Table 1 Articles identified after a narrative review according to the research country, the period (before or during the Covid-19 pandemic), the study method, the population of ICU healthcare workers included, the PTSD measurement tool, the risk and protective factors for PTSD in this population, the prevalence of PTSD, and the proposed psychological support
Author (date) ref Country | Purpose of study Extracted from the summary of the article | Study design | Tools (for PTSD*) | Sample HCW = health care workers | PTSD results (risk factors, protective factors, PTSD support …) |
|---|---|---|---|---|---|
Before the pandemic | |||||
Cho, et Kang [37] South Korea | “To investigate the relationship between Type D personality and post-traumatic stress disorder (PTSD) symptoms in ICU nurses.” “To determine the mediating effect of resilience on this relationship.” | A prospective, cross-sectional, multicentric study Quantitative method | DS 14 Post-traumatic Diagnostic Scale (PDS)* CD-RISC | 179 nurses | 18.2% of ICU professionals with type D personality were considered to be at a higher risk of developing PTSD A type D personality is positively correlated with PTSD and negatively correlated with resilience PTSD Support: Early assessment of PTSD in healthcare professionals, building resilience |
Colville, et al. [38] UK | “To examine the associations with symptoms of 1) burnout and 2) work-related post-traumatic stress in adult and pediatric intensive care staff, focusing on the particular contributions of resilience and coping strategies.” | A prospective, cross-sectional, multicentric study Quantitative method | BRS aMBI Trauma Screening Questionnaire (TSQ)* HADS List of coping strategies List of options for additional forms of support | 377 HCW | 52% reported between one and five symptoms in the previous fortnight, and 13% reported six or more symptoms, indicating that they were potentially at risk of PTSD because of an experience they had at work and that they might benefit from further psychological assessment Risk factors associated with PTSD: Suffering from burnout; working in pediatric ICU; critical care nurses with a graduate degree in nursing Protective factors: Among the coping strategies, seeking of social support is particularly used but is associated with greater distress; resilience; outdoor activities (leisure); discussions with "senior citizens"; expression of emotions PTSD Support: More debriefing; more time for reflective practice; training in mindfulness or relaxation; spending more time with their managers and having more training, especially on the range of psychological reactions that they may experience, to help them to identify and address symptoms earlier |
Dennis, et al. [27] Australia | “To elicit the nature and sources of workplace emotional distress in an international sample of intensivists.” | A retrospective, cross-sectional, multicentric study Qualitative method | Semi-structured interview | 19 physicians | Risk factors: Experiencing clinical situations that remind one of past traumatic situations PTSD Support: Explicit training in negotiation, difficult conversations, effective supervision; consensus building, which seems to be common in the business and leadership literature, seem very relevant for Intensivists |
Janda, et al. [8] Czech Republic | “To determine the occurrence of post-traumatic symptoms and symptoms of anxiety and depression among nurses in a Czech tertiary hospital.” “To explore the relationship between stressful work factors, work overload, and disturbed interpersonal relationships, and the appearance of their symptoms.” | A prospective, cross-sectional, multicentric study Quantitative method | PTSS-10* HADS | 151 nurses | 3.3% of ICU nurses have signs of PTSD but there is no information on the duration between the traumatic event and the moment when the symptoms are assessed Risk factors: Caring for an organ donor; insufficient nursing staff |
McMeekin, et al. [9] USA | “To explore the relationships between postcode stress, coping behaviors, and PTSD symptom severity in critical care nurses after experiencing unsuccessful cardiopulmonary resuscitations, and to see whether institutional support attenuates these repeated psychological traumas.” | A retrospective, cross-sectional, multicentric study Quantitative method | PCSS Brief cope The Impact of Event Scale (IES-R)* | 490 nurses | 23.7% of nurses have a high score at four months of resuscitation failure Risk factors associated with PTSD: The study identifies being female and having so-called “ineffective” coping strategies (denial, self-distraction, self-blaming, behavioral disengagement); debriefings; or participation in ICU failures Protective factors: Active adaptation, instrumental support, acceptance |
Mealer, et al. [39] USA | “To determine if a multimodal resilience training program for ICU nurses was feasible to perform and acceptable to the study participants.” | A single-center, prospective, randomized, and controlled study Quantitative method | 12 weeks intervention CD-RISC The Post Traumatic Diagnostic Scale (PDS)* HADS MBI CSQ-8 | 27 nurses | 44% of ICU nurses have signs of PTSD Resilience is the protective factor studied primarily in this study PTSD Support: Develop resilience among ICU nurses by proposing adapted programs |
