Post-traumatic stress disorder amongst surgical trainees: An unrecognised risk?

BACKGROUND: Experiences of actual/threatened death or serious injury to patients are commonplace in surgery. Pathological symptoms following stress may lead to Acute Stress Reaction (ASR) and Post-Traumatic Stress Disorder (PTSD). PTSD symptoms of insomnia, anger, poor concentration, hyper-vigilance and exaggerated startle have implications for patient safety. The current study investigates the prevalence of occult, untreated psychological morbidity amongst surgical trainees. METHODS: A web-based survey of UK surgical trainees based upon the Impact of Events Scale-Revised (IES-R) was distributed using social media platforms and email. A score of ≥33 was indicative of ASR or PTSD (the former lasting <1 month, the latter >1 month). Additional questions concerned chronicity of symptoms, mentorship, team-working and access to support. RESULTS: For 167 returned surveys the mean age was 32.7 (SD 3.6) years; 102/167 (61%) were male. Mean years in training were 6.1 (SD 3.6). Median IES-R score was 14 (IQR 7-23.5). Of 144 respondents who answered about stress symptoms, 23/144 (16%) had IES-R score ≥ 33; 6 of these had symptoms < 1 month (suggesting ASR); 17 had symptoms lasting >1 month (suggesting PTSD). Those with IES-R ≥ 33 group were more likely to have repeated years of training, and have witnessed severe pain, traumatic injury, and acute haemorrhage. Seven with score ≥ 33 had sought support. CONCLUSION: Occult psychological morbidity amongst surgical trainees may be higher than in the general population. Recognition and management of this risk is important for the mental health of trainees and the safety of patients.

Coping with cancer: a brief report on stress and coping strategies in medical students dealing with cancer patients.

BACKGROUND: This pilot study explored factors associated with stress in medical students during their initial clinical contact with cancer patients, in particular identifying stress levels and coping strategies used. METHODS: A total of 80 medical students at The University of Birmingham Medical School, UK, completed retrospective self-report questionnaires measuring socio-demographics, potential stressors and coping strategies (using the Brief COPE inventory). Statistical analysis followed data collection. FINDINGS: Of all socio-demographic categories, female gender correlated with the highest stress score (p<0.05). The most stressful situations reported related to the patient's condition, the biopsychosocial effects of the cancer on the patient and his/her family, and breaking bad news. A combination of problem- and emotion-focussed strategies were used to manage stress; and the extent of their usage was significantly related to individual stress levels (p<0.01) in both instances. INTERPRETATION: Medical students in an oncology setting experience moderate stress and utilise a combination of problem- and emotion-focussed coping strategies to combat this stress. A greater use of both coping strategies was seen in students experiencing higher levels of stress. This may suggest a relative lack of effective coping skills. In light of this, the implementation of coping strategy training as a part of the medical course and/or support groups may be beneficial.

Mental health symptoms in a cohort of hospital healthcare workers following the first peak of the COVID-19 pandemic in the UK.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic is likely to lead to a significant increase in mental health disorders among healthcare workers (HCW). AIMS: We evaluated the rates of anxiety, depressive and post-traumatic stress disorder (PTSD) symptoms in a population of HCW in the UK. METHOD: An electronic survey was conducted between the 5 June 2020 and 31 July 2020 of all hospital HCW in the West Midlands, UK using clinically validated questionnaires: the 4-item Patient Health Questionnaire(PHQ-4) and the Impact of Event Scale-Revised (IES-R). Univariate analyses and adjusted logistic regression analyses were performed to estimate the strengths in associations between 24 independent variables and anxiety, depressive or PTSD symptoms. RESULTS: There were 2638 eligible participants who completed the survey (female: 79.5%, median age: 42 years, interquartile range: 32-51). The rates of clinically significant symptoms of anxiety, depression and PTSD were 34.3%, 31.2% and 24.5%, respectively. In adjusted analysis a history of mental health conditions was associated with clinically significant symptoms of anxiety (odds ratio (OR) = 2.3, 95% CI 1.9-2.7, P < 0.001), depression (OR = 2.5, 95% CI 2.1-3.0, P < 0.001) and PTSD (OR = 2.1, 95% CI 1.7-2.5, P < 0.001). The availability of adequate personal protective equipment (PPE), well-being support and lower exposure to moral dilemmas at work demonstrated significant negative associations with these symptoms (P ≤ 0.001). CONCLUSIONS: We report higher rates of clinically significant mental health symptoms among hospital HCW following the initial COVID-19 pandemic peak in the UK. Those with a history of mental health conditions were most at risk. Adequate PPE availability, access to well-being support and reduced exposure to moral dilemmas may protect hospital HCW from mental health symptoms.