The Invisible COVID-19 Crisis: Post-Traumatic Stress Disorder Risk Among Frontline Physicians Treating COVID-19 Patients

TL;DR

This study compares PTSD symptoms between frontline and second-line physicians treating COVID-19 patients, identifying key risk and protective factors using machine learning to inform future healthcare interventions.

Contribution

It applies machine learning models to identify nonlinear predictors of PTSD among frontline physicians, highlighting both damaging and protective factors in a large US sample.

Findings

Frontline physicians show higher PTSD symptom endorsement than second-line physicians.

Predictors of PTSD include depression, burnout, fears of COVID-19, and perceived stigma.

Protective factors include resilience and social support.

Abstract

This study evaluated post traumatic stress disorder (PTSD) among frontline US physicians (treating COVID-19 patients) in comparison with second-line physicians (not treating COVID-19 patients), and identified the significance and patterns of factors associated with higher PTSD risk. A cross-sectional, web-based survey was deployed during August and September, 2020, to practicing physicians in the 18 states with the largest COVID-19 cases. Among 1,478 responding physicians, 1,017 completed the PTSD Checklist (PCL-5). First, the PCL-5 was used to compare symptom endorsement between the two physician groups. A greater percentage of frontline than second-line physicians had clinically significant endorsement of PCL-5 symptoms and higher PCL-5 scores. Second, logistic regression and seven nonlinear machine learning (ML) algorithms were leveraged to identify potential predictors of PTSD risk by analyzing variable importance and partial dependence plots. Predictors of PTSD risk included cognitive/psychological measures, occupational characteristics, work experiences, social support, demographics, and workplace characteristics. Importantly, the final ML model random forest, identified patterns of both damaging and protective predictors of PTSD risk among frontline physicians. Key damaging factors included depression, burnout, negative coping, fears of contracting/transmitting COVID-19, perceived stigma, and insufficient resources to treat COVID-19 patients. Protective factors included resilience and support from employers/friends/family/significant others. This study underscores the value of ML algorithms to uncover nonlinear relationships among protective/damaging risk factors for PTSD in frontline physicians, which may better inform interventions to prepare healthcare systems for future epidemics/pandemics.