A traumatic crisis
The recent suicides of Lorna Breen, a New York doctor of emergency medicine and Bronx EMT John Mondello have drawn attention to the emotional impact of the COVID-19 pandemic on healthcare workers. Hopefully their deaths do not portend a mental health crisis for the healthcare workers who provided care during the worst of the outbreak. Read on to explore the factors that may have affected these two tragic heroes, and to learn how PTSD and depression are concerns for healthcare workers caring for COVID-19 patients.
What led Dr. Breen and Mr. Mondello to end their lives?
We don’t know the specifics of why either of them took their own lives. But we do know which factors are likely to increase risk for suicide: depression, childhood maltreatment, PTSD, substance use and feeling isolated are all among the risk factors for suicide.
Here’s what we do know about Dr. Breen: she was treating a lot of COVID-19 patients in a hospital emergency department in “Armageddon-like conditions,” according to her sister. We also know that Dr. Breen contracted the virus herself and recovered. It is certainly possible that her work with emergency COVID-19 patients (or her own illness) was traumatizing for her. Comments from her sister suggest that she was struggling with depression or post-traumatic symptoms that resulted in an 11-day inpatient stay at a mental health facility prior to her death.
As he navigated his first weeks on the job as an EMT, Mr. Mondello described to friends having difficulties coping with the death and severe illness stemming from the coronavirus. A friend said, “He told me he was experiencing a lot of anxiety witnessing a lot of death, he’d feel it was a heavy experience when he’d fail to save a life.” Seeing someone die in those circumstances is certainly the type of traumatic event that can cause PTSD. If we blame ourselves to some extent for the death, the risk of PTSD is higher. If your first few weeks on the job as an EMT involve the worst pandemic in 100 years, it is an overwhelming experience. These factors point to the possibility that Mr. Mondello was suffering from post-traumatic distress.
Not everyone with PTSD is depressed, of course, but when PTSD happens, changes in thinking happen as well. For example, after an assault, someone with PTSD might believe “the world is a dangerous place” and “people cannot be trusted.” These changes in thinking can be broad. Military veterans with PTSD often describe feeling responsible for their fellow soldiers who were killed in combat, even though there was likely nothing they could have done to prevent it. This leads to believing “It’s my fault he’s dead,” a kind of thinking associated with PTSD. It’s easy to see how COVID-19 similarly invites this type of self-blame by doctors and nurses.
PTSD and suicide
These types of changes in thinking may elevate the risk of suicide in people with PTSD. How high is that risk? A 2014 study found that 24% of a sample of members of the military with PTSD had suicidal symptoms in the previous year. If a traumatic experience leads us to believe demoralizing things about the future or about ourselves, this can lead to depression and hopelessness, both of which are associated with suicidal thinking.
Risk of PTSD in frontline healthcare workers
Not everyone who experiences a traumatic event develops PTSD. In fact, most do not. So why would healthcare workers now be at higher risk?
It’s really the twin impact of:
- putting oneself repeatedly in situations where catching the virus is an obvious possibility and
- seeing many of your patients die. This clearly affected Mr. Mondello, the EMT.
With healthcare workers in the New York and New Jersey areas experiencing so much of the above, the ingredients for an upsurge of PTSD cases are there. Let’s consider both factors a bit further.
Putting themselves in harm’s way
Think about how much fear some people had in March and April going to the grocery store. Now think about the fear many healthcare workers must have as they go to work on a COVID-19 unit — a disease more contagious than any they’ve been around before. Now think about the fear they’d have doing that without adequate protective equipment! That level of exposure to known dangerous situations increases risk for PTSD.
Having many of your patients die
Being present for the death of someone is often traumatic, especially if the death was unexpected. Most of us can only imagine what it’s like to feel responsible for a patient’s life and then to lose them. At the worst of the outbreak, some healthcare workers experienced this multiple times per day. The likelihood of PTSD increases if healthcare workers felt defeated, powerless, or that they could have done something to save the person.
How likely is a PTSD surge among healthcare workers?
In the US, 61% of men and 51% of women report exposure to a traumatic event. The lifetime prevalence of PTSD has been measured at 3.6% for men and 9.7% for women. Some quick math suggests that approximately 6% of men and 19% of women develop PTSD after a traumatic event. Given the number of healthcare workers in China, Spain, Italy, the United States, and elsewhere who worked in severely strained hospital settings, we should soon expect a global uptick in PTSD among healthcare workers who treat COVID-19.
How can you help COVID-19 healthcare workers?
If you know a frontline healthcare worker who is currently working with COVID-19 patients, let them know you’re there for them if they need you. Take an interest in their experiences, even if they’re scary for you to hear about, but understand they may not want to talk about them. It’s a widely held belief that if something has emotionally affected you, it’s important to share — to talk about it with others. However, in the case of traumatic experiences, research suggests that letting people cope on their own for the first few weeks, if that’s their preference, can be best.
Letting them know that you’re there to aid and support them, if and when they want your help, is the best thing to do.
After a month or so, if a healthcare worker has symptoms of post-traumatic stress, it may be good for them to seek help. There is excellent help available for PTSD. The primary treatments are specific short-term psychotherapies such as cognitive processing therapy (CPT) and prolonged exposure (PE). If he or she is unsure if their difficulties are part of post-traumatic stress, it might be good for them to seek a professional consultation.
Additionally, for at least the remainder of 2020, the Manhattan Center for CBT will be offering free hourlong consultations for healthcare workers who worked with COVID-19 patients and are concerned about post-traumatic stress.
After a mass traumatic experience like 9/11, military conflict, or a lethal pandemic, some PTSD is inevitable. But effective help is out there. For most people, PTSD does not have to be a lifelong struggle.
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