Prevalence and Predictors of Post-Traumatic Stress Disorder Symptoms Among Emergency Physicians in the United States During the COVID-19 Pandemic

ABSTRACT

Study Objectives: Our study aims to identify the prevalence of post-traumatic stress disorder (PTSD) symptoms among emergency physicians in the United States following the COVID-19 pandemic, and explore related factors and predictors of PTSD symptoms. Methods: Study participants included board-certified & board-eligible emergency physicians’ residents, and non-emergency physicians working in an EM setting, who were practicing in the US. Convenience sampling recruitment via multiple national EM listservs was used to complete an anonymous, online self-report survey from September 2020 to April 2021. Research data was stored on Qualtrics, a secure, password-protected multi-user database with access granted to the study team only. Surveys included demographics, a binary PTSD experience question and a PSS-I-5 scale pre-piloted for ease of use and comprehension. Based on Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition (DSM-5) criteria, we asked participants to dichotomously self-report trauma. We used the American Psychological Association-approved PTSD Symptom Scale (PSS-I-5), a validated, reliable tool, to assess the severity of the PTSD symptoms in frontline health care workers during the COVID-19 pandemic categorized into minimal 0-8, mild 9-18, moderate 19-30, severe 31-45, and very severe 46-80. Descriptive analyses were reported with percentages, means, and medians using RStudio. Figures were used to visualize variations in reported PSS-I-5 scores through the course of the pandemic. Results: Our sample included 315 total complete surveys of the 362 initiated surveys. PSS-I-5 scores ranged from 0-67 (IQR 4-27, median=13, mean=17.2). The majority of participants are age 35-50 (45.7%), EM board-certified (69.5%), white (86.4%), practice at urban level 1 trauma centers (44.8%), and do not have previous PTSD (91.8%) or other mental health diagnoses (73.3%). More than half (55.9%) of the respondents self-identified as having experienced trauma based on the DSM-5 criteria. PSS-I-5 scores were higher from those completing the survey in March-April 2021 (median=13, mean=17.3) compared to those sent in September-October 2020 (median=11, mean=16.5). Most participants had PTSD symptoms (92.1%);40.7% with minimal (129), 22.1% mild (70), followed by moderate (57, 18.0%), severe (39, 12.3%), and very severe (23, 7.3%). A higher proportion of those reporting severe and very severe PTSD symptoms are female and practice at level 3/4 trauma centers. Of non-emergency physicians who participated in the study, a majority reported severe symptoms (median=31, mean=25.4). Major perceived causes of stress included shift acuity, crowding, fear of self/family/friends getting sick, lack of personal protective equipment, and dissatisfaction with hospital administration. Conclusion: The prevalence of PTSD symptoms among our sample following the COVID-19 pandemic is 92.1%, with higher PSS-I-5 scores generally reported later in the pandemic. Race, age, and practice setting all appear to be associated with more severe PTSD symptoms. More research is needed to describe and reduce the burden of PTSD among those on the COVID front lines in the ED. [Formula presented] Figure 1. Frequency histogram of PSS scores [Formula presented] Figure 2. PSS mean (circle) and median (star) scores per month of survey end date [Formula presented]