Post-traumatic stress disorder in health care professionals: symptoms, causes, prevention and treatment (a literature review)

Authors

DOI:

https://doi.org/10.14739/2310-1210.2022.3.253119

Keywords:

traumatic stress disorder, post-traumatic stress disorder, prevention, treatment, doctors, health care professionals

Abstract

The aim of this work is to analyze the available scientific information and summarize the main results of modern research on the symptoms and causes, clinical consequences and methods of prevention and treatment of post-traumatic stress disorder in medical staff.

Materials and methods. An analysis of published full-text articles from PubMed, Web of Science, APA PsychNet, Google Scholar, Scopus databases was performed to systematize data on symptoms and causes, clinical consequences and methods of prevention and treatment of post-traumatic stress disorder in health care professionals. In addition, earlier publications of historical interest value were included in the analysis.

Results. The analysis of the main symptoms and factors of post-traumatic stress disorder of medical workers was carried out. The analysis found that 15–43 % of physicians suffered from depression, anxiety, and other symptoms of post-traumatic stress disorder. Its occurrence in health professionals was associated with a number of risk factors, which can be divided into labor, social and psychological. The labor factors were of the greatest importance in the syndrome occurrence.

Despite the fact that there were a number of psychological and pharmacological care programs aimed at the prevention and treatment of post-traumatic stress disorder, none of them currently has evidence of its effectiveness. There are no clinical prediction methods that would identify health care workers at a high risk of post-traumatic stress disorder development. The risk of traumatic exposure was particularly pronounced among resident physicians, who usually lack training and practice compared with more experienced physicians.

Conclusions. A funding is needed for methodologically based researches and effective measures, developed on this ground, to eliminate post-traumatic stress disorder in health care professionals. If the prevention of post-traumatic stress disorder could not be addressed at the state level, it would jeopardize the stability of the entire health care system functioning.

Author Biographies

Ye. Ye. Timchenko, Danylo Halytsky Lviv National Medical University, Ukraine

MD, Assistant of the Department of Disaster Medicine and Military Medicine

O. V. Liubinets, Danylo Halytsky Lviv National Medical University, Ukraine

MD, PhD, DSc, Professor, Head of the Department of Public Health

P. V. Oliinyk, Danylo Halytsky Lviv National Medical University, Ukraine

PhD, DSc, Professor of the Department of Disaster Medicine and Military Medicine

V. V. Chaplyk, Danylo Halytsky Lviv National Medical University, Ukraine

MD, PhD, Associate Professor, Head of the Department of Disaster Medicine and Military Medicine

S. P. Oliinyk, Nobel-Ukraine Pharmaceutical Company, Kyiv, Ukraine

PhD, Advisor

References

Kendell, R. E. (1988). Diagnostic and Statistical Manual of Mental Disorders, 3rd ed., revised (DSM-III-R). American Journal of Psychiatry, 145(10), 1301-1302. https://doi.org/10.1176/ajp.145.10.1301

Mykhailov, B. V., Semykopna, T. V., Lupei-Tkach, S. I., Serdiuk, O. I., Zinchenko, O. M., Viazmitinova, S. O., Lemko, I. S., Haisak, M. O., Halachenko, O. O., & Sychevskyi, A. S. (2018). Medyko-psykholohichna reabilitatsiia uchasnykiv ATO v sanatorno-kurortnykh ustanovakh (klinichna nastanova) [Medical and psychological rehabilitation of participants in anti-terrorist operation at spa facilities: clinical guidelines]. VAFK. [in Ukrainian].

Korolchuk, O. (2016). Posttravmatychnyi stresovyi rozlad yak novyi vyklyk suchasnii Ukraini [Post-traumatic stress disorder as a new challenge to the modern Ukraine]. Investytsii: praktyka ta dosvid, (17), 104-111. [in Ukrainian].

Ustinov, O. V. (2016, March 04). Posttravmatychnyi stresovyi rozlad: spetsializovana dopomoha [Post-traumatic stress disorder: specialized care]. Ukrainskyi medychnyi chasopys. https://www.umj.com.ua/article/93804/posttravmatichnij-stresovij-rozlad-specializovana-dopomoga [in Ukrainian].

