Combat Veterans and Medical Professionals (MP) are very similar when it comes to dealing with PTSD. Post-Traumatic Stress Disorder (PTSD) is an anxiety disorder that develops through an event creating a psychological trauma resulting from an actual or threatened death, serious injury, or sexual violation. This direct exposure to the event or trauma may be experienced anywhere in the world like combat in wars, natural disasters, car accidents, sexual abuse, domestic violence, first responder scenarios, and in the hospitals, primarily since COVID has been occurring and the witnessing of so many deaths and traumas. MPs are exposed to "traumas" multiple times per day, and these events are not accounted for in many instances or institutions. Many MPs hold more than one job to compound the stress, which multiplies the exposure and stress level. Research shows that one in four nurses experience PTSD at some point in their careers. The National Institute of Mental Health has found that 3.5 percent, or 7.7 million, adults have PTSD.
Symptoms of PTSD can include nightmares, flashbacks, sleep disturbance, mood disorders, suicidal ideation, avoidance, and hyper-arousal, which respond to trauma-related stimuli. Other common disorders related to PTSD are depression, anxiety, and various substance addictions causing significant distress and impairment in areas of occupational and social functioning. These symptoms are not taken seriously due to heavy job tempo and fear of social judgment.
Compassion fatigue (CF) and burnout syndrome (BOS) are two disorders that must be considered when discussing PTSD with MPs. Compassion fatigue is a condition that describes the gradual lessening of compassion over time. With emergency trauma nurses, CF signs and symptoms can be as high as 85%! BOS is the inability to cope with the emotional stress of work. This is the psychological term for the experience of long-term exhaustion and diminished interest in a work context. Burnout is often understood as the result of expending too much effort at work while having too little recovery.
Treatment for PTSD and other associated disorders includes Cognitive Behavior Therapy (CBT), Exposure Therapy (ET), Psychotherapy, and eye movement desensitization and reprocessing (EMDR). Other forms of treatment include Pharmacological interventions like anti-depressants such as serotonin reuptake inhibitors (SSRIs). Recently, technology has provided computer-aided exposure therapy to significantly improved the experience and effectiveness of exposure therapy.
Healthcare Leaders must take a proactive role in preventing, identifying, and treating PTSD with their staff. Ensuring staff has proper training before responding to traumatic events and conducting debriefings after critical events are methods to help prevent PTSD. Staff MPs must be educated in identifying the signs and symptoms of PTSD. Leaders of MPs must be prepared to understand how to respond to these occupational challenges with their team members, patients, and families. Leaders must remain engaged with their staff regularly by listening, encouraging, and supporting them. When leaders know their team, this develops their trust and confidence, which is key to helping them cope and preventing PTSD.
When MPs are identified with PTSD, they should be encouraged to share their feelings and thoughts. If their experiences become overwhelming, they should also seek help from a qualified practitioner. Discussions in small groups at work will help reduce the stress of the individual situations or feelings. Zen rooms or specific areas designated to destress are also beneficial. Zen rooms are located away from patient care areas which allow team members to destress through relaxation. The support structure established by leadership throughout the entire healing process will enhance recovery and refer to the organization's employee assistance program when needed.
Addressing the Coming PTSD Wave
Healthcare workers who have been on the front lines of the COVID pandemic may suffer mental scars for years to come.
Across the United States, a significant percentage of hospital care providers who treated COVID patients will have traumatic memories, nightmares, and insomnia – all indicators of PTSD.
Courageous healthcare professionals continue to fight a deadly COVID enemy that is taking lives at an extreme pace. Doctors, nurses, and respiratory therapists are healing as many people as possible yet still witnessing death on a level that no one should ever endure, all while confronting the ever-present risk of becoming infected themselves. They frequently absorb the anguish of a patient's final hours alone since the coronavirus has made it too treacherous for family members to be by the bedside.
The scope of the COVID pandemic is scary. Recent modeling predicts more than 145,000 Americans may die from the novel coronavirus by early August. Compare that rough calculation to the loss of 58,200 U.S. soldiers during the eight years that our troops fought in Vietnam.
