Yale School of Medicine, New Haven, Connecticut.
Yale School of Medicine, Department of Emergency Medicine, New Haven, Connecticut.
West J Emerg Med. 2022 Feb 28;23(2):251-257. doi: 10.5811/westjem.2021.11.53186.
Emergency medicine is characterized by high volume decision-making while under multiple stressors. With the arrival of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus in early 2020, physicians across the world were met with a surge of critically ill patients. Emergency physicians (EP) are prone to developing burnout and post-traumatic stress disorder (PTSD), due to experiencing emotional trauma as well as the cumulative stress of practice. Thus, calls have been made for attempts to prevent physician PTSD during this current pandemic.
From July 2019-January 2020, emergency medicine (EM) resident physicians at a large, academic healthcare system were surveyed for symptoms of burnout using the Maslach Burnout Inventory (MBI). In late April and early May 2020, during the outbreak surge of coronavirus disease 2019 (COVID-19) in the Northeast USA, these same residents and the whole EM residency at the institution were again surveyed for symptoms of burnout as well as post-traumatic stress using the PTSD Checklist for Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (PCL-5). A final survey was administered to the EM residents after the COVID-19 surge had largely subsided in June 2020.
Twenty-two residents participated in the pre-pandemic study and completed the MBI. Twelve (55%) completed the two follow-up MBI surveys. In the larger EM residency cohort, 31/60 residents completed the MBI and PCL-5 survey during the pandemic peak and 30/60 (50%) completed the follow-up surveys. There were no significant differences in the three MBI burnout category measures of emotional exhaustion (P = 0.49), depersonalization (P = 0.13), and personal accomplishment (P = 0.70) pre-, during, and post-COVID. Of 31 participants, 11 (35%) scored greater than 31 on the PCL-5. Two residents had scores between 21-30, interpreted as "at risk." At greater than one month follow-up, 2/30 continued to meet criteria for a preliminary PTSD diagnosis, and five were "at risk."
A significant proportion of residents (35%) experienced post-traumatic symptoms acutely during the COVID-19 pandemic crisis, potentially indicating a high prevalence of acute stress disorder in this population and increased risk of developing PTSD. However, there was no significant difference in burnout levels in this cohort before, during, or after the initial COVID-19 surge. Early screening for physicians at risk and referral for assessment and treatment may be important to mitigate pandemic-related PTSD.
急诊医学的特点是在多种压力源下进行大量的决策。2020 年初，严重急性呼吸系统综合症冠状病毒 2（SARS-CoV-2）病毒的出现，使世界各地的医生都面临着大量重症患者。由于经历了情感创伤以及实践中的累积压力，急诊医师（EP）容易出现倦怠和创伤后应激障碍（PTSD）。因此，有人呼吁在当前大流行期间尝试预防医生 PTSD。
2019 年 7 月至 2020 年 1 月，对一家大型学术医疗机构的急诊医学（EM）住院医师进行了使用 Maslach 倦怠量表（MBI）的倦怠症状调查。2020 年 4 月下旬和 5 月初，在美国东北部冠状病毒病 2019（COVID-19）爆发期间，该机构的这些住院医师和整个急诊住院医师再次接受了关于倦怠和创伤后应激的调查，使用了《精神障碍诊断和统计手册》第 5 版创伤后应激障碍检查表（PCL-5）。在 2020 年 6 月 COVID-19 爆发基本平息后，向急诊住院医师进行了最后一次调查。
22 名住院医师参加了疫情前的研究并完成了 MBI。12 名（55%）完成了两项后续 MBI 调查。在更大的急诊住院医师队列中，31/60 名住院医师在疫情高峰期完成了 MBI 和 PCL-5 调查，30/60 名（50%）完成了后续调查。在三个 MBI 倦怠类别测量中，情感耗竭（P=0.49）、去人格化（P=0.13）和个人成就（P=0.70）没有显著差异。在 31 名参与者中，有 11 名（35%）在 PCL-5 上的得分大于 31。两名住院医师的得分在 21-30 之间，被认为是“有风险”。在一个月以上的随访中，有 2/30 名住院医师继续符合初步 PTSD 诊断标准，有 5 名“有风险”。
在 COVID-19 大流行期间，相当一部分住院医师（35%）出现了创伤后症状，这可能表明该人群中急性应激障碍的发病率较高，患 PTSD 的风险增加。然而，在 COVID-19 最初爆发之前、期间和之后，该队列的倦怠水平没有显著差异。早期对有风险的医生进行筛查，并转介进行评估和治疗，可能对减轻与大流行相关的 PTSD 很重要。
