Clinician Trauma, PTSD and Building a Culture of Resilience

 

Exposure to trauma and life-or-death situations has always been a part of the medical profession. So have the effects of post-traumatic stress disorder (PTSD). In the U.S., about six percent of all adults will have PTSD during their lifetime—clinicians are at an even greater risk of developing PTSD than the general population. 

One study found, prior to the COVID-19 pandemic, the rate of PTSD among physicians ranged from about five percent to roughly 40 percent, depending on their specialty. Emergency room physicians and trauma surgeons showed the highest prevalence. 

Several studies conducted during and after the height of the pandemic have revealed significant increases in PTSD among health care workers. A study presented at the 2021 American Psychiatric Association Annual Meeting showed an overall rate of PTSD among health care professionals of nearly 40 percent. In the same study, the rate among physicians in all specialties was 36 percent, while nonphysician health care workers had an overall PTSD rate of nearly 50 percent. 

It’s too soon to know what all of the long-term effects will be from the increased incidence of pandemic-related PTSD. However, we can effectively address current issues related to PTSD and act on personal and organizational levels to decrease the rate of PTSD in our clinicians. 

Recognizing the Risk Factors, Effects and Signs of PTSD

Most people who experience a traumatic event do not develop PTSD. But for those who do, keeping risk factors and signs of PTSD in mind can help detect issues early and increase the likelihood of successful treatment. 

Risk factors for developing PTSD may include:

• A history of childhood abuse or trauma

• Being female

• Exposure to one or more traumatic events over a long period

• History of mental health diagnoses or substance abuse

• Lack of social support

Burnout, an occupational phenomenon frequently seen in health care workers, can also increase the risk of developing PTSD. 

Signs and symptoms of PTSD are varied, and no two people will experience them the same way. For clinicians who are used to putting others first, recognizing signs within themselves may be particularly difficult. Still, there are common signs to watch for, including:

• Avoidance of feelings, thoughts, objects or places related to the traumatic event

• Decreased concentration

• Difficulty regulating emotions

• Feeling anxious, on edge, or tense

• Flashbacks, intrusive thoughts or nightmares related to the trauma

• Having feelings of guilt related to the trauma

• Negative self-talk

• Sleep issues

In addition to affecting the personal lives and overall well-being of medical professionals, PTSD can significantly interfere with patient care abilities due to:

• A drop in job performance or productivity

• Decreased functioning and physical capabilities

• Impaired communication with coworkers and patients

• Increased absences from work

• Lower engagement in work-related responsibilities and tasks

If PTSD isn’t addressed, it can become a chronic condition. However, it can generally be successfully managed or treated with psychotherapy and medication.

Secondary Traumatic Stress in Health Care Settings

In addition to PTSD, clinicians are at risk for secondary traumatic stress (STS), also called compassion fatigue. STS is caused by indirect exposure to traumatic events and can have symptoms similar to PTSD. Whether caring for patients injured due to abuse, car accidents, community violence, natural disasters or other traumatic events, health care providers are frequently brought face-to-face with the mental and physical consequences of trauma they did not experience firsthand. 

Medical professionals often enter the field because they have deep compassion for others. Seeing the effects of suffering, especially on an ongoing basis, can affect the mental and physical health of those providing care. Paramedics, mental health professionals, ER and ICU staff, and those who frequently work with patients at the end of life may be particularly at risk for STS, though all health care workers can experience it. Like PTSD, a combination of psychotherapy and medication can provide relief from STS. 

Building Resilience Among Health Care Professionals

In addition to affecting clinicians’ personal and professional well-being, PTSD and STS may contribute to lower patient satisfaction and rising health care costs due to decreased job performance. Developing resilience can help prevent burnout, PTSD and STS among professionals while supporting positive patient outcomes and lowering overall costs. 

Resilience is the ability to bounce back from challenging or traumatic events or situations. Instead of avoiding or becoming overwhelmed by difficulties, resilient people can acknowledge, adapt, process and recover from trauma in healthy ways. 

Health care workers can enhance resilience and improve mental health by:

• Asking for help when needed

• Abstaining from social media use if it is causing extra stress

• Developing strong social support networks

• Living a healthy lifestyle

• Participating in expressive arts or keeping a journal

• Practicing mindfulness

• Taking all scheduled breaks and using vacation time

Creating a Culture of Resilience and Positive Mental Health

A larger culture of resilience and positive mental health is essential to maintaining a healthy workforce while optimizing patient care. Organizational and team leaders can promote a culture of resilience through multiple means, including:

• Creating a safe space to discuss mental health and workplace concerns

• Developing or improving supportive employee mental health policies

• Encouraging open discussions about mental health to reduce stigma

• Ensuring health insurance plans cover behavioral health services

• Fostering a sense of shared decision making

• Limiting shift length and on-call hours

• Offering mentoring opportunities and other initiatives to build strong professional relationships

• Promoting healthy work-life balance on and off the clock

• Providing mental health self-assessment tools

• Raising awareness of burnout, PTSD, STS and other mental health concerns through training and special events

When we work together as a team and keep lines of communication open while also maintaining awareness of our individual needs and concerns, we can lower the risks of PTSD.