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D'Alessandro-Lowe AM, Ritchie K, Brown A, Easterbrook B, Xue Y, Pichtikova M, Altman M, Beech I, Millman H, Foster F, Hassall K, Levy Y, Streiner DL, Hosseiny F, Rodrigues S, Heber A, O'Connor C, Schielke H, Malain A, McCabe RE, Lanius RA, McKinnon MC. Canadian respiratory therapists who considered leaving their clinical position experienced elevated moral distress and adverse psychological and functional outcomes during the COVID-19 pandemic. Health Promot Chronic Dis Prev Can 2023; 43:460-471. [PMID: 37991889 PMCID: PMC10753904 DOI: 10.24095/hpcdp.43.10/11.04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2023]
Abstract
INTRODUCTION Respiratory therapists (RTs) faced morally distressing situations throughout the COVID-19 pandemic, including working with limited resources and facilitating video calls for families of dying patients. Moral distress is associated with a host of adverse psychological and functional outcomes (e.g. depression, anxiety, symptoms of posttraumatic stress disorder [PTSD] and functional impairment) and consideration of position departure. The purpose of this study was to understand the impact of moral distress and its associated psychological and functional outcomes on consideration to leave a clinical position among Canadian RTs during the COVID-19 pandemic. METHODS Canadian RTs (N = 213) completed an online survey between February and June 2021. Basic demographic information (e.g. age, sex, gender) and psychometrically validated measures of moral distress, depression, anxiety, stress, PTSD, dissociation, functional impairment, resilience and adverse childhood experiences were collected. RESULTS One in four RTs reported considering leaving their position. RTs considering leaving reported elevated levels of moral distress and adverse psychological and functional outcomes compared to RTs not considering leaving. Over half (54.5%) of those considering leaving scored above the cut-off for potential diagnosis of PTSD. Previous consideration to leave a position and having left a position in the past each significantly increased the odds of currently considering leaving, along with system-related moral distress and symptoms of PTSD, but the contribution of these latter factors was small. CONCLUSIONS Canadian RTs considering leaving their position reported elevated levels of distress and adverse psychological and functional outcomes, yet these individual-level factors appear unlikely to be the primary factors underlying RTs' consideration to leave, because their effects were small. Further research is required to identify broader, organizational factors that may contribute to consideration of position departure among Canadian RTs.
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Affiliation(s)
| | - Kimberly Ritchie
- McMaster University, Hamilton, Ontario, Canada
- Homewood Research Institute, Guelph, Ontario, Canada
| | | | | | - Yuanxin Xue
- McMaster University, Hamilton, Ontario, Canada
- University of Toronto, Toronto, Ontario, Canada
| | - Mina Pichtikova
- McMaster University, Hamilton, Ontario, Canada
- University of Toronto, Toronto, Ontario, Canada
| | - Max Altman
- McMaster University, Hamilton, Ontario, Canada
| | - Isaac Beech
- McMaster University, Hamilton, Ontario, Canada
- Homewood Research Institute, Guelph, Ontario, Canada
| | | | - Fatima Foster
- St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Kelly Hassall
- St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Yarden Levy
- McMaster University, Hamilton, Ontario, Canada
| | - David L Streiner
- McMaster University, Hamilton, Ontario, Canada
- University of Toronto, Toronto, Ontario, Canada
| | - Fardous Hosseiny
- Atlas Institute for Veterans and Families, Ottawa, Ontario, Canada
- Institute of Mental Health Research at the Royal, University of Ottawa, Ottawa, Ontario, Canada
| | - Sara Rodrigues
- Atlas Institute for Veterans and Families, Ottawa, Ontario, Canada
- Institute of Mental Health Research at the Royal, University of Ottawa, Ottawa, Ontario, Canada
| | - Alexandra Heber
- McMaster University, Hamilton, Ontario, Canada
- Veterans Affairs Canada, Ottawa, Ontario, Canada
| | | | | | - Ann Malain
- Homewood Health Centre, Guelph, Ontario, Canada
| | - Randi E McCabe
- McMaster University, Hamilton, Ontario, Canada
