need for establishing ways to mitigate mental-health risks and adjusting psychological interventions and support for HCWs seems to be significant as the pandemic continues.
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Affiliation(s)
- Christiana Nicolaou
- Department of Nursing, School of Health Sciences, Cyprus University of Technology, Limassol, Cyprus
| | - Joanna Menikou
- Department of Health Sciences, European University Cyprus, Nicosia, Cyprus
| | - Demetris Lamnisos
- Department of Health Sciences, European University Cyprus, Nicosia, Cyprus
| | - Jelena Lubenko
- Psychological Laboratory, Faculty of Public Health and Social Welfare, Riga Stradiņš University, Riga, Latvia
| | - Giovambattista Presti
- Kore University Behavioral Lab (KUBeLab), Faculty of Human and Social Sciences, Kore University of Enna, Italy
| | - Valeria Squatrito
- Kore University Behavioral Lab (KUBeLab), Faculty of Human and Social Sciences, Kore University of Enna, Italy
| | - Marios Constantinou
- Department of Social Sciences, School of Humanities and Social Sciences, University of Nicosia, Cyprus
| | | | - Gokcen Aydın
- Department of Psychological Counseling and Guidance, Faculty of Education, Hasan Kalyoncu University, Gaziantep, Turkey
| | - Yuen Yu Chong
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Wai Tong Chien
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Ho Yu Cheng
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Francisco J. Ruiz
- Faculty of Psychology, Fundación Universitaria Konrad Lorenz, Bogotá, Colombia
| | | | | | | | | | - Louise McHugh
- School of Psychology, University College Dublin, Ireland
| | - Stefan Höfer
- Department of Medical Psychology, Medical University Innsbruck, Austria
| | - Adriana Baban
- Department of Psychology, Babeş-Bolyai University (UBB), Cluj-Napoca, Romania
| | - David Dias Neto
- ISPA – Instituto Universitário; APPsyCI – Applied Psychology Research Center Capabilities & Inclusion, Lisboa, Portugal
| | - Ana Nunes da Silva
- Faculdade de Psicologia, Universidade de Lisboa, Alameda da Universidade, Lisboa, Portugal
| | | | - Javier Alvarez-Galvez
- Department of Biomedicine, Biotechnology and Public Health, University of Cadiz, Spain
| | | | | | | | - Dorottya Ori
- Department of Mental Health, Heim Pal National Pediatric Institute, Budapest, Hungary
| | | | | | - Iva Ivanović
- Clinical Centre of Montenegro, Institute for Children’s diseases, Department for Child Psychiatry, Podgorica, Montenegro
| | - David Gosar
- Ljubljana University Medical Centre, Ljubljana, Slovenia
| | - Frederick Dionne
- Department of Psychology, Université du Québec à Trois-Rivières, Canada
| | - Rhonda M. Merwin
- Department of Psychiatry and Behavioral Science, Duke University, Durham, NC, USA
| | - Angelos P. Kassianos
- Department of Applied Health Research, University College London, United Kingdom
- Department of Psychology, University of Cyprus, Nicosia, Cyprus
| | - Maria Karekla
- Department of Psychology, University of Cyprus, Nicosia, Cyprus
| | - Andrew T. Gloster
- Division of Clinical Psychology & Intervention Science, Department of Psychology, University of Basel, Switzerland
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