Work-related trauma exposure, PTSD common among intern physicians

Intern physicians commonly experienced work-related trauma exposure and PTSD, according to results of a cohort study published in JAMA Network Open.

“Most prior research on PTSD in physicians consists of small studies of specific medical specialties at a limited number of institutions,” Mary C. Vance, MD, MSc, of the Center for the Study of Traumatic Stress in the department of psychiatry at the Uniformed Services University in Maryland, and colleagues wrote. “Of the [three] studies we identified with more than 1,000 participants, all found considerable rates of PTSD symptoms or probable PTSD in physician populations. However, there have been no nationwide longitudinal studies of work-related trauma exposure and PTSD among physicians-in-training — a time when trauma exposure and the resultant mental health consequences may substantially impact the ability to learn and care for patients.”

To address this research gap, the investigators analyzed data of 1,134 resident physicians in their internship year of training who entered an internship at U.S. residency programs nationwide in 2018. Interns answered a baseline survey 1 to 2 months prior to the start of their internship, as well as follow-up surveys at four time points during the internship, with 12 months of internship as the exposure. Prevalence of work-related trauma and PTSD among those who experienced work-related trauma served as the main outcomes and measures. Vance and colleagues evaluated trauma exposure and PTSD symptoms via the Primary Care PTSD Screen for DSM-5 by assessing risk factors including depression, anxiety, early family environment, stressful life experiences, medical specialty, hours worked and concern about medical errors.

A total of 58.6% of participants were women, 61.6% were non-Hispanic white and the mean age was 27.52 years. Results showed 640 interns (56.4%) reported work-related trauma exposure, of whom 123 (19%) had a positive PTSD screen. By the end of internship years, 123 (10.8%) of training physicians screened positive for PTSD, whereas the 12-month prevalence rate was 3.6% in the general population. According to multivariable logistic regression analyses adjusted for demographic characteristics, risk factor linked to trauma exposure included non-Hispanic white race ethnicity (OR = 1.51; 95% CI, 1.14-2.01), more hours worked (OR = 1.01; 95% CI, 1.00-1.03), early family environment (OR = 1.03; 95% CI, 1.01-1.05) and stressful life experiences at baseline (OR = 1.46; 95% CI, 1.06-2.01). Risk factors linked to PTSD included being unmarried (OR = 2; 95% CI, 1.07-3.73) and non-Hispanic White (OR = 1.77; 95% CI, 1.01-3.11), concern about medical errors (OR = 1.21; 95% CI, 1-1.46), stressful life experiences during internship (OR = 1.43; 95% CI, 1.14-1.81), depression at month 12 of internship (OR = 2.52; 95% CI, 1.36-4.65) and anxiety at month 12 of internship (OR = 2.14; 95% CI, 1.13-4.04).

“More research is needed to determine the prevalence of trauma exposure and PTSD at different stages of a physician’s career,” Vance and colleagues wrote. “Also needed are studies on specific groups of physicians and physicians in training who may be at particularly high risk for work-related trauma exposure and PTSD (eg, in medical specialties with high rates of trauma exposure or PTSD, from racial/ethnic groups who may develop PTSD at higher rates). Finally, studies to identify effective interventions following work-related trauma exposure in physicians are needed, with the goal of enhancing physician performance, increasing professional satisfaction and ultimately improving patient care.”