Miao, X. R., Chen, Q. B., Wei, K., Tao, K. M., & Lu, Z. J. (2018). Posttraumatic stress disorder: from diagnosis to prevention. Military Medical Research, 5(1), Article 32. https://doi.org/10.1186/s40779-018-0179-0

Forneris, C. A., Gartlehner, G., Brownley, K. A., Gaynes, B. N., Sonis, J., Coker-Schwimmer, E., Jonas, D. E., Greenblatt, A., Wilkins, T. M., Woodell, C. L., & Lohr, K. N. (2013). Interventions to Prevent Post-Traumatic Stress Disorder A Systematic Review. American Journal of Preventive Medicine, 44(6), 635-650. https://doi.org/10.1016/j.amepre.2013.02.013

Feldner, M. T., Monson, C. M., & Friedman, M. J. (2007). A Critical Analysis of Approaches to Targeted PTSD Prevention: Current Status and Theoretically Derived Future Directions. Behavior Modification, 31(1), 80-116. https://doi.org/10.1177/0145445506295057

Draga, T. M., Myaluk, O. P., & Krynytska, I. Ya. (2017). Osoblyvosti syndromu emotsiinoho vyhorannia u medychnykh pratsivnykiv [Features of emotional burnout syndrome in health care workers]. Medsestrynstvo, 48-51. [in Ukrainian].

Seys, D., Wu, A. W., Van Gerven, E., Vleugels, A., Euwema, M., Panella, M., Scott, S. D., Conway, J., Sermeus, W., & Vanhaecht, K. (2013). Health Care Professionals as Second Victims after Adverse Events: A Systematic Review. Evaluation & the Health Professions, 36(2), 135-162. https://doi.org/10.1177/0163278712458918

Rinaldi, C., Leigheb, F., Vanhaecht, K., Donnarumma, C., & Panella, M. (2016). Becoming a "second victim" in health care: Pathway of recovery after adverse event. Revista de Calidad Asistencial, 31(Suppl. 2), 11-19. https://doi.org/10.1016/j.cali.2016.05.001

Assonov, D. (2021). Emotsiine vyhorannia medychnykh pratsivnykiv: modeli, faktory ryzyku ta protektyvni faktory [Emotional burnout of healthcare professionals: models, risk factors and protective factors]. Neironews. Psykhonevrolohiia ta neiropsykhiatriia, (10), 28-33. https://neuronews.com.ua/ua/archive/2021/10%28131%29/pages-28-33/emociyne-vigorannya-medichnih-pracivnikiv-modeli-faktori-riziku-ta-protektivni-faktori#gsc.tab=0 [in Ukrainian].

Vanhaecht, K., Seys, D., Schouten, L., Bruyneel, L., Coeckelberghs, E., Panella, M., Zeeman, G., & Dutch Peer Support Collaborative Research Group. (2019). Duration of second victim symptoms in the aftermath of a patient safety incident and association with the level of patient harm: a cross-sectional study in the Netherlands. BMJ Open, 9(7), Article e029923. https://doi.org/10.1136/bmjopen-2019-029923

Han, K., Bohnen, J. D., Peponis, T., Martinez, M., Nandan, A., Yeh, D. D., Lee, J., Demoya, M., Velmahos, G., & Kaafarani, H. (2017). The Surgeon as the Second Victim? Results of the Boston Intraoperative Adverse Events Surgeons' Attitude (BISA) Study. Journal of the American College of Surgeons, 224(6), 1048-1056. https://doi.org/10.1016/j.jamcollsurg.2016.12.039

Chan, S. T., Khong, P., & Wang, W. (2017). Psychological responses, coping and supporting needs of healthcare professionals as second victims. International Nursing Review, 64(2), 242-262. https://doi.org/10.1111/inr.12317

