When the COVID-19 pandemic hit the U.S. hard and fast in March of 2020, the country underwent the beginning of “collective trauma” — a life-changing and upsetting event experienced by a group of people, large or small, that results in psychological trauma. 

As video footage of freezer trucks parked outside hospitals followed reports of nurses and doctors wearing garbage bags as makeshift PPE, it became clear that healthcare workers were among those at the forefront of our collective trauma. Doctors who had been trained to save lives were forced to make decisions over who would get a ventilator, and nurses worked long shifts through the loss of their colleagues to COVID-19.

As COVID vaccines roll out and pandemic numbers begin to decline, many of our healthcare workers who were exposed to this prolonged crisis situation will start to reckon with the aftermath, which can include anxiety, depression, and Post-Traumatic Stress Disorder (PTSD) — the more severe outcomes of collective trauma. 

Pandemic PTSD: The Psychological Impact of COVID-19 on Healthcare Workers

The pandemic (and therefore, the trauma itself) isn’t yet over, which means this area of study is both new and incomplete. At Total Brain, we are big on data— so we turned to PTSD research specific to doctors, nurses, and healthcare employees to better understand how COVID-19 will impact their mental, emotional, and physical health.

A study that looks exclusively at COVID PTSD in medical staff showed that almost half of Italian healthcare workers reported “PTSD symptoms, severe depression, anxiety, and insomnia.” For doctors and nurses in Chinese hospitals, the rate was more than 70%. (In the Chinese study, PTSD in nurses was more prevalent, as it was with women and those directly involved in “diagnosing, treating, or providing nursing care” to COVID-19 patients.) The study concluded that such high rates of mental duress would require “psychological support or interventions.”

A U.S. study conducted in April 2020 that looked at the effects of COVID-19 on healthcare workers found that 14% screened positive for PTSD. 63% reported some degree of anxiety symptoms consistent with Generalized Anxiety Disorder (GAD), 47% had symptoms of mild depression, and 17% had “clinically significant depressive symptoms.” Across the board, 39% of respondents showed signs of significant mental health challenges resulting from the Coronavirus pandemic. 

Just one month later, in May 2020, an online survey showed an uptick in PTSD and depression rates -- 22.8% of frontline healthcare workers had probable PTSD and 42.8% had probable Major Depression. 

If we pair these findings with those of studies following prior pandemics like MERS and SARS, there is significant data on how collective trauma translates to PTSD and other mental health challenges in healthcare workers.

In one comprehensive study that compiled the findings of 19 other studies around previous Coronavirus pandemics, there were definitive correlations between the severity of trauma and factors such as levels of exposure, personal support systems, and coping styles. Differing circumstances influenced healthcare workers’ resilience levels in numerous ways, but overall, around one in six healthcare workers developed “significant stress symptoms.” 

For doctors and nurses who want to understand where they stand in terms of risk for developing post-COVID mental health challenges, studies found the following factors influenced outcomes:

• Level of exposure - Workers in high-risk wards showed higher rates of PTSD, making it fair to assume that doctors and nurses who worked directly in COVID wards are more likely to develop mental health challenges.
• Occupational role - Nurses typically had higher rates of post-trauma mental health challenges than physicians.
• Age and gender - A lower level of professional experience was linked to a higher risk of Post-Traumatic Stress Syndrome (PTSS). (As a reminder of how each of these studies differs in methodology and context, males had a higher rate of experiencing negative symptoms, which contradicts the findings in the COVID-19 Chinese study mentioned earlier.)
• Marital status - Several studies showed unmarried respondents were more affected than their married counterparts.
• Quarantine and isolation - Those who were isolated so as to not be a health threat to family and friends (as well as healthcare workers who survived infection) were at higher risk.
• Previous psychiatric disorders - Healthcare workers with a history of mood disorders were at increased risk. Another study found that existing psychiatric disorders increased the likelihood of suicidal thoughts and severe anxiety.

The chances that a frontline healthcare worker will develop clinically significant symptoms of collective trauma from the pandemic also depended on a list of resilience factors: 

• Colleague and supervisor support - Was there a sense of protection from leadership? More support from the top translated to a higher level of resilience.
• Family/social support - A bigger, personal support network reduced reports of acute stress.
• Training - The perception that one had sufficient medical and professional training to meet challenges in the workplace made a difference.
• Work organization - Clear directives and structured units in times of chaos were helpful.
• Coping strategies- Those who used positive coping strategies had a protective factor against PTSD that others did not. Negative coping factors, like avoidance, led to worse outcomes.

It’s important to note that all of these studies had different criteria and measurements, and were conducted at different points in the pandemic, where healthcare worker burnout was at different levels. But there’s no doubt that doctors and nurses are two of the most at-risk groups for PTSD, anxiety, and depression following COVID-19. The next question is — how can we treat it?

Post-traumatic Stress Disorder Treatment

COVID PTSD in healthcare workers poses a cultural challenge; studies have shown that starting as early as medical school, doctors (and other personnel) tend not to seek mental health treatment, sometimes as a result of having their ability to practice questioned or being seen as weak. Educating staff on the importance of seeking treatment and removing stigmas around mental health challenges will need to be a priority for healthcare organizations offering support to their doctors and nurses.

Another important step toward healing is the development of the targeted intervention, a recommendation echoed across studies. The pandemic brought a collective trauma, but the unique trauma that healthcare workers endured need to be a central part of informing effective treatment. We don’t yet know if PTSD and depression among nurses as a result of COVID-19 will have significantly different rates or appearances than in doctors, so targeted intervention can be best informed by observations over time.

Outside of these two approaches, there are daily practices that doctors and nurses with COVID PTSD symptoms — as well as anxiety, depression, and other mental health challenges — can undertake to better cope with overall and in-the-moment side effects.

Regardless of profession, around 1 in 30 people will experience PTSD at some point in their lives. We expect to see a rise in medical PTSD following the pandemic, which goes beyond healthcare workers (medical PTSD can affect patients who were near death, on ventilators and isolated for long periods of time, or who saw fellow ICU patients, for example.) 

The sizable rate of those who will experience PTSD, anxiety, and depression in their lives is why Total Brain included the conditions as part of the app’s evaluation and symptom management system. 

When users download the Total Brain app, they must answer a series of screening questions that center around frightening experiences in their lives to determine whether they engage in avoidance of the trauma. Our commitment to building the app on the foundations of neuroscience means we can do this with a high degree of accuracy (80%).

Research findings from Total Brain’s international database show that high rates of negative emotions, deficits in concentration and memory, and reduced heart rate variability are common signs of the excessive activation of the “fight or flight” response and the over-activation of our brain’s central alarm system, the amygdala.

Total Brain’s adjunctive digital exercises can help to both prevent and support people with PTSD and anxiety via in-the-moment tools — users can gain control through stress reduction breathing using Resonant Breathing, the CBT-based Thought Tamer exercise, and the Body, Breath, Thoughts meditation tool.

We believe the future of mental health is measurement-based, which we know is equally important to science-minded healthcare workers. The Total Brain app provides data-rich diagnosis, clinical analytics, and targeted treatment plans using an initial baseline to customize the app to each user’s needs — as well as monitor commitment and progress.

If you’re a healthcare facility looking to help employees or patients suffering from the aftermath of the COVID-19 pandemic, please contact us for a demo.