- St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Ruth A Lanius
- Homewood Research Institute, Guelph, Ontario, Canada
- University of Western Ontario, London, Ontario, Canada
- Lawson Health Research Institute, London, Ontario, Canada
| | - Margaret C McKinnon
- McMaster University, Hamilton, Ontario, Canada
- Homewood Research Institute, Guelph, Ontario, Canada
- St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
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Patel H, Easterbrook B, D'Alessandro-Lowe AM, Andrews K, Ritchie K, Hosseiny F, Rodrigues S, Malain A, O'Connor C, Schielke H, McCabe RE, Nicholson AA, Lanius R, McKinnon MC. Associations between trauma and substance use among healthcare workers and public safety personnel during the SARS-CoV-2 (COVID-19) pandemic: the mediating roles of dissociation and emotion dysregulation. Eur J Psychotraumatol 2023; 14:2180706. [PMID: 36930578 PMCID: PMC10026820 DOI: 10.1080/20008066.2023.2180706] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/18/2023] Open
Abstract
BACKGROUND Given the highly stressful environment surrounding the SARS-CoV-2 pandemic, healthcare workers (HCW) and public safety personnel (PSP) are at an elevated risk for adverse psychological outcomes, including posttraumatic stress disorder (PTSD) and alcohol/substance use problems. As such, the study aimed to identify associations between PTSD severity, related dissociation and emotion dysregulation symptoms, and alcohol/substance use problems among HCWs and PSP. METHODS A subset of data (N = 498; HCWs = 299; PSP = 199) was extracted from a larger study examining psychological variables among Canadian HCWs and PSP during the pandemic. Structural equation modelling assessed associations between PTSD symptoms and alcohol/substance use-related problems with dissociation and emotion dysregulation as mediators. RESULTS Among HCWs, dissociation fully mediated the relation between PTSD and alcohol-related problems (indirect effect β = .133, p = .03) and emotion dysregulation partially mediated the relation between PTSD and substance-related problems (indirect effect β = .151, p = .046). In PSP, emotion dysregulation fully mediated the relation between PTSD and alcohol-related problems (indirect effects β = .184, p = .005). For substance-related problems among PSP, neither emotion dysregulation nor dissociation (ps >.05) had any effects. CONCLUSION To our knowledge, this is the first study examining associations between PTSD severity and alcohol/substance use-related problems via mediating impacts of emotion dysregulation and dissociation among HCWs and PSP during the SARS-CoV-2 pandemic. These findings highlight dissociation and emotion dysregulation as important therapeutic targets for structured interventions aimed at reducing the burden of PTSD and/or SUD among Canadian HCWs or PSP suffering from the adverse mental health impacts of the SARS-CoV-2 pandemic.
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Affiliation(s)
- Herry Patel
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Canada
| | - Bethany Easterbrook
- Department of Psychology, Neuroscience, and Behaviour, McMaster University, Hamilton, Canada
| | | | - Krysta Andrews
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Canada
| | - Kimberly Ritchie
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Canada
- Homewood Research Institute, Guelph, Canada
| | | | - Sara Rodrigues
- The Atlas Institute for Veterans and Families, Ottawa, Canada
| | | | | | | | - Randi E McCabe
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Canada
- Department of Psychology, Neuroscience, and Behaviour, McMaster University, Hamilton, Canada
- Mental Health and Addictions Program, St. Joseph's Healthcare Hamilton, Hamilton, Canada
| | - Andrew A Nicholson
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Canada
- Homewood Research Institute, Guelph, Canada
| | - Ruth Lanius
- Department of Psychiatry, Western University, London, Canada
- Homewood Research Institute, Guelph, Canada
| | - Margaret C McKinnon
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Canada
- Homewood Research Institute, Guelph, Canada
- Mental Health and Addictions Program, St. Joseph's Healthcare Hamilton, Hamilton, Canada
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