Siddaiah-Subramanya, M., To, H., & Haigh, C. (2021). The psychosocial impact of surgical complications on the operating surgeon: A scoping review. Annals of Medicine and Surgery, 67, Article 102530. https://doi.org/10.1016/j.amsu.2021.102530

Marmon, L. M., & Heiss, K. (2015). Improving surgeon wellness: The second victim syndrome and quality of care. Seminars in Pediatric Surgery, 24(6), 315-318. https://doi.org/10.1053/j.sempedsurg.2015.08.011

Pinto, A., Faiz, O., Bicknell, C., & Vincent, C. (2013). Surgical complications and their implications for surgeons' well-being. British Journal of Surgery, 100(13), 1748-1755. https://doi.org/10.1002/bjs.9308

Patel, A. M., Ingalls, N. K., Mansour, M. A., Sherman, S., Davis, A. T., & Chung, M. H. (2010). Collateral damage: the effect of patient complications on the surgeon's psyche. Surgery, 148(4), 824-830. https://doi.org/10.1016/j.surg.2010.07.024

Biggs, S., Waggett, H. B., & Shabbir, J. (2020). Impact of surgical complications on the operating surgeon. Colorectal Disease, 22(9), 1169-1174. https://doi.org/10.1111/codi.15021

Shanafelt, T. D., Balch, C. M., Bechamps, G., Russell, T., Dyrbye, L., Satele, D., Collicott, P., Novotny, P. J., Sloan, J., & Freischlag, J. (2010). Burnout and Medical Errors Among American Surgeons. Annals of Surgery, 251(6), 995-1000. https://doi.org/10.1097/SLA.0b013e3181bfdab3

Vance, M. C., Mash, H., Ursano, R. J., Zhao, Z., Miller, J. T., Clarion, M., West, J. C., Morganstein, J. C., Iqbal, A., & Sen, S. (2021). Exposure to Workplace Trauma and Posttraumatic Stress Disorder Among Intern Physicians. JAMA Network Open, 4(6), Article e2112837. https://doi.org/10.1001/jamanetworkopen.2021.12837

Duarte, D., El-Hagrassy, M. M., Couto, T., Gurgel, W., Fregni, F., & Correa, H. (2020). Male and Female Physician Suicidality: A Systematic Review and Meta-analysis. JAMA Psychiatry, 77(6), 587-597. https://doi.org/10.1001/jamapsychiatry.2020.0011

Lindeman, S., Läärä, E., Hirvonen, J., & Lönnqvist, J. (1997). BRIEF COMMUNICATION Suicide mortality among medical doctors in Finland: Are females more prone to suicide than their male colleagues? Psychological Medicine, 27(5), 1219-1222. https://doi.org/10.1017/s0033291796004680

Torre, D. M., Wang, N. Y., Meoni, L. A., Young, J. H., Klag, M. J., & Ford, D. E. (2005). Suicide Compared to Other Causes of Mortality in Physicians. Suicide & Life-Threatening Behavior, 35(2), 146-153. https://doi.org/10.1521/suli.35.2.146.62878

Carpenter, L. M., Swerdlow, A. J., & Fear, N. T. (1997). Mortality of doctors in different specialties: findings from a cohort of 20000 NHS hospital consultants. Occupational & Environmental Medicine, 54(6), 388-395. https://doi.org/10.1136/oem.54.6.388

Richings, J. C., Khara, G. S., & McDowell, M. (1986). Suicide in Young Doctors. British Journal of Psychiatry, 149, 475-478. https://doi.org/10.1192/bjp.149.4.475

Hawton, K., Clements, A., Sakarovitch, C., Simkin, S., & Deeks, J. J. (2001). Suicide in doctors: a study of risk according to gender, seniority and specialty in medical practitioners in England and Wales, 1979-1995. Journal of Epidemiology & Community Health, 55(5), 296-300. https://doi.org/10.1136/jech.55.5.296

GBD 2015 Mortality and Causes of Death Collaborators. (2016). Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980-2015: a systematic analysis for the Global Burden of Disease Study 2015. The Lancet, 388(10053), 1459-1544. https://doi.org/10.1016/S0140-6736(16)31012-1

