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When the trauma never ends: (Post)-Traumatic Stress Disorder after COVID-19 amongst trauma and acute care surgeons

      Dr. Melissa James and her group at Jamaica Hospital Medical Center reported their results of a web-based survey examining COVID-19 induced Post-Traumatic Stress Disorder (PTSD) amongst trauma and acute care surgeons from the Eastern Association for the Surgery of Trauma (EAST).
      • James M.K.R.R.
      • McKenzie K.
      • Valenzuela J.Y.
      • Esposito T.J.
      COVID-19 induced PTSD: stressors for trauma and acute care surgeons.
      They found that the COVID-19 pandemic had a psychological impact on surgeons surveyed, and they identified several personal and professional stressors that contributed to increased PTSD amongst surgeons.
      Among the 393 surgeons surveyed, the incidence of PTSD was 16.3%, using an instrument that was validated amongst civilian healthcare professionals. Several risk factors were associated with having PTSD, including a range of personal and professional factors. This study exemplifies the psychological toll that the COVID-19 pandemic has had on the emergency general, trauma, and critical care surgeons that make up the EAST community and suggests some potential directions for intervention. These data are intriguing and consistent with previous studies measuring PTSD and moral injury amongst surgeons and healthcare workers.
      • Nieuwsma J.A.
      • O'Brien E.C.
      • Xu H.
      • Smigelsky M.A.
      • Meador K.G.
      Patterns of potential moral injury in post-9/11 combat veterans and COVID-19 healthcare workers.
      ,
      • Joseph B.
      • Pandit V.
      • Hadeed G.
      • et al.
      Unveiling posttraumatic stress disorder in trauma surgeons: a national survey.
      Interestingly, there did not appear to be an increase in self-reported PTSD compared with historical data. This highlights the demanding nature of a surgeon's day-to-day life beyond a pandemic. The authors report qualitative findings and PTSD risk factors that may be unique to COVID-19, as well as many factors that remain troublesome.
      Influential studies, such as this one, are often hypothesis-generating and give nuanced insight into meaningful interventions. Further research might examine longitudinal data amongst surgeons to determine if the severity of their PTSD changes over time or in response to major world events. As the authors note, acute care and trauma surgeons are constantly bombarded with stress, does adding on one more variable change this? The authors also compare their work to historical baselines, suggesting that a similar proportion of surgeons have PTSD. Are these the same individuals impacted more severely by COVID, or does the combination of stressors change? As this study was distributed to the EAST members, a similar survey distributed more broadly may address this potential source of selection bias. Also, it would be interesting to note if the PTSD rates were different amongst EAST trauma and EAST non-trauma surgeons. With myriad institution-level interventions to help surgeons self-actualize and retain a very talented and specialized workforce, this manuscript highlights the importance of consistent and individualized factors.
      In summary, the authors should be congratulated for their thought-provoking investigation and contribution to the field.

      References

        • James M.K.R.R.
        • McKenzie K.
        • Valenzuela J.Y.
        • Esposito T.J.
        COVID-19 induced PTSD: stressors for trauma and acute care surgeons.
        Am J Surg. 2022 Mar 4; 2022 (S0002-9610(22)00140-4) (Epub ahead of print. PMID: 35277241; PMCID: PMC8896861)https://doi.org/10.1016/j.amjsurg.2022.02.060
        • Nieuwsma J.A.
        • O'Brien E.C.
        • Xu H.
        • Smigelsky M.A.
        • Meador K.G.
        Patterns of potential moral injury in post-9/11 combat veterans and COVID-19 healthcare workers.
        J Gen Intern Med. 2022; : 1-8
        • Joseph B.
        • Pandit V.
        • Hadeed G.
        • et al.
        Unveiling posttraumatic stress disorder in trauma surgeons: a national survey.
        J Trauma Acute Care Surg. 2014; 77: 148-154