Results As Table 1 shows, 1 38 (62 percent) of the 224 clinical staff who nesponded to the survey reported expeniencing a critical incident involving a serious threat to life or physical safety on witnessing a serious injury or death. Sixty-two clinical staff (28 percent) had had such experiences within the previous six months. Of the 224 clinical staff, 1 37 (61 percent) reported symptoms of PTSD, such as intrusive thoughts or increased emotional reactivity. Of those reporting such symptoms, 23 (10 percent) would have been given the DSM-iii-R diagnosis of PTSD based on the number of symptoms reported (6). Of the nonclinical staff at Site A, 21 (28 pencent)ofthe 76 who responded had experienced a traumatic cnitical incident, nine (12 percent) in the previous six months. Eighteen (24 percent) had developed symptoms of PTSD, and five (7 percent) qualified for the diagnosis. Of the 1 38 clinicians who reported experiencing traumatic incidents, only 20 (1 5 percent) reported any later external review of the expenience. Many were supervisory on disciplinary reviews of the staff mernbers’ actions, rather than debriefing sessions to help the person recover from the trauma (2).

Incidence of PTSD Among Staff Victims of Patient Violence Michael

F. Caldwell,

Psy.D.

In recent years interest in patient violence and its effect on staff victims has increased. Similarities have been found between hospital staff victims ofviolence and other victims, such as victims ofstreet crimes and of natural and man-made disasters (1). Even closer similarities have been found between hospital staff and police, fire, and rescue personnel who arc victims ofviolence or other traumatic experiences (2-4). Although studies ofpatients’ patterns of aggression have been undertaken (4,5), to our knowledge no studies have attempted to determine the frequency ofstafftrauma in mental health facilities or the incidence of related posttraumatic stress disorder (PTSD). This paper reports the results ofa survey ofthe incidence of trauma and PTSD among the staff of two mental health facilities. Methods Questionnaires were distributed in 1988 to 546 mental health staff members who worked at two sites. Site A was a private psychiatric facility with an outpatient community mental health center that served a growing middle-class urban area. A total of 276 one-page questionnaires were distributed at this site; 102 clinical and 76 nonclinical staff members (housekeeping, security, and dietary staff and others) respon-

Dr. Caidwell is in private and is associated with

practice

agement Health consin. to P.O.

the manunit at Mendota Mental Institute in Madison, WisAddress correspondence Box 2654, Madison, Wis-

consin

53701.

838

ded, representing a 64.5 percent response rate. Site B was a state hospital located in a lower-middle-class innercity area. A total of 270 questionnames were distributed to clinical staffon!y; 122 staffmembers nesponded, a 45.2 percent response rate. The two sites represented a fairly broad range of treatment settings. The sites provided acute stabilization in voluntary private and state hospital settings; intermediate treatment in a state facility; services to children, adolescents, and adults; and outpatient community mental health 5crvices. Thus the sample population of staff studied was considered fairly typical of the field in genera!. The questionnaire asked whether any traumatically stressful events for the employee had occurred on the job and how recently they had occurred. Another section included a checklist of symptoms of PTSD adapted from DSM-iii-R diagnostic criteria. Data were analyzed to estimate how many staff experienced traumatically stressful events on the job and how many had PTSD or symptoms of PTSD as a result. Data were also gathered on the availability and effectiveness of posttraumatic debriefing sessions.

Table 1 Incidence of job-related members at two mental

trauma, PTSD health ftcilities

Traumatic event Staff

Nonclinical Clinical

N

(N=76)

SiteA(N=102)

SiteB(N=122) Total (N=224) Total(N=300)

August

1992

%

symptoms,

and

PTSD

Traumatic event past 6 months

symptoms

N

N

%

among

300

staff

PTSD

PTSD %

N

%

21

28

9

21

18

24

5

7

54 84

53 69 62 53

24 38 62 71

24 31 28 24

53 84 137 155

52 69 61 52

9 14 23 28

9 12 10 9

138

159

Vol.

Discussion Cleanly, a survey of this kind represents only an initial examination of the incidence ofPTSD among hospital staff. In addition, determining the incidence ofPTSD in any population

43

No.

8

Hospital

and

Community

Psychiatry

involves an inherent methodological difficulty. It is well known that the most common psychological defenses against trauma include repression and suppression. Thus the researcher is, in essence, asking subjects to report an experience that they are most likely to have repressed on are trying to forget. It is therefore unlikely that staffwho did not respond to the survey represent a more symptom-free group than those who did, since one would expect some symptomatic recipients of the questionnaire to simply “forget” to send it in. Nonetheless, even if all 246 staff who did not respond were asymptomatic, the data would indicate that more than one staff member in 20 suffers from PThD. The higher rates of occurrence of traumatic incidents and resulting

gram(ASAP)at Cambridge Hospital in Cambridge, Massachusetts (8), and the Staff Assistance for Employces (SAFE) program at the Mendota Mental Health Institute in Madison, Wisconsin. Among the mental health staff in this study, debriefing sessions based on the current model were rare. Many of the reviews of the traumatic mcidents involved an examination of what the staff member had done wrong during the incident. During other reviews, traumatized staff were simply referred to psychotherapy.

case in mental health facilities. Should these findings prove typical, it may be, ironically, that one of the most hazardous work settings for employee mental health is the local mental health facility.