Ivey-Stephenson, A. Z., Crosby, A. E., Jack, S., Haileyesus, T., & Kresnow-Sedacca, M. J. (2017). Suicide Trends Among and Within Urbanization Levels by Sex, Race/Ethnicity, Age Group, and Mechanism of Death - United States, 2001-2015. Morbidity and mortality weekly report. Surveillance Summaries, 66(18), 1-16. https://doi.org/10.15585/mmwr.ss6618a1

DeLucia, J. A., Bitter, C., Fitzgerald, J., Greenberg, M., Dalwari, P., & Buchanan, P. (2019). Prevalence of Post-Traumatic Stress Disorder in Emergency Physicians in the United States. Western Journal of Emergency Medicine, 20(5), 740-746. https://doi.org/10.5811/westjem.2019.7.42671

Miao, X. R., Chen, Q. B., Wei, K., Tao, K. M., & Lu, Z. J. (2018). Posttraumatic stress disorder: from diagnosis to prevention. Military Medical Research, 5(1), Article 32. https://doi.org/10.1186/s40779-018-0179-0

American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596

Karachevskyi, A. B. (2016). Adaptatsiia shkal ta opytuvalnykiv ukrainskoiu ta rosiiskoiu movamy shchodo posttravmatychnoho stresovoho rozladu [Adaptation of PTSD scales and questionnaires for ukrainian and russian languages]. Zbirnyk naukovykh prats spivrobitnykiv NMAPO im. P. L. Shupyka, (25), 607-622. [in Ukrainian].

Antony, M. M., Orsillo, S. M., & Roemer, L. (Eds.). (2001). Practitioner’s Guide to Empirically Based Measures of Anxiety. ABCT Clinical Assessment Series. Springer New York. https://doi.org/10.1007/b108176

PTSD: National Center for PTSD. (2014). PTSD Checklist for DSM-5 (PCL-5). U.S. Department Of Veterans Affairs. https://www.ptsd.va.gov/professional/assessment/adult-sr/ptsd-checklist.asp

(2016). Reaktsiia na vazhkyi stres ta rozlady adaptatsii. Posttravmatychnyi stresovyi rozlad. Unifikovanyi klinichnyi protokol pervynnoi, vtorynnoi (spetsializovanoi) ta tretynnoi (vysokospetsializovanoi) medychnoi dopomohy : Nakaz Ministerstva okhorony zdorov’ia Ukrainy vid 23.02.2016 № 121 [Severe stress response and maladaptation. Post-traumatic stress disorder. The standardized clinical guideline for primary, secondary (specialized) and tertiary (highly specialized) medical care: Order of the Minister of Health of Ukraine No. 121]. Neironews. Psykhonevrolohiia ta neiropsykhiatriia, (3), 49-64. https://neuronews.com.ua/ua/archive/2016/3%2877%29/article-1676/reakciya-na-vazhkiy-stres-ta-rozladi-adaptaciyi-posttravmatichniy-stresoviy-rozlad#gsc.tab=0 [in Ukrainian].

Newport, D. J., & Nemeroff, C. B. (2000). Neurobiology of posttraumatic stress disorder. Current Opinion in Neurobiology, 10(2), 211-218. https://doi.org/10.1016/s0959-4388(00)00080-5

Neigh, G. N., & Ali, F. F. (2016). Co-morbidity of PTSD and immune system dysfunction: opportunities for treatment. Current Opinion in Pharmacology, 29, 104-110. https://doi.org/10.1016/j.coph.2016.07.011

Eraly, S. A., Nievergelt, C. M., Maihofer, A. X., Barkauskas, D. A., Biswas, N., Agorastos, A., O'Connor, D. T., Baker, D. G., & Marine Resiliency Study Team. (2014). Assessment of Plasma C-Reactive Protein as a Biomarker of Posttraumatic Stress Disorder Risk. JAMA Psychiatry, 71(4), 423-431. https://doi.org/10.1001/jamapsychiatry.2013.4374

