High Rates of PTSD Plague Psychiatric
Hospital Staff

Megan Brooks

December 10, 2019

Staff at psychiatric hospitals are frequently exposed to violence and physical threats that often lead to symptoms of posttraumatic stress disorder (PTSD), new research shows.

In a cross-sectional survey of clinical staff working in adult psychiatric units, 16% met or exceeded the cut off score on a self-report measure of PTSD symptoms.

The level of trauma and impairment among mental health care providers in the workplace is "concerning," N. Zoe Hilton, PhD, CPsych, senior research scientist, Waypoint Research Institute, and associate professor of psychiatry, University of Toronto, Canada, told Medscape Medical News.

The study was published online December 4 in the journal Psychiatric Services.

Need for PTSD Prevention Strategies

The investigators surveyed 761 staff (69% female) at three psychiatric hospitals in Canada. Nursing was the most common discipline (57%) followed by allied health (27%).  Two thirds of the sample had more than 5 years of experience working in mental health.

Almost all staff (96%) reported direct or indirect exposure to at least one critical event — including a physical threat, assault, or death — that may have constituted a traumatic event. Two thirds (67%) reported direct exposure to at least one such event.

In addition, 86% of staff reported exposure to at least one chronic stressor, most commonly verbal abuse, constant screaming, or physical resistance to care.

A total of 16% percent of those surveyed met the PTSD screening cutoff score of at least 33 on the PTSD Checklist-5 (PCL-5), and nearly half (49%) reported having been bothered by PTSD symptoms for more than a month.

PTSD symptoms were statistically and independently explained by both exposure to critical events and chronic stressors. "This is another concerning finding," said Hilton, "because, while workplaces can do many things to reduce staff's exposure to critical events, it also means that workplace interventions may need to address cumulative effects of multiple sources of stress."

"Our results provide an empirical basis for establishing mental health programs for staff in psychiatric settings that provide assessment and treatment of PTSD in addition to basic wellness activities," the investigators write.

"It's important to keep in mind that resilience is not just about individual strength and what individuals can do for themselves," Hilton told Medscape Medical News. "It's about the resources that we have as individuals and communities, and how we navigate the resources available and negotiate for the resources that we need to protect and optimize our mental health."

"Workplace wellness programs are important, but workplaces also need services specifically to prevent PTSD and to support and treat workers who develop PTSD," she added.

High Rate of Violence

Commenting on the findings for Medscape Medical News, C. Vaile Wright, PhD, director of research and special projects at the American Psychological Association, said the findings are not surprising.

"Inpatient psychiatric hospitals have a high rate of violence and frontline staff are more likely to experience that violence and, as such, more likely to experience the negative consequences of that violence, whether it be PTSD or depression or other chronic health problems.

"Certainly within psychological training, there are discussions and training around safety and how to protect yourself, de-escalate conflicts and create safe spaces and maintain your own safety," said Wright.

"Organizations should have comprehensive plans in place to reduce violence and address these situations when they do occur," stressed Wright. "This includes having plans to help patients regulate their emotions and de-escalate when they get worked up."

Th e study was supported by funds from WorkSafeBC through its Innovation at Work program and from the Ontario Ministry of Labour through its Research for the Workplace program. Hilton, study coauthors, and Wright have disclosed no relevant financial relationships.

Psychiatr Serv. Published online December 4, 2019. Abstract

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