Main Article Content
Post-traumatic stress disorder, healthcare work, risk assessment, risk management, covid-19
Background and aims: Healthcare workers (HCWs) employed in hospital settings frequently experience many occupational stressors leading to post-traumatic stress disorder (PTSD) symptoms. Literature has increasingly highlighted PTSD as a major issue that involves both staff and healthcare organizations; the consequences of PTSD may include medication errors and lower standards of care. The current COVID-19 pandemic poses the need for preventing PTSD in HCWs working closely with COVID-19 patients. The purpose of this systematic review was to analyze the latest developments in assessing and managing the occupational risk of PTSD symptoms in hospital HCWs. Methods: We searched for publications in MEDLINE/Pubmed using selected keywords. Each article was reviewed and categorized into one or more of the following four categories based on its subject matter: risk assessment, risk management and occurrence rates. Results: Our search resulted in a total of 32 publications that matched our inclusion criteria. Increased years of service, older age, previous year exposure to violence, personality traits (i.e. neuroticism), history of mental disorders, being non-graduates, were found to be workers’ pre-trauma factors predicting PTSD symptoms. Conclusions: The findings suggest the need to prioritize preventative interventions aimed to anticipate the effects of traumatic exposure by training HCWs in evidence based anticipatory methods of coping with stressful events. With regard to the current COVID-19 pandemic, we found evidence of the need to strength social support and training targeted at psychological skills of medical staff who treated COVID-19 patients.
2. Hallin K, Danielson E. Registered nurses’ experiences of daily work, a balance between strain and stimulation: a qualitative study. Int J Nurs Stud 2007; 44: 1221-1230.
3. d’Ettorre G, Pellicani V, Mazzotta M, Vullo AM. Preventing and managing workplace violence against healthcare workers in Emergency Departments. Acta Biomed for Health Professions. 2018; Vol. 89, S. 4: 28-36
4. Magnavita N, Heponiemi T. Violence towards health care workers in a Public Health Care Facility in Italy: a repeated cross-sectional study. BMC Health Serv Res 2012; 12: 108.
5. Lauvrud, C., Nonstad, K., Palmstierna,T. Occurrence of post traumatic stress symptoms and their relationship to professional quality of life (ProQoL) in nursing staff at a forensic psychiatric security unit: A cross-sectional study. Health and Quality of Life Outcomes. 2009. 7, 1-6. doi:10.1186/1477-7525-7-31
6. Gates, D. M., Gillespie, G. L., Succop, P. Violence against nurses and its impact on stress and productivity. Nursing Economics. 2011. 29, 59-66.
7. Czaja, A. S., Moss, M., Mealer, M. Symptoms of posttraumatic stress disorder among pediatric acute care nurses. Journal of Pediatric Nursing. 2012. 27, 357–365. doi:10.1016/j.pedn.2011.04.024
8. Karanikola, M., Giannakopoulou, M., Mpouzika, M., Kaite, C. P., Tsiaousis, G. Z., Papathanassoglou, E. D. E. Dysfunctional psychological responses among intensive care unit nurses: A systematic review of the literature. Revista da Escola de Enfermage daUSP. 2015. 49, 847-857
9. Hamama-Raz Y, Walker R, Palgi MA, Mashiach R, Lee-Ovadia K, Manny A, Ben-Ezra M. Comorbidity of Post-traumatic Stress Symptoms and Depressive Symptoms among Obstetric Nurses with Perinatal Death Exposure. Isr J Psychiatry Relat Sci. 2016. Vol. 53. 2, 58-63.
10. Ginzburg K. Comorbidity of PTSD and depression following myocardial infarction. J Affect Disord 2007; 94:135-143.
11. Frayne SM, Seaver MR, Loveland S, Christiansen C, Spiro A, Parker VA, et al. Burden of medical illness in women with depression and posttraumatic stress disorder. Arch Intern Med 2005; 164:1306-1312.
12. Fjeldheim CB, Nöthling J, Pretorius K, Basson M.Trauma exposure, posttraumatic stress disorder and the effect of explanatory variables in paramedic trainees. BMC Emergency Medicine 2014, 14:11.
13. Xiao H, Zhang Y, Kong D, Li S, Yang N. The Effects of Social Support on Sleep Quality of Medical Staff Treating Patients with Coronavirus Disease 2019 (COVID-19) in January and February 2020 in China. Med Sci Monit. 2020 Mar 5;26:e923549
14. Peters, L., Slade, T. and Andrews, G., 1999. A comparison of ICD10 and DSM‐IV criteria for posttraumatic stress disorder. Journal of Traumatic Stress: Official Publication of The International Society for Traumatic Stress Studies, 12(2), pp.335-343.
15. American Pyschiatric Association. Sleep-wake disorders. Available online at: http://www.dsm5.org/ (last accessed 03-03-2017)
16. Moher D. Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement. Annals of Internal Medicine Ann Intern Med 2009; 151: 264
17. 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.
