Psychiatric staff are exposed to critical events (e.g., violence, physical threats) in the workplace and thus are at risk of posttraumatic stress disorder (PTSD). The authors examined the prevalence of PTSD symptoms among psychiatric hospital staff in Canada and the role of potentially traumatic critical events and chronic stressors (e.g., witnessing patients engaging in self-injury) in affecting psychiatric staff's mental health.Methods: The authors analyzed cross-sectional survey data from 761 psychiatric staff (69% female, 57% nursing, 64% with more than 5 years of experience in mental health). The analysis focused on questions about exposure to critical events and chronic stressors.Results: Sixteen percent of participants met a screening cutoff score on the PTSD Checklist-5, a self-report PTSD Psychiatric Services 71:3, March 2020 ps.psychiatryonline.org 223 HILTON ET AL.

What is known on the subject?• Trauma among psychiatric nurses and other healthcare workers is related to workplace violence, but other risk factors may also contribute, including those occurring before, during or after workplace violence. What does this paper add to existing knowledge?• Most previously identified PTSD risk factors were not tested or supported in research with psychiatric nurses, although there is promising evidence for risk factors including severe or injurious assault, cumulative exposure, burnout, and other worker characteristics.• We identify directions for research needed to improve knowledge, including collecting data before nurses experience workplace violence, defining workplace risk factors consistently and conducting and reporting qualitative analysis. What are the implications for practice?• Provide training in risk assessment and violence prevention to psychiatric nurses.• Offer mental health support to those exposed to violence, especially with cumulative exposure.

We examined the use of graphs as an aid to communicating statistical risk among forensic clinicians. We first tested four graphs previously used or recommended for forensic risk assessment among 442 undergraduate students who made security recommendations about two offenders whose risk differed by one actuarial category of risk for violent recidivism (Study 1). Effective decision making was defined as actuarially higher risk offenders being assigned to greater security than lower risk offenders. The graph resulting in the largest distinction among less numerate students was a probability bar graph. We then tested this graph among 54 forensic clinicians (Study 2). The graph had no overall effect. Among more experienced staff, however, decisions were insensitive to actuarial risk in the absence of the graph and in the desirable direction with the addition of the graph. Further research into the benefit of graphs in violence risk communication appears viable.

Workplace factors associated with the development of posttraumatic stress disorder (PTSD) in inpatient psychiatric settings have received limited attention. In this study, we examined critical exposures, patient care stressors, and aspects of workplace environment that are potentially associated with PTSD symptoms in a sample of 633 clinical staff (68% nursing staff, 70% female) who provided direct day-to-day care for patients, and indicated they worked in either forensic (57%) or nonforensic units (43%). Forensic staff reported more direct exposure (74%) to a wider variety of potentially traumatic events and chronic stressors than nonforensic staff (66%). Forensic staff also endorsed more PTSD symptoms. Using the PTSD Checklist for DSM-5 (PCL-5; Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition, DSM-5), 22% of forensic staff and 11% of nonforensic staff met the screening cut-off for possible PTSD; PTSD symptom scores were predicted both by direct exposure and unit type. Additionally, workplace environment and organizational trust were negatively correlated with PTSD symptom scores, where forensic staff reported a greater degree of incongruence with their workplace and lower levels of trust in management, compared with nonforensic staff. These results offer a snapshot of the more adverse work environment and associated risks faced by clinical staff on forensic units compared with nonforensic settings.