Symptoms of post-traumatic stress disorder among emergency medicine residents

doi:10.1016/j.jemermed.2004.05.009

The Journal of Emergency Medicine

Volume 28, Issue 1, January 2005, Pages 1-4

Presented at the Society for Academic Emergency Medicine Scientific Assembly, St. Louis, Missouri, May 2000.

https://doi.org/10.1016/j.jemermed.2004.05.009 Get rights and content

Abstract

There have been anecdotal reports of post-traumatic stress disorder (PTSD) in physicians responding to mass casualty events. No formal, prospective study has addressed the presence of PTSD symptoms as a result of the work of Emergency Medicine residents in non-mass casualty settings. The purpose of this study is to evaluate the presence of symptoms of PTSD among Emergency Medicine residents (EMR). The study was a survey of EMR, administered in an anonymous, voluntary format in late June 2001. The survey was conducted at an Emergency Medicine residency program that serves a large, urban, county hospital. Four groups, incoming interns and three EM resident classes were surveyed. PTSD symptoms were divided into three categories according to the DSM IV. The Jonckheere-Terpstra test for trends was applied to each of the three categories of symptoms. Sixty-three surveys were administered, with a 93.6% response rate. All respondents reported experience with patient death or dying. Seven residents reported sufficient symptoms to meet the DSM IV criteria for PTSD. Each of the three symptom categories showed a statistically significant increase in the proportion of positive responses as the resident time in training increased (p < 0.01). In conclusion, many EM residents reported symptoms of PTSD. Symptoms of PTSD significantly increased as resident level of training increased.

Introduction

Post-traumatic stress disorder (PTSD) is a syndrome that may occur in people who have been exposed to a life-threatening event. Symptoms include reliving the event, avoidance behavior, and increased arousal. The criteria for PTSD were expanded in the Diagnostic and Statistical Manual of Mental Disorders IV (DSM IV) to include witnessing the death or near death of another person as an inciting event for PTSD (1).

PTSD may begin immediately or be delayed by several months after the inciting event. In the psychiatric literature, this disorder is well established, studied extensively among veterans of war and survivors of acute traumatic events. Using a survey of the general population, Kessler determined that PTSD occurs commonly (2). Psychiatrists now assume that PTSD is more prevalent than previously recognized (3).

Few studies assess the occurrence of PTSD among health care professionals who deal with death routinely. There have been anecdotal reports of PTSD in physicians responding to mass casualty events. One survey of PTSD symptoms in physicians treating victims of the Omagh bombing (August 5, 1998) revealed that doctors involved with patient death developed more symptoms of PTSD than doctors who did not witness patient death (4).

No formal, prospective study has addressed the presence of PTSD symptoms as a result of the routine medical practice of Emergency Medicine residents (EMR). PTSD has a higher prevalence among people who feel helpless during a traumatic event or who have additional life stressors (5, 6). Multiple studies have documented higher levels of stress in house officers than faculty physicians (7, 8, 9, 10, 11). Therefore, EMR are at unique risk for PTSD. The purpose of this study is to evaluate the presence of symptoms of PTSD among Emergency Medicine residents (EMR).

Section snippets

Study design

This study received Institutional Review Board (IRB) approval with waiver of informed consent. This study was a survey of EMR, administered in an anonymous, voluntary format. To maintain true anonymity, the IRB required that no demographic data, other than year in residency, be collected.

Study setting and population

The study was conducted at an Emergency Medicine residency program that serves a large, urban, county hospital. The teaching hospital serves approximately 100,000 patients per year and is a level one trauma

Results

Sixty-three surveys were distributed. All surveys were returned, with 59 (93.6%) complete. The response rate by training level was 100% of MS4, 87.5% of R1, 86.7% R2, and 100% R3. All returned surveys were completed in their entirety. All residents reported an experience with patient death or dying. Forty-nine% (29/59) reported distress or fear associated with this event (Appendix 1, Question 2). The number of residents reporting distress in response to a patient dying increased with increasing

Discussion

EMRs routinely deal with death and dying. Traditional Emergency Medicine curricula do not include training to deal with the emotional impact of stressful events (15). Although there are anecdotal reports of PTSD symptoms among physicians in a mass casualty setting, no study has inquired about PTSD symptomotology as a result of the routine practice of EMR (15, 16, 17, 18, 19, 20). Thirty percent of residents participating in this study report symptoms associated with PTSD.

A significant finding

Limitations

The survey employed in this study is not a validated screening tool for PTSD. The symptoms recorded in the study are self-reported, dependent upon physician self-awareness. A trained psychiatrist may discover a significantly higher prevalence of symptoms in these residents. This study was conducted at a single residency population, which may reflect a unique population.

Conclusion

EMR report symptoms of PTSD with increasing frequency as time in training increases.

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: Original Contributions is coordinated by John Marx,md, of Carolinas Medical Center, Charlotte, North Carolina

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Original contributionsSymptoms of post-traumatic stress disorder among emergency medicine residents

Abstract

Introduction

Section snippets

Study design

Study setting and population

Results

Discussion

Limitations

Conclusion

Lancet

Behav Res Ther

Is posttraumatic stress disorder underdiagnosed in routine clinical settings?

J Nerv Ment Dis

Questionnaire survey of post-traumatic stress disorder in doctors involved in the Omagh bombing

BMJ

Predictors of chronic post-traumatic stress disorder

Br J Psychiatry

Natural disasterspsychiatric response

Psychiatr Ann

Post-traumatic stress disorder in doctors involved in the Omagh bombing

BMJ

The impact of job stress and working conditions on mental health problems among junior house officerA nationwide Norwegian prospective cohort study

Med Educ

Original contributions
Symptoms of post-traumatic stress disorder among emergency medicine residents