Prevalence of PTSD among NHS staff highlighted

A new University of Liverpool-led study has revealed the prevalence of work-related post-traumatic stress disorder (PTSD) among obstetricians and gynaecologists.

Published in BJOG: An International Journal of Obstetrics and Gynaecology, the study highlights the need for a system of care for front-line staff and mental health in the profession as a global concern.

Doctors can be exposed at work to events that they find traumatic, and obstetricians and gynaecologists may be particularly at risk. Whilst the majority of births proceed straightforwardly to positive outcomes, adverse events in which a previously healthy mother or her baby is suddenly at risk of serious injury or death will occur.

Exposure to trauma through the provision of care can lead to work-related PTSD, defined as a psychological response to exposure to an event involving actual (or threatened) death or serious injury and characterised by four symptom groups: intrusions (e.g. intrusive thoughts or images, flashbacks); avoidance of reminders; arousal (e.g. feeling ‘on edge’) and negative alterations to beliefs or mood (e.g. anger, guilt).

Two thirds of participants reported exposure to traumatic work-related events. Of these, 18 per cent of responding consultants and trainees reported clinically significant PTSD symptoms, with staff of black or minority ethnicity deemed at increased risk of PTSD. Clinically significant PTSD symptoms were associated with lower job satisfaction, emotional exhaustion and depersonalisation which means treating people like objects.

Organisational impacts included sick leave, and ‘seriously considering leaving the profession’, with the culture in obstetrics and gynaecology was identified as a barrier to trauma support. A strategy to manage the impact of work-place trauma is proposed.

Work related PTSD leads to high levels of distress for the individual staff members, but also affects women having their babies as it can lead staff to practise more defensively, intervening earlier because of their own anxieties. If women have less sensitive care they, themselves are more at risk of PTSD after childbirth.

PTSD also has an impact on maternity services as it is linked to staff thinking of leaving the speciality and 30 per cent of trainee obstetricians do leave during their seven-year training.

Professor Pauline Slade, who led the research, said: “Exposure to trauma in obstetrics and gynaecology is a work place hazard and employers have a duty of care. There is no adequate system of care and staff report a culture of stigma and blame.  We need to look after staff so they can look after women and their families.”

Janice Rymer, spokesperson for the Royal College of Obstetricians and Gynaecologists, said: “It is extremely concerning that two thirds of O&G doctors, including both consultants and trainees, who responded to this survey experience traumatic events in the workplace, and of these nearly 20 per cent report PTSD symptoms.

“The RCOG takes the welfare of doctors extremely seriously. It is only with a healthy and sustainable O&G workforce that the safest quality of care can be provided to women and their babies. This study provides even more compelling evidence that urgent action is needed to improve the workplace environment for doctors and ensure they are supported as well as possible.

“System-wide pressures are adversely impacting the well-being of healthcare professionals and we must understand how to overcome these and make the necessary improvements. In addition to our ongoing hard work, this paper makes a number of important recommendations on what future support care plans for doctors should include.”