What Did Pre-COVID PTSD Look Like for Interns?

Symptoms of work-related post-traumatic stress disorder (PTSD) were three times higher for interns than the general population, according to a 2018 study.

There were 10.8% of intern physicians who screened positive for PTSD at the end of their first internship year compared with a 12-month prevalence of 3.6% in the general population, reported Mary Vance, MD, of the Uniformed Services University’s Center for the Study of Traumatic Stress in Bethesda, Maryland, and colleagues.

Among 1,134 resident physicians surveyed, 56.4% reported exposure to trauma in the workplace, and 19% of that group screened positive for PTSD by the end of their residency, the authors wrote in JAMA Network Open.

“Doctors with PTSD … in addition to being unwell, don’t necessarily function at the top of their ability,” commented Albert Wu, MD, of Johns Hopkins Bloomberg School of Public Health in Baltimore, who was not involved with the study. “This can diminish their ability to deliver the best quality care, and may increase incidents of medical errors,” he told MedPage Today.

Wu coined the term “second victim” over 2 decades ago to highlight the need for mental health services for doctors who were involved in a medical error. He explained that physicians-in-training are particularly susceptible to trauma exposure, as they are just beginning to adjust to the onslaught of new stressors from residency.

For the study, Vance and colleagues contacted interns from participating institutions across a wide array of specialties 2 months before the start of participants’ training. After this baseline assessment, there were four follow-up surveys sent via email at months 3, 6, and 12 of internship. The authors used the Primary Care PTSD Screen for DSM-5 to assess trauma exposure and PTSD symptoms.

The mean age of those surveyed was about 28; 58.6% were women and 61.6% were non-Hispanic white.

Multivariable logistic regression analyses found, not surprisingly, that those who reported working longer hours experienced higher rates of exposure to work-related trauma (OR 1.01, 95% CI 1.00-1.03, P=o.03). Early family environment and the presence of stressful life events at baseline were also significant risk factors (OR 1.03, 95% CI 1.01-1.05, P<0.001; OR 1.46, 95% CI 1.06-2.0, P=0.02, respectively) for trauma exposure, the researchers found.

There were associations between screening positive for PTSD and certain risk factors, such as being unmarried (OR 2.00, 95% CI 1.07-3.73, P=0.03) or experiencing stressful life events during internship (OR 1.43, 95% CI 1.14-1.81, P=0.002).

While there was no association between specialty and trauma exposure overall, the authors found surgery and psychiatry were “less associated” with PTSD following work exposure (OR 0.26, 95% CI 0.09-0.81, OR 0.15, 95% CI 0.03-0.77, respectively), but Vance’s group urged caution when interpreting these findings as they were only compared to internal medicine.

For interns and residents who reported depression during their last month of training, there was a significant association between depression and PTSD (OR 2.52, 95% CI 1.36-4.65, P=0.003). PTSD and reports of anxiety during the last month of residency were also significant (OR 2.14, 95% CI 1.13-4.04, P=0.02), the team reported.

Study limitations included the relatively low response rate to the survey (26% overall).

“More research is needed to determine the prevalence of trauma exposure and PTSD at different stages of a physician’s career,” the researchers concluded.

Wu agreed, noting that the interns who made it through the survey process may have wanted a platform to air out frustrations and grievances; he suggested that, as a result, the study’s rates of PTSD symptoms might be an overestimation.

He said that considering the physicians who started their journey into residency during a pandemic, COVID-19, and the high rates of work-related trauma that emerging doctors have experienced this year have made medicine more receptive to conversations around PTSD and funding future research.

“Interns experience tremendous stress during training,” he said. “I’d like to see every training program … take steps to make sure they have adequate support systems in place for … their most valuable asset — their health workers.”