18. Somville, F. J., De Gucht, V., Maes, S. The impact of occupational hazards and traumatic events among Belgian emergency physicians. Scandinavian journal of trauma, resuscitation and emergency medicine. 2016. 24(1), 59.
19. Shi, L., Wang, L., Jia, X., Li, Z., Mu, H., Liu, X. et al. Prevalence and correlates of symptoms of post-traumatic stress disorder among Chinese healthcare workers exposed to physical violence: a cross-sectional study. BMJ open. 2017. 7(7), e016810.
20. Carmassi, C., Gesi, C., Simoncini, M., Favilla, L., Massimetti, G., Olivieri, M. C., et al. DSM-5 PTSD and posttraumatic stress spectrum in Italian emergency personnel: correlations with work and social adjustment. Neuropsychiatric disease and treatment. 2016. 12, 375.
21. Carmassi, C., Gesi, C., Corsi, M., Cremone, I. M., Bertelloni, C. A., Massimetti, E. et al. Exploring PTSD in emergency operators of a major University Hospital in Italy: a preliminary report on the role of gender, age, and education. Annals of general psychiatry. 2018. 17(1), 17.
22. Baas, M. A., Scheepstra, K. W., Stramrood, C. A., Evers, R., Dijksman, L. M., van Pampus, M. G. Work-related adverse events leaving their mark: a cross-sectional study among Dutch gynecologists. BMC psychiatry. 2018. 18(1), 73.
23. Shamia, N. A., Thabet, A. A. M., Vostanis, P. Exposure to war traumatic experiences, post‐traumatic stress disorder and post‐traumatic growth among nurses in Gaza. Journal of psychiatric and mental health nursing. 2015. 22(10), 749-755.
24. Pajonk, F. G., Cransac, P., Müller, V., Teichmann, A., & Meyer, W. Trauma and stress-related disorders in German emergency physicians: the predictive role of personality factors. International journal of emergency mental health. 2012. 14(4), 257-268.
25. Jacobowitz, W., Moran, C., Best, C., Mensah, L. Post-traumatic stress, trauma-informed care, and compassion fatigue in psychiatric hospital staff: A correlational study. Issues in mental health nursing. 2015. 36(11), 890-899.
26. Luftman, K., Aydelotte, J., Rix, K., Ali, S., Houck, K., Coopwood, T. B., et al. PTSD in those who care for the injured. Injury. 2017. 48(2), 293-296.
27. Colville, G. A., Smith, J. G., Brierley, J., Citron, K., Nguru, N. M., Shaunak, P. D. et al. Coping with staff burnout and work-related posttraumatic stress in intensive care. Pediatric Critical Care Medicine. 2017. 18(7), e267-e273.
28. Hilton, N. Z., Ham, E., Dretzkat, A. Psychiatric hospital workers’ exposure to disturbing patient behavior and its relation to post-traumatic stress disorder symptoms. Canadian journal of nursing research. 2017. 49(3), 118-126.
29. Lavoie, S., Talbot, L. R., Mathieu, L. Post‐traumatic stress disorder symptoms among emergency nurses: their perspective and a ‘tailor‐made’solution. Journal of Advanced Nursing. 2011. 67(7), 1514-1522.
30. Lavoie, S., Talbot, L. R., Mathieu, L., Dallaire, C., Dubois, M. F., Courcy, F. An exploration of factors associated with post‐traumatic stress in ER nurses. Journal of nursing management. 2016. 24(2), 174-183.
31. Mishra, S., Goebert, D., Char, E., Dukes, P., Ahmed, I. Trauma exposure and symptoms of post-traumatic stress disorder in emergency medical services personnel in Hawaii. Emergency medicine journal. 2010. 27(9), 708-711.
32. Adriaenssens, J., De Gucht, V., Maes, S. The impact of traumatic events on emergency room nurses: Findings from a questionnaire survey. International journal of nursing studies. 2012. 49(11), 1411-1422.
33. Hosseininejad, S. M., Jahanian, F., Elyasi, F., Mokhtari, H., Koulaei, M. E., Pashaei, S. M. The prevalence of post-traumatic stress disorder among emergency nurses: a cross sectional study in northern Iran. BioMedicine, 2019. 9(3).
34. Iranmanesh, S., Tirgari, B., Bardsiri, H. S. Post-traumatic stress disorder among paramedic and hospital emergency personnel in south-east Iran. World journal of emergency medicine. 2013. 4(1), 26.
35. Lee, J., Daffern, M., Ogloff, J. R., Martin, T. Towards a model for understanding the development of post‐traumatic stress and general distress in mental health nurses. International journal of mental health nursing, 2015. 24(1), 49-58.
36. Naghavi, S. H. R., Shabestari, O., Alcolado, J. Post-traumatic stress disorder in trainee doctors with previous needlestick injuries. Occupational medicine. 2013. 63(4), 260-265.
