During the pandemic, frontline hospital workers have seen more deaths than U.S. soldiers have seen during all the wars combined. COVID-19 posed a great challenge to frontline healthcare workers. They were forced to measure themself against a disease that was risky to their own health as well as their patients. This was particularly challenging at the beginning, when protective equipment was in short supply.
Frontline hospital staff faced unprecedented scenarios often outside their ordinary levels of expertise and training. They were at the forefront of the fight against the virus. Workers had to deal with staff shortages that affected patient care. They dealt with the repeated trauma of losing patients, which made them feel inadequate, some even crying on their way home after a tough shift. They faced exhaustion, stress, and anxiety as they were seeing some of their coworkers dying from the disease.
What Is PTSD and How Common Is It Among Frontline Healthcare Workers?
PTSD refers to severe, chronic somatic and emotional symptoms brought on by a traumatic event. PTSD can involve chronic severe anxiety of…
- Re-experiencing of the traumatic events expressed as flashbacks and/or nightmares
- Increased arousal, feeling jittery, problems concentrating and problems sleeping
- Avoidance of talking about the event
- Negative changes in beliefs, such as losing interest and losing trust
Left untreated, it can affect the whole body and increase the risk of cardiovascular disease, diabetes mellitus, and autoimmune disease. It can also have repercussions on spouses and families.
PTSD can affect 3-4% of the U.S. population with a 10% lifetime prevalence in women and up to 20% in veterans. During the pandemic, 30% of the patients hospitalized endorsed PTSD at 6 months, and it is estimated that 20% of the healthcare workers experienced at least moderate PTSD. The time course in symptom development and maintenance after trauma can vary among individuals. PLOS ONE‘s meta-analysis of 65 studies comprising over 97,000 healthcare workers across 21 countries estimates that 21% have moderate depression, 22% anxiety, and 21.5% PTSD.
Who Is at Risk of Developing PTSD Among Frontline Healthcare Workers?
Pre-trauma risk factors include gender, particularly mothers who are caregiving at home, workers with low work experience and lack of training, those with a heavy workload and work in unsafe settings, singles who lack a partner, and workers who lack social support. Healthcare workers who have pre-existing or previous struggles with anxiety, depression, PTSD, ADHD, etc. are also at elevated risk of these re-occurring when placed under the stressors that a pandemic induces.
Other general psychosocial risk factors include low socioeconomic status, previous history of trauma, and childhood adversity or abuse. Biological or physiological risk factors are still being studied and include heart rate variability and the balance between sympathetic and parasympathetic activity, general inflammation as measured by CRP (C-reactive protein), and sleep disorders.
Can We Prevent PTSD Among Frontline Healthcare Workers?
The first line of prevention is a healthy lifestyle. This includes exercising on a regular basis, eating well, and good sleep hygiene constitutes the first line of prevention. Sleep disorders are present in 70% of patients who will develop PTSD. Sleep quality and the presence of REM sleep may provide a mechanism for fear extinction and prevent PTSD. Healthcare workers may work swing and night shifts, which permanently alter sleep/wake cycles, cortisol levels, quality of sleep, and quality of relationships/interaction with others.
Other modifying risk factors include increased education and training about the disease, increased support in the work environment, and participation in decision making, facilitation of coping mechanisms, buddy systems, increased flexibility in the work schedule, and monitoring of the health of the staff. Hospitals/clinics could offer support groups and process time. This is especially necessary after deaths occur and the medical staff is the only person present. But a worker asking to process death or a “code” with poor outcome is unheard of. There is often a fear of being seen as “weak, unstable, can’t handle the pressure!”
How Do We Treat PTSD Among Frontline Healthcare Workers?
People with PTSD are prone NOT to seek care because of barriers like lack of information about the disease, being afraid of stigmatization with fear of repercussion at work or the renewal of their professional license, and beliefs that symptoms will diminish over time.
Adjunctive treatment that includes behavioral and pharmacological therapies is probably the most effective in treating PTSD. Behavioral therapies such as cognitive processing therapy and EMDR (Eye Movement Desensitization Reprocessing) are resource-intensive. Pharmacotherapy such as antidepressants (Zoloft, Effexor), prazosin for nightmares, mood stabilizers, and antipsychotic medications can have significant side effects.
A recent study of MDMA-assisted therapy for severe PTSD was shown to be very effective and well-tolerated. Estrogen treatment has been studied as a pharmacological adjunct. Other treatments such as the use of cannabinoids lack double-blind, randomized clinical trials. Legal Delta-8 CBD has been shown to be helpful for anxiety, depression, and PTSD. Unfortunately, nursing is one of the most monitored careers. Even prescribed MDMA or cannabinoids can lead to loss of nursing license.