PTSD Ran High Among Physicians During COVID-19 Pandemic

Nearly 1 in 5 physicians experienced post-traumatic stress disorder (PTSD) during the COVID-19 pandemic, according to a review and meta-analysis.

In an analysis of 57 studies, the estimated pooled prevalence of PTSD among physicians was 18.3%, a figure more than 3 times higher than the general population, Manish Sood, MD, of Ottawa Hospital Research Institute in Canada, and colleagues reported in JAMA Network Open.

Female physicians were almost twice as likely as male physicians to develop PTSD (OR 1.93, 95% CI 1.56-2.39, P<0.001), and medical trainees were more likely to develop PTSD than attendings (OR 1.33, 95% CI 1.12-1.57), they found.

When analyzed by specialty, PTSD was most common among family medicine physicians (31.2%), followed by emergency medicine physicians (23.4%), they reported.

“We have to think about how we support these physicians [and] the consequences of [the pandemic],” Sood told MedPage Today, noting that there’s been increased awareness of physician mental health issues, but more investment is needed in physician well-being, especially in the aftermath of the pandemic.

Michael Myers, MD, of SUNY Downstate Medical Center in New York and an expert on physician health who wasn’t involved in the study, told MedPage Today the findings aren’t surprising given that during the pandemic, “many doctors were feeling that they didn’t [have] enough PPE [personal protective equipment], having to work brutal hours, and they didn’t always feel supported. So they kind of felt like sacrificial lambs.”

Myers said there were two important outcomes not mentioned in the paper: moral injury and post-traumatic growth, the latter of which occurs when a person feels “a sense of resilience that comes out of the processing and hard work of growing through PTSD.”

“In other words, you end up on the other side feeling stronger,” he said.

Even before the pandemic, studies showed that PTSD was more prevalent among physicians than the general population, at around 15% versus 4% or 5%. “Exposure to patient deaths, life-threatening emergencies, heavy workloads, and workplace violence may contribute to this heightened risk,” the researchers wrote.

They suspected PTSD prevalence would be even higher during the COVID pandemic, as the disease pushed up hospitalizations and deaths, sometimes exceeding hospital capacity. Hospitals tried to cope by boosting staff work hours and decreasing time off. In addition, physicians themselves were at high risk of contracting the infection, all together putting them at higher risk for PTSD, the researchers wrote.

For the review and meta-analysis, Sood and colleagues assessed 57 studies involving 28,965 physicians from 25 countries, published from December 2019 through November 2022, based on a literature search of MEDLINE, Embase, and PsycINFO.

Of those studies, 46 (80.7%) were conducted early in the pandemic during 2020, six studies (10.5%) were conducted in 2021, four studies (7%) during 2020 and 2021, and one study during 2021 and 2022.

For the studies that stratified PTSD outcomes by demographic details, 16 included career stage, 14 included sex, 13 included specialty, and 10 included age. Among all participants, 52.6% were men, 37.1% were trainees, and 62.9% were attending physicians.

The analysis was limited by two key factors. First, most studies were based on survey responses and half of those studies did not report response rates, which limits the generalizability of the results. Second, the definition of PTSD used in the analysis overlapped with the definition for adjustment disorder, which is a more temporary condition. The authors noted the similarity of those symptoms in the short-term could overestimate the prevalence of PTSD.

Sood said he hopes the findings will push physicians to understand how the pandemic may have affected their own mental health.

“Maybe [physicians] will have moments of reflection and say, ‘You know, I could be prone to this,'” Sood said. “If they’re having symptoms, they’ll at least know they’re not alone. This is very common and this will hopefully promote them to seek out help if they need it.”

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