Mealer, et al. [19] USA | “ To determine whether post-traumatic stress disorder (PTSD) and burnout syndrome (BOS) are common in nurses, and whether the co-existence of PTSD and BOS is associated with altered perceptions of work and non-work-related activities” | A single-center, prospective randomized, and controlled study Quantitative method | HADS PTSS-10* PDS MBI | 332 nurses | 11% of ICU nurses have a positive score on the PTSD diagnostic scale 33% of ICU nurses have signs of PTSD Risk factors associated with PTSD: The study identifies be exposed to a traumatic event such as witnessing patients dying, massive bleeding, open surgical wounds, trauma-related injuries, and providing futile care to critically or terminally ill patient Age (younger people) and year of experience (less you had experience more chance you had to be trauma) was also associated with PTSD |
During the pandemic | |||||
Altmayer, et al. [10] France | “To investigate and to compare the psychological impact of the pandemic on ICU regular staff and on reinforcement.” | A prospective, cross-sectional, single-center study Quantitative method | HADS The Post-traumatic Stress Disorder Checklist (PSDC)* MQOL-R CD-RISC-10 | 69 HCW | 16% of HCW have PTSD, assessed at the peak of the first wave (online survey available from March to April 2020) Risk factors: Team reorganizations during the first wave (reception and training of reinforcement personnel); lack of recognition of the work done; taking responsibility for errors committed by the reinforcement personnel The protective factors identified are the sense of belonging, the time spent in intensive care, and the age of the healthcare professional PTSD Support: free and easy access to a psychologist during such a period |
Caillet, et al. [12] France | ”To assess the psychological impact of Covid-19 on the healthcare professionals at the peak of the ‘crisis period’.” | A prospective, cross-sectional, multicentric study Quantitative method | HADS IES-R* | 208 HCW | 27% of participants, at the acute phase of the first peak (April 8 to 21, 2020) Protective factors: Informing ICU professionals about the Covid-19 outbreak (mode of transmission, prevention procedure) could reduce the associated stress PTSD Support: Managers must be vigilant when dealing with professionals prone to psychological disorders. In addition, training and/or reorientation should be considered to prevent psychological repercussions on teams during a new health crisis or a traumatic event |
Carmassi, et al. [16] Italy | ”To investigate post-traumatic stress symptoms (PTSS), anxiety and depressive symptoms, and their relationship with impairment in the functioning impairment among frontline HCWs from three Italian regions differently exposed to the first wave of the Covid-19 emergency: Tuscany (low), Emilia-Romagna (medium), and Lombardy (high).” | A prospective, cross-sectional, multicentric study Quantitative method | IES-R* PHQ-9 GAD-7 WSAS | 129 ICU HCW / 514 HCW | IES-R score 18.79 ± 21.02, p < 0.05, during the acute phase of the first peak of the Italian outbreak Risk factors: Being a nurse PTSD Support: Enable early detection of PTSD and facilitate access to psychiatric care following a pandemic |
Crowe, et al. [11] Canada | ”To examine the mental health of CCRNs providing direct patient care during the initial phase of the Covid-19 pandemic in Canada.” | A retrospective, cross-sectional, single-center study Mixed method | Semi-structured interviews IES-R* DASS-21 | 109 nurses | 73.3% of critical care professionals show signs of PTSD two months before the onset of the crisis (May 2020) Risk factors: Fear and anxiety associated with the virus and with contamination; poor communication; substantial and unclear information PTSD Support: Organization of stress management sessions; regular monitoring of healthcare professionals with the intervention of a psychiatrist |
Foli, et al. [20] USA | “To describe the experiences of frontline nurses who are working in critical care areas during the Covid-19 pandemic with a focus on trauma and on the use of substances as a coping mechanism.” | A retrospective, cross-sectional multicentric study Qualitative method | Two open-ended items | 73 nurses | One month before the beginning of the crisis (mid-June 2020 to early September 2020), nurses speak of psychological distress that takes various forms. This is marked by having to face frequent death and end-of-life situations, and by conflict that arises between the fear of being contaminated and of contaminating one's loved ones, on the one hand, and undertaking one's professional duties on the other hand; a sense of institutional and societal betrayal related to constant changing of practice guidelines and public ignorance, perceived lack of support, insufficient resources (personal protective equipment, resources for patient care) PTSD Support: Provide organizational and governmental support for healthcare professionals. Also provide individual support in the workplace |
Greenberg, et al. [13] UK | “To identify the rates of probable mental health disorder in staff working in ICUs in nine English hospitals during June and July 2020.” | A prospective, cross-sectional, multicentric study Quantitative Method | GAD PHQ-9 The 6-item Post-traumatic Stress Disorder checklist (PCL-6)* AUDIT-C WEMWBS | 709 HCW | 45% of the sample reporting probable PTSD symptoms, severe depression, or severe anxiety disorder at three months of the fifth peak (June to July 2020) Risk factor: Being a nurse PTSD Support: Become conscious of the pathological risk incurred by professionals for preventive and therapeutic purposes; provide timely access to treatment for the professionals who need it; ensure the support of supervisors and peers |