Conclusions This study clearly demonstrated that traumatically stressful events occurred fairly frequently among clinical and noncliical staff. The clinical staff reported a very high rate of

3.

symptoms at Site B were not surprising. State hospital patients are much more likely to be involuntarily cornmitted on the basis of dangerousness to others than are patients at a private psychiatric hospital or outpatient fitcility. Nonetheless, these data suggest that trauma, even recent trauma, and subsequent symptoms are penvasive and may be more the rule than the exception. Although traumatic events occurred fairly often, organizational support for traumatized staff at the two sites was minimal or nonexistent. It has been increasingly recognized that the major cause of PTSD is not an internal deficit in personal-

dence was found that clinicians were immune to traumatic events. Indeed, clinicians reported reactive symptoms at a higher rate than nonclinicians. Eighty-six percent of the noncliicians who experienced traumatic events reported later syrnptoms; all but one ofthe 1 38 clinicians who had such experiences reported symptoms.

ity functioning

Newsletter

so much

as the

nature

ofthe traumatic experience itself (7). This awareness has led to the deve!opment of the debriefing model of intervening with traumatized mdividuals(2). The approach emphasizes a rapid intervention with all those involved in the traumatic incident. The intervention focuses on the emotional reactions of the victims, who are given information about the norma! response to trauma and are rcferred for ongoing supportive counseling. This major advance in the treatment of traumatic stress has been slow to appear in mental health institutions.

are

the

Hospital

Two

notable

Assaulted

Staff

and Community

exceptions

Action

PTSD-nelatcd

symptoms.

No

cvi-

for

mental

health

Emergency

Workers.

DHHS

pub

(ADM)

87-1496. Rockville, Md, National stitute ofMental Health, 1987 Williams

C: Peacetime

combat:

In-

treating

and preventing delayed stress reactions in police officers, in Post-Traumatic Stress Disorders: A Handbook for Clinicians. Edited by Williams T. Cincinnati, Disabled American Veterans, 1987 4. Cannel H, Hunter M: Staff injuries from inpatient violence. Hospital and Community Psychiatry 40:41-46, 1989 5. Thackery M, Bobbirt RG: Patient aggression against clinical and nonclinical staff in a VA medical center. Hospital and Cornmunity Psychiatry 41:195-197, 1990 6. Diagnostic and Statistical Manual of Mental Disorders, 3rd ed, rev. Washington, DC, American Psychiatric Association, 1987

Post-Traumatic

Stress

Disorders:

A

Handbook for Clinicians. Edited by Wilhams T. Cincinnati, Disabled American Veterans, 1987 8. Flannery RB, Fulton P, Tausch J, et al: A

program

to help staff cope with psycho-

logical sequelae of assaults by patients. Hospital and Community Psychiatry 42: 935-938, 1991

to H&CP

The H&CP Service Update, a quarterly newsletter highlighting the benefits ofthe Hospital and Community Psychiatry Service and describing useful resources

1. Figley CR(ed): Traumaand Its Wake, Vol 2: Traumatic Stress: Theory, Research, and Intervention. New York, Brunnen/ Mazel, 1985 2. Prevention and Control of Stress Among

7. Goodwin J: The etiology of combat-related post-traumatic stress disorders, in

If one in ten employees in an industry was expected to develop a jobrelated psychiatric disorder, the industry would likely face intense pressure to address the issue. This study shows that quite the opposite is the

Added

References

profes-

sionals, is now being sent to 8,600 key staff members in facilities that belong to the H&CP Service. The newsletter is designed to increase the visibility of the H&CP Service to staff in its member facilities. The service is sponsored by the American Psychiatric Association as an information and education nesource for mental health fi,cilities and agencies. Benefits of H&CP Service mem-

Service

Benefits

benship include subscriptions to H&CP at greatly reduced rates; access to a video and film rental library; quarterly mailings providing useful books, newsletters, and other information; and discounts on fees for the annual H&CP Institute and for use ofthe Psychiatric Placement Service. Staff in H&CP Service facilities also receive discounts on books from the American Psychiatric Press and on consultations by APA’s Consultation Service. For more information, contact the H&CP Service, APA, 1400 K Street, N.W., Washington, D.C. 20005; telephone, 202-682-6173.

Pro-

Psychiatry

August

1992

VoL

43

No.

8

839

Incidence of PTSD among staff victims of patient violence.

Results As Table 1 shows, 1 38 (62 percent) of the 224 clinical staff who nesponded to the survey reported expeniencing a critical incident involving...
398KB Sizes 0 Downloads 0 Views