PTSD, Workplace Trauma Lower Among First-Year Residents During COVID-19

Karina Pereira-Lima, PhD, MSc

Credit: Twitter

Contrary to popular belief, rates of posttraumatic stress disorder (PTSD) and workplace trauma exposure was lower among first-year medical residents during the COVID-19 pandemic than in years prior, according to new research.¹

In new cohort analysis from a team of University of Michigan investigators, first-year residents training at US hospitals were significantly less likely to screen positive for PTSD—as well as report more weekly work hours, poor workload satisfaction and increased medical errors—than residents who trained prior to the pandemic. The findings lend credence to applied strategies that sought to resolve the risk of burnout or workplace trauma among trainees during COVID-19—including better management of their workload.

Led by Michelle K. Ptak, BA, of the department of psychology, and Karina Pereira-Lima, PhD, MSc, of the department of neurology, investigators sought to analyze differences in PSTD symptoms among first-year medical residents training during versus before the first COVID-19 pandemic wave, defined as March – June 2020. Their research, which accounted for established factors linked to mental health outcomes among training physicians, acknowledged the clear risk of trauma residents faced in joining the workforce during a turbulent period of public health emergency.

“During the COVID-19 pandemic, resident physicians experienced rapidly changing training environments, raising concerns about their risk of trauma exposure and PTSD,” they wrote. “Although cross-sectional studies reported a high prevalence of PTSD symptoms among residents during the pandemic, to our knowledge, no studies have assessed whether this prevalence differs from prepandemic levels.”

Trauma and resulting mental health disorders and illnesses are more common among the health care profession than the general population, according to numerous research—with some early COVID-19-era research indicating up to 1 in 5 clinicians were experiencing symptoms of PTSD by 2021.²

Ptak, Pereira-Lima and colleagues analyzed data from 2 cohorts from the longitudinal Intern Health Study to interpret PTSD and trauma symptoms among first-year residents: 2018 – 19 data representing pre-pandemic impact, and 2019 – 20 representing mid-pandemic impact. Cohort participants completed a baseline survey, followed by quarterly updates including the adapted Primary Care PTSD Screen for the 5th Edition DSMMD (PC-PTSD-5). Positive PTSD screens were defined as PC-PTSD-5 scores of ≥3, while self-reported workplace trauma exposure was assessed through univariable and multivariable logistic regression models.

The parent study included 3814 residents, of whom 1957 (51.3%) completed the PC-PTSD-5 survey and were included in the analysis. Mean participant age was 27.6 years old; 48.2% were female. Nearly 3 in 5 (58.1%) comprised the prepandemic cohort, versus 41.9% in the pandemic cohort. The lone non-residency factor that was significantly higher among pandemic-era residents was neuroticism.

Residents training during COVID-19 reported significantly lower weekly duty hours, lower mean reports of medical errors committed, and higher satisfaction with their workload.

What’s more, residents training during the pandemic were 36% less likely to screen positive for PTSD than pre-pandemic residents (7.1% vs 10.7%; odds ratio [OR], 0.64; 95% CI, 0.46 – 0.88; P = .01). They were additionally 20% less likely to report exposure to workplace trauma (50.9% vs 56.6%; OR, 0.80; 95% CI, 0.66 – 0.95; P = .01).

After investigators adjusted for multivariable outcomes accounting only for non-residency factors, residents training during COVID-19 were even less likely to screen positive for PTSD than those training prior to the pandemic (OR, 0.59; 95% CI, 0.42 – 0.82). The team still observed no significant association between training during the pandemic and increased odds of presenting with PTSD symptoms after incorporating residency-related factors (OR, 0.76; 95% CI, 0.53 – 1.09).

Investigators concluded that training during the COVID-19 pandemic was not associated with increased risk of PTSD symptoms among first-year residents—in fact, the cohort was significantly less likely to report trauma-related outcomes than their pre-pandemic peers.

“This study builds on prior work by demonstrating that, although the prevalence of PTSD symptoms among residents was high during the pandemic, it was significantly lower than prepandemic levels,” they wrote. “In addition, these findings identify work hours, workload, and medical errors as potential targets of intervention to prevent PTSD among residents.”

References

1. ^{Ptak MK, Frank E, Ross KET, Cleary JL, Sen S, Pereira-Lima K. Posttraumatic Stress Disorder Symptoms Among First-Year Resident Physicians Working Before and During the COVID-19 Pandemic. JAMA Netw Open. 2023;6(8):e2330241. doi:10.1001/jamanetworkopen.2023.30241}
2. ^{Kunzmann K. Falling Dust: Considering the COVID-19 Effect on Physician Suicide. HCPLive. Published March 12, 2021. https://www.hcplive.com/view/falling-dust-considering-covid-19-effect-on-physician-suicide}