Heesakkers, et al. [21] Netherlands | “To determine the impact of the first Covid-19 surge (March through June 2020) on mental well-being and the associated risk factors among intensive care unit nurses.” | A prospective, cross-sectional, multicentric study Quantitative method | HADS-A HADS-D IES-6* NFR | 726 nurses | 22.2% of the sample showing signs of PTSD more than 1 month before the first wave (online study from August to September 2020) Risk factors: Working in a University Hospital Center, fear of contaminating relatives, insufficient staff, working longer hours or doing longer shifts PTSD Support: Optimize working conditions, reduce workload, ensure a sufficiently large and trained team |
Hernandez, et al. [33] USA | “To assess the prevalence of traumatic stress among American frontline nurses following the initial Covid-19 surge in the United States during March 2020, using the Trauma Screening Questionnaire.” | A prospective, cross-sectional, multicentric study Quantitative method | The Trauma Screening Questionnaire (TSQ)* | 298 nurses | One month after the beginning of the crisis, 58.7% are suffering from PTSD with disturbing thoughts or memories of the event. They feel upset when they remember the event; they have sleep disorders and an increased awareness of dangers Risk factors: Being a nurse; being female; an increased incidence of Covid-19; lack of personal protection and other medical equipment; insufficient knowledge about the virus PTSD Support: Educate nurses about their mental health; early detection of PTSD; train clinical psychologists to support frontline professionals in such situations; develop research on PTSD |
Lasalvia, et al. [14] Italy | ”To assess the magnitude of psychological distress and associated factors among hospital staff during the Covid-19 pandemic in a large tertiary hospital located in north-east Italy.” | A prospective, cross-sectional, single-center study Quantitative method | IES-R* SAS PHQ-9 | 2195 HCW | 66% of HCW reported symptoms of PTSD during the first wave (21 April to 6 May 2020) Risk factors: Being female; being a nurse; working in a Covid-19 unit or in an ICU; living alone; having more than 20 years’ professional experience; having a psychopathological history; fear of being infected with Covid-19; demanding working conditions; having to deal with death and end-of-life situations PTSD Support: - Active monitoring of reactions and performance, altering assignments and schedules, modifying expectations, assessing occupational risks, and offering − where necessary − psychosocial support - Adapting the type of intervention to the time of the crisis and the specific needs − ranging from peer support to professional aid - To prevent the development of psychological disorders in the long term, active monitoring and provision of psychological support should be delivered once the crisis begins to recede (Greenberg et al., 2020) - Develop research on the long-term effects of the pandemic, and on proposed interventions to support healthcare professionals' mental health |
Laurent, et al. [15] France | ”To measure the prevalence of post-traumatic stress disorder in HCWs.” “To identify risk factors and protective factors during the epidemic in France.” | A prospective, longitudinal, multicentric study Mixed method | PS-ICU scale GHQ 12 Brief cope IES-R* Open questions | 2153 HCW | Three months after the beginning of the first peak (June-July 2020), 24.10% of doctors, 29.68% of residents, 32.78% of nurses, 32.80% of medical students, 34.85% of nurses, and 36.36% of caregivers show signs of PTSD Risk factors: Being female; experiencing other difficult events during the crisis; having a high score of psychological distress during the crisis; having a high level of perceived stress related to workload and human resource issues; an emotional load related to the patient and family; and having a high level of perceived stress related to the risks of contamination, powerlessness, and insecurity associated with the crisis Protective factors: Turning to positive thinking PTSD Support: Set up support systems adapted to the crisis situation for professionals, and allow them to develop positive-thinking coping skills |
Van Steenkiste, et al. [40] Belgium | “To assess the mental health impact of Covid-19 on nurses working on the frontline during the first wave of Covid-19 hospitalizations in Belgium in 2020.” | A prospective, longitudinal, single-center study Quantitative method | 4 DSQ IES-R* Brief cope | 39 nurses | 10% of participants were at risk of PTSD during the first peak (1 April to 30 June 2020) Risk factors: High workload, poor communication, caring for Covid-19 patients PTSD Support: Use a multidisciplinary support team (psychologists, palliative support team, philosophical services, social workers, liaison psychiatrist, and palliative doctors) to increase resilience by means of individual sessions where needed; discuss themes such as “dealing with change in times of crisis”, “preservation of, resilience”, “work/life balance”, and “burnout prevention” on a regular basis; develop external training and coaching modules for head nurses and an internal e-learning module |
Mehta et al. [17] Canada | “To evaluate the impact of the COVID-19 pandemic on Canadian intensive care unit (ICU) workers” | A prospective, cross-sectional multicentric study Quantitative method | IES-R* K-10 | 455 ICU’S HCW | 37% have signs of PTSD 25% have an IES-R score indicating a probable diagnosis of PTSD 33% of nurse had an IES-R score indicating a probable diagnosis of PTSD VS 5% of physicians Nurses have a higher score of IES-R than physicians Risk factors: female sex, high-risk health status, living with a child or children, and feeling at increased risk because of PPE shortage or inadequate training |