Article Text

Download PDFPDF

Original research
Potential traumatic events in the workplace and depression, anxiety and post-traumatic stress: a cross-sectional study among Dutch gynaecologists, paediatricians and orthopaedic surgeons
  1. Karel Willem Frank Scheepstra1,
  2. Hannah S Pauw2,
  3. Minouk Esmee van Steijn3,4,
  4. Claire A I Stramrood3,
  5. Miranda Olff1,5,
  6. Maria G van Pampus3
  1. 1 Psychiatry, Amsterdam UMC - Locatie AMC, Amsterdam, The Netherlands
  2. 2 Faculty of Medicine, Amsterdam UMC - Locatie AMC, Amsterdam, The Netherlands
  3. 3 Obstetrics and Gynaecology, OLVG Locatie Oost, Amsterdam, The Netherlands
  4. 4 Obstetrics and Gynaecology, Amsterdam UMC - Locatie AMC, Amsterdam, The Netherlands
  5. 5 Psychotrauma Research, Arq National Psychotrauma Center, Diemen, North Holland, The Netherlands
  1. Correspondence to Karel Willem Frank Scheepstra; k.w.scheepstra{at}


Objective To compare the prevalence of work-related potential traumatic events (PTEs), support protocols and mental health symptoms across Dutch gynaecologists, orthopaedic surgeons and paediatricians.

Design Cross-sectional study, supplementary analysis of combined data.

Setting Nationwide survey between 2014 and 2017.

Participants An online questionnaire was sent to all Dutch gynaecologists, orthopaedic surgeons and paediatricians, including resident physicians (4959 physicians). 1374 questionnaires were eligible for analysis, corresponding with a response rate of 27.7%.

Outcome measures Primary outcome measures were the prevalence of work-related PTEs, depression, anxiety, psychological distress and traumatic stress, measured with validated screening instruments (Hospital Anxiety and Depression Scale, Trauma Screening Questionnaire). Secondary outcomes were the association of mental health and defensive practice to traumatic events and support protocols.

Results Of the respondents, 20.8% experienced a work-related PTE at least 4 weeks ago. Prevalence rates indicative of depression, anxiety or post-traumatic stress disorder (PTSD) were 6.4%, 13.6% and 1.5%, respectively. Depression (9.2% vs 5.2%, p=0.019), anxiety (18.2% vs 8.2%, p<0.001) and psychological distress (22.8% vs 12.5%, p<0.001) were significantly more prevalent in female compared with male attendings. The absence of a support protocol was significantly associated with more probable PTSD (p=0.022). Those who witnessed a PTE, reported more defensive work changes (28.0% vs 20.5%, p=0.007) and those with probable PTSD considered to quit medical work more often (60.0% vs 35.8%, p=0.032).

Conclusion Physicians are frequently exposed to PTEs with high emotional impact over the course of their career. Lacking a support protocol after adverse events was associated with more post-traumatic stress. Adverse events were associated with considering to quit medical practice and a more defensive practice. More awareness must be created for the mental health of physicians as well as for the implementation of a well-organised support system after PTEs.

  • occupational & industrial medicine
  • psychiatry
  • depression & mood disorders
  • anxiety disorders
  • adverse events
  • protocols & guidelines

This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See:

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Contributors KWFS, MEvS, CAIS and MGvP were involved in the design of this study. KWFS and HSP analysed the data and made the first draft. KWFS, HSP, MEvS, CAIS, MO and MGvP were involved in finalising the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Patient consent for publication Not required.

  • Ethics approval This study was exempted from ethical approval by the Medical Research Ethics Committees United (MEC-U), and registered under numbers W17.169 and W18.096.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available on reasonable request. The data can be made available by the corresponding author on reasonable request and for a well-defined purpose. The request will be discussed in our research group. The data will be de-identified participant data. A statistical analysis plan is available.