Snijders, C., Maihofer, A. X., Ratanatharathorn, A., Baker, D. G., Boks, M. P., Geuze, E., Jain, S., Kessler, R. C., Pishva, E., Risbrough, V. B., Stein, M. B., Ursano, R. J., Vermetten, E., Vinkers, C. H., PGC PTSD EWAS Consortium, Smith, A. K., Uddin, M., Rutten, B., & Nievergelt, C. M. (2020). Longitudinal epigenome-wide association studies of three male military cohorts reveal multiple CpG sites associated with post-traumatic stress disorder. Clinical Epigenetics, 12(1), Article 11. https://doi.org/10.1186/s13148-019-0798-7

Yang, R., Xu, C., Bierer, L. M., Flory, J. D., Gautam, A., Bader, H. N., Lehrner, A., Makotkine, I., Desarnaud, F., Miller, S. A., Jett, M., Hammamieh, R., & Yehuda, R. (2021). Longitudinal genome-wide methylation study of PTSD treatment using prolonged exposure and hydrocortisone. Translational Psychiatry, 11(1), Article 398. https://doi.org/10.1038/s41398-021-01513-5

Danyk, Yu., & Zborovska, O. (2019). Metodyka aparatno-instrumentalnoho vyiavlennia ta diahnostyky stres-asotsiiovanykh ta posttravmatychnykh stresovykh rozladiv [Methods of Hardware and Instrumental Detection and Diagnosis of Stress-Associated and Post-Traumatic Stress Disorders]. Ukrainskyi zhurnal medytsyny, biolohii ta sportu, 4(2), 114-121. https://doi.org/10.26693/jmbs04.02.114 [in Ukrainian].

Committee on the Assessment of Ongoing Efforts in the Treatment of Posttraumatic Stress Disorder, Board on the Health of Select Populations, & Institute of Medicine. (2014). Treatment for Posttraumatic Stress Disorder in Military and Veteran Populations: Final Assessment. National Academies Press (US). https://www.ncbi.nlm.nih.gov/books/NBK224878/#!po=12.5000

d'Ettorre, G., Ceccarelli, G., Santinelli, L., Vassalini, P., Innocenti, G. P., Alessandri, F., Koukopoulos, A. E., Russo, A., d'Ettorre, G., & Tarsitani, L. (2021). Post-Traumatic Stress Symptoms in Healthcare Workers Dealing with the COVID-19 Pandemic: A Systematic Review. International Journal of Environmental Research and Public Health, 18(2), Article 601. https://doi.org/10.3390/ijerph18020601

Theorell, T. (2020). COVID-19 and Working Conditions in Health Care. Psychotherapy and Psychosomatics, 89(4), 193-194. https://doi.org/10.1159/000507765

Vagni, M., Maiorano, T., Giostra, V., & Pajardi, D. (2020). Coping With COVID-19: Emergency Stress, Secondary Trauma and Self-Efficacy in Healthcare and Emergency Workers in Italy. Frontiers in Psychology, 11, Article 566912. https://doi.org/10.3389/fpsyg.2020.566912

Chew, N., Ngiam, J. N., Tan, B. Y., Tham, S. M., Tan, C. Y., Jing, M., Sagayanathan, R., Chen, J. T., Wong, L., Ahmad, A., Khan, F. A., Marmin, M., Hassan, F. B., Sharon, T. M., Lim, C. H., Mohaini, M., Danuaji, R., Nguyen, T. H., Tsivgoulis, G., Tsiodras, S., … Sharma, V. K. (2020). Asian-Pacific perspective on the psychological well-being of healthcare workers during the evolution of the COVID-19 pandemic. BJPsych Open, 6(6), Article E116. https://doi.org/10.1192/bjo.2020.98

Coventry, P. A., Meader, N., Melton, H., Temple, M., Dale, H., Wright, K., Cloitre, M., Karatzias, T., Bisson, J., Roberts, N. P., Brown, J., Barbui, C., Churchill, R., Lovell, K., McMillan, D., & Gilbody, S. (2020). Psychological and pharmacological interventions for posttraumatic stress disorder and comorbid mental health problems following complex traumatic events: Systematic review and component network meta-analysis. PLOS Medicine, 17(8), Article e1003262. https://doi.org/10.1371/journal.pmed.1003262

Sendler, D. J., Rutkowska, A., & Makara-Studzinska, M. (2016). How the exposure to trauma has hindered physicians' capacity to heal: prevalence of PTSD among healthcare workers. European Journal of Psychiatry, 30(4), 321-334.

