Repeated epidemic exposure not protective against trauma-related symptoms among HCWs

The current pandemic has seen more than a quarter of healthcare workers (HCWs) who have sustained psychological trauma in Singapore, regardless of prior experience with the SARS epidemic, a study has found.

Of 3,616 HCWs surveyed in nine healthcare institutions across Singapore, the median score on the Impact of Events Scale (IES) was 15, and 28.2 percent of the sample scored in the moderate-to-severe range. There was no difference in the proportion of respondents who had clinically significant IES scores (total >25) between the SARS-experienced and the non-SARS-HCW groups (25.2 percent vs 25.9 percent, p=0.904). [BMJ Open 2021;11:e05189]

“For SARS HCWs, [the proportion of those with significant post-traumatic symptoms] was higher than the 20 percent reported from a local nondesignated SARS hospital during the SARS epidemic in 2003. Additionally, this proportion was not lower than the non-SARS HCWs group as we expected,” the investigators pointed out. [Occup Med 2004;54:190-196]

The finding could be attributed to the larger scale impact and longer duration of COVID-19 compared with SARS, the investigators explained. Furthermore, the potential cumulative effects of repeated exposure to front-line trauma stemming from an epidemic/pandemic response could have contributed to increasing the risk of developing clinically significant psychological symptoms instead of increasing one’s resilience and protection from such effects. [J Emerg Nurs 2009;35:199-204]

“Another possible reason for this result could be that SARS HCWs were already experiencing persistent symptoms post-SARS and these effects were exacerbated by new-onset symptoms triggered by COVID-19, thus giving rise to a higher proportion than expected… Hence, the long intervening time between SARS and COVID-19 and prior experience as a SARS HCW do not appear to be protective,” they said. [Psychiatr Serv 2008;59:91-95]

Trauma-informed support strategies needed

Majority of the respondents were female (74.7 percent), nurses (51.7 percent), foreign-born (53.2 percent), and not working in the tertiary care setting (52.1 percent). About 23 percent of the respondents were also HCWs during SARS, and they were more likely to be older, local-born, married with children and staying with family, and have longer working experience than non-SARS HCWs.

More than half of the SARS HCWs felt that they were safer (54.8 percent), better equipped (72.1 percent), and had better managed workload (58.9 percent) in the current pandemic as compared with during the SARS epidemic.

Multivariable logistic regression showed that racial minority groups and living apart from family were associated with a higher likelihood of having high IES in the SARS-experienced group. On the other hand, daily exposure to confirmed or suspect COVID-19 cases increased the odds of high IES for non-SARS HCWs only.

“Considering that a quarter of the respondents experienced clinically significant trauma-related symptoms despite the existence of active HCW psychological support resources, we advocate for (1) the examination of current resources and their limitations in the current pandemic, (2) the modification of existing programs to be more specifically trauma-informed in approach, and (3) more targeted and focused trauma-informed care for HCWs who have experienced repeated exposure,” according to the investigators.