Exposure to Workplace Trauma and Posttraumatic Stress Disorder Among Intern Physicians
Authors: Mary C. Vance, Holly B. Herberman Mash, Robert J. Ursano, Zhuo Zhao, Jessica T. Miller, Michael Jeremy D. Clarion, James C. West, Joshua C. Morganstein, Abeer Iqbal, Srijan Sen
Journal: JAMA Network Open (2021)

<h3>Importance</h3> Physicians are exposed to traumatic events during their work, but the impact and outcomes of these exposures are understudied. <h3>Objective</h3> To determine the prevalence and associations of work-related trauma exposure and posttraumatic stress disorder (PTSD) among a cohort of resident physicians in their internship year of training. <h3>Design, Setting, and Participants</h3> This cohort study involved physicians entering internship at US residency programs nationwide in 2018. Participants completed a baseline survey 1 to 2 months before commencing internship, as well as follow-up surveys at 4 time points during internship. Statistical analysis was performed from April 2020 to January 2021. <h3>Exposures</h3> Twelve months of internship. <h3>Main Outcomes and Measures</h3> Prevalence of work-related trauma and prevalence of PTSD among those who experienced work-related trauma. Trauma exposure and PTSD symptoms were assessed using the Primary Care PTSD Screen for<i>Diagnostic and Statistical Manual of Mental Disorders</i>(Fifth Edition) (PC-PTSD-5). Risk factors assessed included depression, anxiety, early family environment, stressful life experiences, medical specialty, hours worked, and concern about medical errors. <h3>Results</h3> Among 1134 interns who completed the PC-PTSD-5 at month 12 of internship, 665 (58.6%) were female and 695 (61.6%) were non-Hispanic White; the mean (SD) age was 27.52 (2.50) years. There were 640 interns (56.4%) who reported work-related trauma exposure; among these interns with trauma exposure, 123 (19.0%) screened positive for PTSD. Overall, 123 of 1134 training physicians (10.8%) screened positive for PTSD by the end of internship year, as compared with a 12-month PTSD prevalence rate of 3.6% in the general population. Multivariable logistic regression analyses, adjusting for demographic characteristics, indicated that risk factors associated with trauma exposure included non-Hispanic White race/ethnicity (odds ratio [OR], 1.51 [95% CI, 1.14-2.01];<i>P</i> = .004), more hours worked (OR, 1.01 [95% CI, 1.00-1.03];<i>P</i> = .03), early family environment (OR, 1.03 [95% CI, 1.01-1.05];<i>P</i> &lt; .001), and stressful life experiences at baseline (OR, 1.46 [95% CI, 1.06-2.01];<i>P</i> = .02). Risk factors associated with PTSD were being unmarried (OR, 2.00 [95% CI, 1.07-3.73];<i>P</i> = .03) and non-Hispanic White (OR, 1.77 [95% CI, 1.01-3.11];<i>P</i> = .05), concern about medical errors (OR, 1.21 [95% CI, 1.00-1.46];<i>P</i> = .05), stressful life experiences during internship (OR, 1.43 [95% CI, 1.14-1.81];<i>P</i> = .002), depression at month 12 of internship (OR, 2.52 [95% CI = 1.36-4.65],<i>P</i> = .003), and anxiety at month 12 of internship (OR, 2.14, [95% CI, 1.13-4.04];<i>P</i> = .02). <h3>Conclusions and Relevance</h3> This study found that work-related PTSD was 3 times more prevalent among intern physicians than the general population. These findings suggest that effective interventions to reduce trauma exposure and mitigate the effects of trauma are needed.