Prevalence of Post-Traumatic Stress Disorder in Emergency Physicians in the United States

Joseph A. DeLucia, DO, FACEP; Cindy Bitter, MD, MPH; Jennifer Fitzgerald, BS, CCRC; Miggie Greenberg, MD; Preeti Dalwari, MD, MSPH; Paula Buchanan, MPH, PhD

Disclosures

Western J Emerg Med. 2019;20(5):740-746. 

In This Article

Abstract and Introduction

Abstract

Introduction: There is increasing concern about the effects of occupational stressors on the wellness of healthcare providers. Given high patient acuity, circadian rhythm disruption, and other workplace stressors, emergency physicians (EP) would be predicted to have high rates of occupational stress. We conducted this study to assess the prevalence of post-traumatic stress disorder (PTSD) in attending EPs practicing in the United States.

Methods: A link to an electronic questionnaire was distributed through the emergency medicine-centric publication Emergency Medicine News. We compared the prevalence of PTSD in EPs to the general population using a chi-square goodness of fit test, and performed logistic regression to assess for significance of risk factors.

Results: We received survey responses from 526 persons. In this study, EPs had a PTSD point prevalence of 15.8%. Being a victim of a prior trauma or abuse is the primary predictor of PTSD (odds ratio [OR] [95% confidence interval {CI}, 2.16 (1.21 – 3.86)], p = 0.009) and PTSD severity score (OR [95% CI, 1.16 (1.07 – 1.26)], p <0.001).

Conclusion: Emergency physicians have a substantial burden of PTSD, potentially jeopardizing their own health and career longevity. Future studies should focus on identifying subgroups at higher risk for PTSD and modifiable risk factors. Prevention and treatment strategies should be developed and tested in healthcare providers.

Introduction

Post-traumatic stress disorder (PTSD) affects some people who have been exposed to traumatic events such as military action, natural disasters, sexual violence, or serious illness/injury. In the United States (U.S.), the point prevalence of PTSD in adults is estimated to be 3.8%. The diagnosis of PTSD requires an exposure to trauma and symptoms from multiple domains, including intrusive memories, avoidance, negative mood, and hyperarousal. Symptoms must occur for more than one month and cause functional impairment to meet criteria for PTSD. Exposure was originally defined as personal experience, witnessing events, or indirect exposure through events that occurrred to loved ones.

The terms secondary traumatic stress (STS) and compassion fatigue were used to describe the emotional toll suffered by persons who have repeated but indirect exposure to trauma as part of their professional or volunteer duties, such as healthcare workers, firefighters, forensic examiners, and humanitarian workers. In recognition of a growing body of literature suggesting STS has a profound effect on workers in these fields, the 2013 update to the Diagnostic and Statistical Manual of Mental Disorders (fifth edition) (DSM-5) added repeated indirect exposure as an exposure class.

Physicians have high rates of substance abuse and suicide, which may be mediated by underlying PTSD.[6–8] STS and PTSD have been described in many types of healthcare providers, but emergency physicians (EP) may be particularly vulnerable. EPs deal with multiple challenges such as the potential to witness death and trauma on a frequent basis, diagnostic uncertainty, high patient acuity, crowding, and circadian rhythm disruption that place them as elevated risk for occupational stress. A single-site study from the U.S. found that 11.9% of emergency medicine (EM) residents met criteria for PTSD, with 30% having symptoms that did not meet the threshold for diagnosis.[9] A study of EPs and advance practice providers from a group practice in the U.S. found a PTSD prevalence of 12.7%.[10] Research from other countries corroborates this vulnerability, with prevalence of self-assessed PTSD of 16.8% in German EPs, 15.4% in Pakistani EPs, and 14.5% in Belgian EPs.[11–13]

The objective of this study was to determine the point prevalence of PTSD in a cohort of practicing EPs from multiple practice settings in the U.S., and to compare this to the prevalence in the general population. The secondary objective was to determine if personal or practice-related factors mediate prevalence of PTSD. Determining the prevalence of PTSD in EPs and identifying high-risk subgroups will hopefully improve methods to prevent and treat PTSD in EPs and other healthcare providers.

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