Defining effective strategies to prevent post-traumatic stress in healthcare emergency workers facing the COVID-19 pandemic in Italy.
Defining effective strategies to prevent post-traumatic stress in healthcare emergency workers facing the COVID-19 pandemic in Italy.
复制标题
DOI：
10.1017/s1092852920001637
复制
发表时间：
2020-07-14
期刊：
影响因子：
3.3
通讯作者：
Dell'Osso L
中科院分区：
文献类型：
--
作者：
Carmassi C;Cerveri G;Bui E;Gesi C;Dell'Osso L
意大利，5月19日。在我们撰写本文之际，COVID-19疫情终于有望结束;然而，其对医护人员（HCW）的心理影响仍然是一个紧迫的问题。意大利是第一个面临始于Codogno（Lodi）的流行病的欧洲国家，该流行病于2020年2月20日宣布为“红色区域”并被隔离。迄今为止，确诊的COVID-19病例超过215 000例，死亡人数超过30 000人，超过23 000名医护人员受到感染，其中161人-130名医生和31名护士-因感染并发症而丧生。由于面对COVID-19爆发的医护人员长期承受极端的工作压力，并有很高的疲惫、倦怠和创伤后应激反应的风险，因此COVID-19危机被定义为“医疗系统的9/11”。自《精神障碍诊断和统计手册》第5版（DSM-5）问世以来，与工作有关的反复或极端暴露于创伤事件的令人厌恶的细节可能符合创伤的标准。与此相一致，最近关于第一反应者和HCW之间的倦怠和创伤后应激障碍（PTSD）的文献强调了特定的风险因素，例如日常工作案例的频繁不可预测性以及患者及其家属在危急情况下的预期。1，2虽然意大利的医疗保健系统因多年来的预算削减而削弱，但COVID-19的爆发加剧了长期的困难，导致医护人员出现负面心理健康结果的风险增加。首先，典型的预先存在的风险因素PTSD经常出现在意大利HCW，包括女性和年轻到中年的幼儿。第二，COVID-19的特殊性进一步增加了负担：重症患者的快速增加迫使医生做出极其困难的决定，这种决定充满了普遍的无助感;临床表现特征为严重窘迫，呼吸困难迅速恶化，病程隐匿且不可预测，需要不断的医学更新，全球范围内出现的多种临床表现和COVID的治疗-19感染增加了病人死亡时的痛苦;在病人护理期间，病人和提供者都需要完全隔离，因为污染风险极高，以及缺乏个人防护设备，导致对当局的恐惧，愤怒和怨恨。第三，该疾病的系统性影响及其社会影响还包括：快速且有时混乱的服务重组以及招募新的急诊科和重症监护室（ICU）人员的后勤挑战，以管理越来越多的患者并替代生病的HCW;在高度专业化的单位引进不熟练的医务人员，导致沮丧、孤立、绝望和易怒的感觉;在工作中缺乏社会支持;需要与新同事或重新部署的陌生人一起工作;由于学校关闭和儿童被关在家中，家庭缺乏社会支持;担心感染家庭成员，导致进一步隔离。
Italy, May 19th. As we write, the end of the COVID-19 outbreak is finally in view; however, its psychological impact on healthcare workers (HCWs) remains an urgent question. Italy was the first European Country to face the pandemic that started in Codogno (Lodi), declared “red zone” and isolated by February 20th 2020. To date, the number of confirmed COVID-19 cases exceeds 215 000, with a death toll exceeding 30 000, over 23 000 HCWs being infected and 161 of them—130 physicians and 31 nurses—losing their life to complications of the infection. Because HCWs facing the COVID-19 outbreak were exposed to extreme and prolonged work-related stress with a high risk of exhaustion, burnout and post-traumatic stress reactions, the COVID-19 crisis was defined as the “9/11 of health care systems.” Since the introduction of the Diagnostic and Statistical Manual for Mental Disorders—5th edition (DSM-5), work-related repeated or extreme exposure to aversive details of traumatic events may qualify for a trauma. In line with this, recent literature on burnout and post-traumatic stress disorder (PTSD) among first responders and HCWs, highlighted specific risk factors such as the frequent unpredictability of daily work cases and perceived expectations from patients and their families in critical cases/situations. 1, 2 While the Italian health care system was weakened by years and years of budgetary cuts, the COVID-19 outbreak amplified the chronic difficulties, leading to increased risk for negative mental health outcomes among HCWs. First, typical pre-existing risk factors for PTSD were frequently present among Italian HCWs, including female gender and young to middle age with young children. Second, specific characteristics of COVID-19 added further burden: rapidly increased flow of critical patients forcing physicians to make extremely difficult decision tainted with pervasive helplessness; clinical presentation characterized by severe distress, rapidly worsening dyspnea with insidious and unpredictable course, requiring constant medical updating with worldwide emerging multiple clinical manifestations and treatment of the COVID-19 infection increasing distress at the time of patient’s death; constant need for complete isolation during patient care, both for the patient and the providers, given the extremely high contamination risk, and the shortage of protective personal equipment that lead to fear, anger, and resentment against the authorities. Third, the systemic impact of the disease and its social repercussions also included: rapid and sometimes chaotic reorganization of services and logistical challenges for recruiting new emergency departments and intensive care unit (ICU) personnel, both to managing the increasing number of patients and to substitute HCWs becoming ill; introducing unskilled HCWs in highly specialized units, leading to feelings of frustration, isolation, hopelessness, and irritability; lack of social support at work; the need to work with new colleagues or redeployed strangers; lack of social support at home with schools closures and children confined at home; fear of infecting family members leading to further isolation.