When the crisis hit the hardest in New York at the pandemic's peak, the surge of patients and fatalities in area hospitals was unrelenting. In the heat of the moment, warriors – whether military or medical – must keep their heads in the fight, so they internalize their mission and stay focused on fulfilling their obligations. But afterward, when the mind has time to relive the ordeal, the heaviest emotional toll hits. Across the U.S., a significant percentage of hospital-based health care providers treating COVID patients will have traumatic memories, nightmares, and insomnia – all indicators of PTSD.
Ten years after the Vietnam War ended, 15.2% of American men and 8.5% of women served in this conflict have PTSD. Decades after the war, 4.5% of males and 6.1% of the female veteran were still suffering from the disorder, and more than one-third of those vets with PTSD were also suffering from severe depression.
The terrorist attacks on the World Trade Center on Sept. 11, 2001, caused almost 3,000 fatalities. Eleven to 13 years later, firefighters, police officers, and other emergency workers who responded to the catastrophe were interviewed. Nearly one-fifth had experienced episodes of PTSD, and roughly 10% were still suffering from the disorder.
These data indicate that severe trauma and death exposure can have adverse psychological effects – including clinically defined PTSD – for many years. Given the horrific number of fatalities resulting from the COVID pandemic, we can expect the rate of PTSD, associated depression, and physical symptoms – including hypertension, cardiovascular disease, gastrointestinal disease, and obesity – to be even higher for today's front-line health care workers, perhaps reaching 25% to 40%, than for Vietnam War veterans and the emergency responders after 9/11.
Therefore the Mount Sinai Center for Stress, Resilience, and Personal Growth have been launched, the first center in the nation to address the psychosocial impact of COVID on health care providers. Drawing on Mount Sinai's extensive experience aiding 9/11 responders and veterans, the multidisciplinary center addresses the emotional, spiritual, and physical needs of health care workers, with an initial focus on building resilience.
Every front-line Mount Sinai employee will meet with a social worker to develop an individualized resilience plan. The center is also conducting workshops focused on building resilience techniques and hosting support groups to help front-line workers process their COVID experiences. Participants are learning to reframe their memories and harness social support to promote healing. For health workers who develop COVID-related PTSD, one-on-one treatment is available with clinicians experienced in addressing trauma-related conditions.
The center's mission is to research to understand the mental health needs of workers engaged in battling pandemics. Researchers will study psychosocial factors associated with COVID-related stress, how memories from the pandemic change over time, and biological responses related to the development of PTSD.
We believe it is imperative that hospitals across the nation that have faced an influx of COVID patients similarly invest in mental health services for their front-line employees.
However, it is not enough to offer services – hospital leaders also need to encourage staff to utilize them actively. Communicating that "it's OK to get help" is essential because the act of seeking care for oneself can conflict with the heroic attitude our health care workers assume when they step into the fire of treating COVID patients. They see their role as caring for others, not receiving care themselves, so many will try to convince themselves they don't need help. Overcoming this resistance and eliminating any stigma associated with seeking mental health care is a critical task for hospitals because the fact is, many of our employees do need help after battling COVID. So, we are aggressively promoting the center within the Mount Sinai community and ensuring its services are easy to access.
The federal government should also play a key role by providing funding for developing PTSD centers of excellence in the regions hardest hit by COVID; extensive training for psychotherapists in evidence-based trauma-focused therapies; and research, through the National Institutes of Health, that will improve PTSD treatments.
As a society, we need to be prepared to provide support and treatment for today's COVID health care professionals, just as we have for soldiers returning from war and responders to terrorist attacks on our nation. Not only do we have an obligation to our employees – the doctors and nurses putting their lives on the line – but we also need them to recover, as the future of our hospitals and health care depends upon their ability to heal.
Davis, K. & and Charney, D. (2020). Addressing the Coming PTSD Wave. Retrieved from https://www.usnews.com/news/healthiest-communities/articles/2020-06-09/hospital-system-addressing-ptsd-among-coronavirus-health-workers
Orloff, D.R. (2020). Post-Traumatic Stress and the Respiratory Therapist. Retrieved from https://www.linkedin.com/pulse/post-traumatic-stress-respiratory-therapist-david-r-/
Image provide by TopDoctors (2021). COVID-19: are healthcare professionals on the frontline at risk of PTSD? Retrieved from https://www.topdoctors.co.uk/medical-articles/covid-19-healthcare-professionals-frontline-risk-ptsd