Nearly one in five physicians experienced symptoms of post-traumatic stress disorder during the COVID-19 pandemic, a new meta-analysis led by a University of Ottawa physician finds.
The survey measured a PTSD prevalence of 18.3% among physicians in 25 countries during the pandemic, which is three times higher than the prevalence in the general population; it is also higher than the prevalence that was generally reported among physicians before the pandemic.
Women, older physicians, residents, and physicians practicing certain specialties were more likely than others to have symptoms of post-traumatic stress disorder.
“It was a perfect storm,” said Dr. Manish Sood.
Doctors who found themselves on the front lines during the pandemic, he said, were concerned about their own health and that of their loved ones in the presence of a virus about which little was initially known. Some even chose to isolate themselves from their families — for example, by taking refuge in hotels for several weeks — so as not to put them in danger.
Doctors may have been faced with patients dropping like flies despite their best efforts, or with scenes worthy of a war zone: a patient they are fighting with all their might to keep alive while his family screams and cries in the corner.
“It may not be the same as a bomb going off and taking a limb, but the feeling of loss, the feeling of fear, the feeling of self-harm all occur at that moment,” Dr. Sood said.
They may also have been asked to make difficult choices. If we run out of beds or ventilators, doctor, who should we give one to?
And all this in a context of great uncertainty, facing an enemy about which we knew almost nothing at the time and which they were not really equipped to confront.
“The public doesn’t see what’s going on behind the curtain in the exam room,” said Dr. Sood, a nephrologist who holds the Chair in Physician Health and Well-Being at the University of Ottawa.
“When faced with a patient injured by a bomb, we know what to do, we have training. But when faced with COVID, we had absolutely no idea what to do at the beginning. There was no treatment. And the first information that came out of China reported a very high mortality rate. Then the media started telling us that it was going to be a disaster…”
Women more vulnerable
Dr. Sood and his colleagues reviewed 57 studies from 25 countries involving nearly 30,000 participants.
The greater vulnerability of female physicians to PTSD is consistent with what is seen in the general population, where women are twice as likely as men to experience it. The authors of the meta-analysis have difficulty explaining this discrepancy, but they note that the pandemic may have deprived women of the social network they normally rely on and that the health crisis may have accentuated their traditional role as caregivers to their loved ones.
Researchers measured more PTSD at both extremes of a medical career, among residents and among older physicians. In the former case, the lack of experience and working conditions of residents probably play a role.
“Older people were, in general, more likely to have complications from COVID,” Sood said. “And older physicians were also more likely to have an older relative at home. So it all makes sense.”
Emergency physicians, anesthesiologists, intensivists and family physicians were more likely than others to have symptoms of post-traumatic stress disorder.
Anesthesiologists, Sood cited as an example, were the ones asked to come in and open the airway of a patient who was literally drowning in his own secretions. Family doctors, on the other hand, did not encounter the critically ill patients, but the chronically ill ones came rushing into their offices when hospitals began to overflow.
“They had a lot of burden to bear because at that time hospitals were only accepting the sickest patients,” Dr. Sood recalled.
The prevalence of PTSD has held steady over time, whether it’s between 2020 and 2021, 2021 and 2022, or even 2022 and now. This may be because PTSD symptoms can take months to emerge, Sood said. It’s also possible that some doctors waited a long time to seek help.
Finally, we can think that the prevalence of 18% that was measured is only the tip of the iceberg since there is still a great culture of silence within the medical profession, he added, even if the situation is starting to improve, possibly because there are more and more women among doctors and because we discuss mental health issues more freely in society.
It is almost inevitable that the world will one day face another pandemic, Dr. Sood warned. At that time, he said, it will be important to support doctors to protect their mental health and to remember that for every doctor who is no longer available, they leave a thousand patients behind.
“When there’s a school shooting, we send trauma counselors to the scene,” he said in conclusion. “We should do the same thing for front-line health workers. We should allow them to talk to psychologists or support groups in real time to help them absorb the shock and help them. A healthy society needs healthy doctors.”
The findings of this study were published by the medical journal JAMA Network Open.