Effects of with holding treatment on mental health in Canadian paramedics during the COVID-19 pandemic

ABSTRACT

IntroductionPsychological effects of withholding treatment that could have benefited a patient during a pandemic remain largely unknown. It is also unclear to what extent their reasons for withholding treatment contributed to the subsequent impact on mental health outcomes. Paramedics may have withheld treatments either due to fear of exposure, being directed by their service, or both. As such, the present research aimed to characterize withholding treatment and investigate potential negative mental health outcomes.Materials and MethodsParamedics from five provinces (Alberta, British Columbia, Manitoba, Ontario, Saskatchewan) working during the COVID-19 pandemic completed online questionnaires assessing withholding treatment (i.e., due to fear of exposure, directed by their service, or both), and mental health outcomes including depression (PHQ-9) and post-traumatic stress (PTSD) symptoms (PC-PTSD-5) as part of the COVID-19 Occupational Risks, Seroprevalence and Immunity among Paramedics (CORSIP) study.ResultsOf the 1453 participants, 54.2% reported withholding treatment due to fear of exposure (4.3%), as directed by their service (76.5%) or both (19.2%). Participants who withheld treatment reported higher rates of PTSD (M=2.6, p < .01) and depression (M=8.2, p < .001) symptoms than those that did not withhold treatments (MPTSD=2.3;Mdepression=6.4). Reason for withholding treatment and PTSD symptom severity were associated (p<.01). Paramedics who withheld treatment due to fear of exposure were more likely to report probable PTSD symptoms (23.5%) than those who withheld treatments as directed by their service (8.7%) or both (12.2%). Depression symptom severity did not differ by reasons for withholding treatment.ConclusionsWithholding treatment is potentially traumatic and may influence the development of depression and PTSD symptoms. Withholding due to fear of exposure rather than being directed to increased PTSD symptoms. Further research will investigate the mental health impact of withholding treatment and reported reasons for withholding over time.