37. Walker, R., Mashiach, R., Manny, A. Comorbidity of post-traumatic stress symptoms and depressive symptoms among obstetric nurses with perinatal death exposure. The Israel journal of psychiatry and related sciences. 2016. 53(2), 58.
38. Wahlberg, Å., Andreen Sachs, M., Johannesson, K., Hallberg, G., Jonsson, M., Skoog Svanberg, A., Högberg, U. Post‐traumatic stress symptoms in Swedish obstetricians and midwives after severe obstetric events: a cross‐sectional retrospective survey. BJOG: An International Journal of Obstetrics & Gynaecology. 2017. 124(8), 1264-1271.
39. van Steijn, M. E., Scheepstra, K. W. F., Yasar, G., Olff, M., de Vries, M. C., & van Pampus, M. G. Occupational well-being in pediatricians—a survey about work-related posttraumatic stress, depression, and anxiety. European journal of pediatrics. 2019. 178(5), 681-693.
40. Nogalski, A. Coping styles and dispositional optimism as predictors of post-traumatic stress disorder (PTSD) symptoms intensity in paramedics. Psychiatr. Pol. 2018. 52(3), 557-571.
41. Wild, J., Smith, K. V., Thompson, E., Béar, F., Lommen, M. J. J., Ehlers, A. A prospective study of pre-trauma risk factors for post-traumatic stress disorder and depression. Psychological medicine. 2016. 46(12), 2571-2582.
42. Olashore, A. A., Akanni, O. O., Molebatsi, K., Ogunjumo, J. A. Post-traumatic stress disorder among the staff of a mental health hospital: Prevalence and risk factors. South African journal of psychiatry. 2018. 24(1).
43. Joseph, B., Pandit, V., Hadeed, G., Kulvatunyou, N., Zangbar, B., Tang, A.,Rhee, P. Unveiling posttraumatic stress disorder in trauma surgeons: a national survey. Journal of Trauma and Acute Care Surgery. 2014. 77(1), 148-154.
44. Zafar, W., Khan, U. R., Siddiqui, S. A., Jamali, S., Razzak, J. A.. Workplace violence and self-reported psychological health: coping with post-traumatic stress, mental distress, and burnout among physicians working in the emergency departments compared to other specialties in Pakistan. The Journal of emergency medicine. 2016, 50(1), 167-177.
45. Ruitenburg, M. M., Frings-Dresen, M. H., Sluiter, J. K. The prevalence of common mental disorders among hospital physicians and their association with self-reported work ability: a cross-sectional study. BMC health services research. 2012. 12(1), 292.
46. Huang, J. Z., Han, M. F., Luo, T. D., Ren, A. K., & Zhou, X. P. Mental health survey of 230 medical staff in a tertiary infectious disease hospital for COVID-19. Zhonghua lao dong wei sheng zhi ye bing za zhi= Zhonghua laodong weisheng zhiyebing zazhi= Chinese journal of industrial hygiene and occupational diseases. 2020. 38, E001.
47. Sendler J, Rutkowska A, Makara-Studzinska M. How the exposure to trauma has hindered physicians' capacity to heal: prevalence of PTSD among healthcare workers. The European Journal of Psychiatry. 2016. 30(4), 321-334.
48. Engel CC, Litz B, Magruder KM, Harper E, Gore K, Stein N, Yeager D, Liu X, Coe TR. Delivery of self training and education for stressful situations (DESTRESS-PC): a randomized trial of nurse assisted online self-management for PTSD in primary care. Gen Hosp Psychiatry. 2015;37(4):323–8.
49. Mealer M, Conrad D, Evans J, Jooste K, Solyntjes J, Rothbaum B, Moss M. Feasibility and acceptability of a resilience training program for intensive care unit nurses. Am J Crit Care. 2014;23(6):e97–105.
50. Engelhard IM, van den Hout MA, Kindt M. The relationship between neuroticism, pre-traumatic stress, and post-traumatic stress: A prospective study. Personality and individual differences, 2003;35(2):381–388.
51. Letvak S: The importance of social support for rural mental health. Issues Ment Health Nurs 2002, 23:249–261.
52. Ozer EJ, Best SR, Lipsey TL, Weiss DS: Predictors of posttraumatic stress disorder and symptoms in adults: a meta-analysis. Psychol Bull 2003, 129(1):52–73.
53. Healy S, Tyrrell M. Stress in emergency departments: experiences of nurses and doctors. Emerg Nurse. 2011;19(4):31–37. doi:10.7748/en2011.07.19.4.31.c8611
54. Guay, S., Beaulieu-Prévost, D., Sader, J., & Marchand, A. A systematic literature review of early posttraumatic interventions for victims of violent crime. Aggression and violent behavior. 2019. 46, 15-24.
55. Richter D, Berger K. Post-traumatic stress disorder following patient assaults among staff members of mental health hospitals: a prospective longitudinal study. BMC Psychiatry 2006;6:15. .