Posttraumatic Stress Disorder in Emergency Medicine Residents

      The emergency department (ED) is an environment of high intensity and stress for all its staff members. In addition to the daily challenges experienced in the ED, emergency medicine resident physicians are also regularly exposed to trauma, illness, death, and violence, which compose the primary triggers for the development of posttraumatic stress disorder (PTSD). They are confronted with these difficult scenarios and tragedies from the onset of their training, leaving them prone to the emotional effects. The terms burnout and depression are often discussed and dissected in relation to physician well-being; however, PTSD may be a more applicable concept than we realize. In fact, physician PTSD has become a new topic of investigation, and with good reason.
      To read this article in full you will need to make a payment
      ACEP Member Login
      ACEP Members, full access to the journal is a member benefit. Use your society credentials to access all journal content and features.
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Shanafelt T.D.
        • Boone S.
        • Tan L.
        • et al.
        Burnout and satisfaction with work-life balance among US physicians relative to the general US population.
        Arch Intern Med. 2012; 172: 1377-1385
        • Lu D.W.
        • Dresden S.
        • McCloskey C.
        • et al.
        Impact of burnout on self-reported patient care among emergency physicians.
        West J Emerg Med. 2015; 16: 996-1001
        • Kimo T.J.
        • Ramoska E.A.
        • Clark T.R.
        • et al.
        Factors associated with burnout during emergency medicine residency.
        Acad Emerg Med. 2014; 21: 1031-1035
        • Daskivich T.J.
        • Jardine D.A.
        • Tseng J.
        • et al.
        Promotion of wellness and mental health awareness among physicians in training: perspective of a national, multispecialty panel of residents and fellows.
        J Grad Med Educ. 2015; 7: 143-147
        • Ben-Ezra M.
        • Yuval P.
        • Nir E.
        Impact of war stress on posttraumatic stress symptoms in hospital personnel.
        Gen Hosp Psychiatry. 2007; 29: 264-266
        • Weiniger C.F.
        • Shalev A.
        • Ofek H.
        • et al.
        Posttraumatic stress disorder among hospital surgical physicians exposed to victims of terror: a prospective, controlled questionnaire survey.
        J Clin Psychiatry. 2006; 67: 890-896
      1. National Institute of Mental Health. Post-Traumatic Stress Disorder. Bethesda, MD: National Institute of Mental Health; 2016.

        • Pai A.
        • Suris A.M.
        • North C.S.
        • et al.
        Posttraumatic stress disorder in the DSM-5: controversy, change, and conceptual considerations.
        Behav Sci. 2017; 7: 7
      2. Delucia J. Rate of post-traumatic stress disorder in emergency medicine physicians. Presented at: Society of Academic Emergency Medicine meeting; May 10-13 2016; New Orleans, LA.