National Health and Medical Research Council. (n.d.). Australian Guidelines for the Prevention and Treatment of Acute Stress Disorder, Posttraumatic Stress Disorder and Complex PTSD. Phoenix Australia. https://www.phoenixaustralia.org/australian-guidelines-for-ptsd/

American Psychiatric Association. (2018). VA/DOD Clinical Practice Guideline for the Management of Posttraumatic Stress Disorder and Acute Stress Disorder: Clinician Summary. Focus, 16(4), 430-448. https://doi.org/10.1176/appi.focus.16408

Inter-Agency Standing Committee. (2007). IASC Guidelines on Mental Health and Psychosocial Support in Emergency Settings. IASC. https://interagencystan dingcommittee.org/system/files/202011/IASC%20Guidelines%20on%20Mental%20Health%20and%20Psychosocial%20Support%20in%20Emergency%20Settings%20%28English%29.pdf

KHSB Berlin. (n.d.). The European Network for Traumatic Stress - Training & Practice (TENTS-TP). https://www.khsb-berlin.de/en/node/92148

National Disaster Management Authority. (2009). National Disaster Management Guidelines: Psycho-Social Support and Mental Health Services in Disasters. New Delhi. https://nidm.gov.in/PDF/pubs/NDMA/8.pdf

Krediet, E., Bostoen, T., Breeksema, J., van Schagen, A., Passie, T., & Vermetten, E. (2020). Reviewing the Potential of Psychedelics for the Treatment of PTSD. International Journal of Neuropsychopharmacology, 23(6), 385-400. https://doi.org/10.1093/ijnp/pyaa018

Resick, P. A., Monson, C. M., & Chard, K. M. (2016). Cognitive Processing Therapy for PTSD. Guilford Press.

Watkins, L. E., Sprang, K. R., & Rothbaum, B. O. (2018). Treating PTSD: A Review of Evidence-Based Psychotherapy Interventions. Frontiers in Behavioral Neuroscience, 12, 258. https://doi.org/10.3389/fnbeh.2018.00258

Ehret, M. (2019). Treatment of posttraumatic stress disorder: Focus on pharmacotherapy. Mental Health Clinician, 9(6), 373-382. https://doi.org/10.9740/mhc.2019.11.373

Bauer, M., Pfennig, A., Severus, E., Whybrow, P. C., Angst, J., Möller, H. J., & Šon behalf of the Task Force on Unipolar Depressive Disorders. (2013). World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for Biological Treatment of Unipolar Depressive Disorders, Part 1: Update 2013 on the acute and continuation treatment of unipolar depressive disorders. The World Journal of Biological Psychiatry, 14(5), 334-385. https://doi.org/10.3109/15622975.2013.804195

Li, H., Su, P., Lai, T. K., Jiang, A., Liu, J., Zhai, D., Campbell, C. T., Lee, F. H., Yong, W., Pasricha, S., Li, S., Wong, A. H., Ressler, K. J., & Liu, F. (2020). The glucocorticoid receptor-FKBP51 complex contributes to fear conditioning and posttraumatic stress disorder. The Journal of Clinical Investigation, 130(2), 877-889. https://doi.org/10.1172/JCI130363

Published

2022-05-30

How to Cite

1.
Timchenko YY, Liubinets OV, Oliinyk PV, Chaplyk VV, Oliinyk SP. Post-traumatic stress disorder in health care professionals: symptoms, causes, prevention and treatment (a literature review). Zaporozhye Medical Journal [Internet]. 2022May30 [cited 2024Nov.20];24(3):343-5. Available from: http://zmj.zsmu.edu.ua/article/view/253119

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