        • Sendler J.
        • Rutkowska A.
        • Makara-Studzinska M.
        How the exposure to trauma has hindered physicians’ capacity to heal: prevalence of PTSD among healthcare workers.
        Eur J Psychiatry. 2016; 30: 321-334
        • Mills L.
        • Mills T.
        Symptoms of post-traumatic stress disorder among emergency medicine residents.
        J Emerg Med. 2005; 28: 1-4
        • Laposa J.
        • Alden L.
        Posttraumatic stress disorder in the emergency room: exploration of a cognitive model.
        Behav Res Ther. 2003; 41: 49-65
        • Howgego I.M.
        • Owen C.
        • Meldrum L.
        • et al.
        Posttraumatic stress disorder: an exploratory study examining rates of trauma and PTSD and its effect on client outcomes in community mental health.
        BMC Psychiatry. 2005; 5: 21
        • Zimmerman M.
        • Mattia J.
        Is posttraumatic stress disorder underdiagnosed in routine clinical settings?.
        J Nerv Ment Dis. 1999; 187: 420-428
        • Einav S.
        • Shalev A.
        • Ofrek H.
        • et al.
        Differences in psychological effects in hospital doctors with and without post-traumatic stress disorder.
        Br J Psychiatry. 2008; 193: 165-166
        • Klamen D.
        • Grossman L.
        • Kopacz D.
        Posttraumatic stress disorder symptoms in resident physicians related to their internship.
        Acad Psychiatry. 1995; 19: 142-149
        • Schernhammer E.
        • Colditz G.
        Suicide rates among physicians: a quantitative and gender assessment (meta analysis).
        Am J Psychiatry. 2004; 161: 2295-2302
        • McKinney J.
        • Hirsch J.
        • Britton P.
        PTSD symptoms and suicide risk in veterans: serial indirect effects via depression and anger.
        J Affect Disord. 2017; 214: 100-107
        • Boffa J.
        • Stanley I.
        • Hom M.
        • et al.
        PTSD symptoms and suicidal thoughts and behaviors among firefighters.
        J Psychiatr Res. 2017; 84: 277-283
        • Lazarus A.
        Traumatized by practice: PTSD in physicians.
        J Med Pract Manage. 2014; 30: 131-134
        • Regehr C.
        • Glancy D.
        • Pitts A.
        • et al.
        Interventions to reduce the consequences of stress in physicians: a review and meta-analysis.
        J Nerv Ment Dis. 2014; 202: 353-359
        • McCue J.
        • Sachs C.
        A stress management workshop improves residents’ coping skills.
        Arch Intern Med. 1991; 151: 2273-2277
        • Sood A.
        • Prasad K.
        • Schroeder D.
        • et al.
        Stress management and resilience training among department of medicine faculty: a pilot randomized clinical trial.
        J Gen Intern Med. 2011; 26: 858-861
        • MacLaughlin B.
        • Wang D.
        • Noone A.-M.
        • et al.
        Stress biomarkers in medical students participating in a mind body medicine skills program.
        Evid Based Complement Alternat Med. 2011; 2011: 1-8
        • Irving J.
        • Dobkin P.
        • Park J.
        Cultivating mindfulness in health care professionals: a review of empirical studies of mindfulness-based stress reduction (MBSR).
        Complement Ther Clin Pract. 2009; 15: 61-66
        • Jain S.
        • Shapiro S.
        • Swanick S.
        • et al.
        A randomized controlled trial of mindfulness meditation versus relaxation training: effects on distress, positive states of mind, rumination, and distraction.
        Ann Behav Med. 2007; 33: 11-21
        • Rosenzweig S.
        • Reibel D.
        • Greeson J.
        • et al.
        Mindfulness-based stress reduction lowers psychological distress in medical students.
        Teach Learn Med. 2003; 15: 88-92
        • Genovese J.
        • Berek J.
        Can arts and communication programs improve physician wellness and mitigate physician suicide?.
        J Clin Oncol. 2016; 34: 1820-1822
        • Lefebvre D.
        Perspective: resident physician wellness: a new hope.
        Acad Med. 2012; 87: 598-602
        • Jennings M.
        • Slavin S.
        Resident wellness matters: optimizing resident education and wellness through the learning environment.
        Acad Med. 2015; 90: 1246-1250
        • Ponniah K.
        • Hollon S.
        Empirically supported psychological treatments for adult acute stress disorder and post-traumatic stress disorder: a review.
        Depress Anxiety. 2009; 26: 1086-1109
        • Kearns M.
        • Ressler K.
        • Zatzick D.
        • et al.
        Early interventions for PTSD: a review.
        Depress Anxiety. 2012; 29: 833-842
        • Halpern J.
        • Maunder R.
        • Schwartz B.
        • et al.
        Downtime after critical incidents in emergency medical technicians/paramedics.
        Biomed Res Int. 2014; 2014: 483140
        • Rose S.
        • Bisson J.
        • Churchill R.
        • et al.
        Psychological debriefing for preventing post traumatic stress disorder (PTSD).
        Cochrane Database Syst Rev. 2002; : CD000560
        • Mishra S.
        • Goebert D.
        • Char E.
        • et al.
        Trauma exposure and symptoms of post-traumatic stress disorder in emergency medical services personnel in Hawaii.
        Emerg Med J. 2010; 27: 708-711
        • Yehuda R.
        • Vermetten E.
        • McFarlane A.
        • et al.
        PTSD in the military: special considerations for understanding prevalence, pathophysiology and treatment following deployment.
        Eur J Psychotraumatol. 2014; 5: 25322
        • Kitchiner N.
        • Roberts N.
        • Wilcox D.
        • et al.
        Systematic review and meta-analyses of psychosocial interventions for veterans of the military.
        Eur J Psychotraumatol. 2012; 3: 19267
        • Crawford C.
        • Wallerstedt D.
        • Khorsan R.
        • et al.
        A systematic review of biopsychosocial training programs for the self-management of emotional stress: potential applications for the military.
        Evid Based Complement Alternat Med. 2013; 2013: 747694
        • Steenkamp M.
        • Nash W.
        • Litz B.
        Post-traumatic stress disorder review of the comprehensive soldier fitness program.
        Am J Prev Med. 2013; 44: 507-512

      Linked Article

      • Posttraumatic Stress Disorder in Emergency Medicine Residents: A Role for Moral Injury?
        Annals of Emergency MedicineVol. 72Issue 3
        • Preview
          We read with interest the perspective piece on posttraumatic stress disorder in emergency medicine residents in the United States.1 The addition of the new exposure criteria to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition,2 those of witnessing events or being exposed to aversive details of these traumatic events, would lead us to consider many emergency medicine and out-of-hospital care practitioners to be potentially at risk of posttraumatic stress disorder.
        • Full-Text
        • PDF
      • In reply:
        Annals of Emergency MedicineVol. 72Issue 3
        • Preview
          Thank you for your fascinating response to our article. We agree with the notion that moral injury as described by Shay1 and Litz et al2 occurs in emergency physicians. Physicians grapple regularly with a sense of personal failure in believing they could have done more despite knowing that medically nothing further could have been done to help a patient. The dissonance between what a physician feels, ie, guilt, and what a physician knows can be overwhelming. This can even lead to self-doubt and questioning of one’s decisions despite following best practices: that sense of “What if I missed something?” or, worse yet, “If another physician were in my shoes, would the patient have been better off?”
        • Full-Text
        • PDF
      • In reply:
        Annals of Emergency MedicineVol. 71Issue 4
        • Preview
          The authors thank you for your commentary on this article.1 We appreciate your acknowledging the importance of the issue of posttraumatic stress disorder in emergency physicians and the necessity that we seek ways to improve physician well-being. Your perspective as mental health professionals is critical and helpful to our cause.
        • Full-Text
        • PDF
      • Posttraumatic Stress Disorder in Emergency Medicine Residents: A Reply and Caveat
        Annals of Emergency MedicineVol. 71Issue 4
        • Preview
          We read with great interest the timely review by Vanyo et al1 that highlighted the routine exposure of emergency medicine providers—particularly medical residents—to trauma, illness, death, and violence, and the resultant risk for the development of posttraumatic stress disorder (PTSD). Investigating the effect of traumatic stress among providers is an important step in improving their welfare and, potentially, the care patients receive. Left untreated, PTSD is a debilitating, chronic condition.
        • Full-Text
        • PDF