Caring for Coronavirus Healthcare Workers: Lessons Learned From Long-Term Monitoring of Military Peacekeepers

Abstract

Background: The current outbreak of the coronavirus disease (COVID-19) is of unprecedented proportions in several regards. Recent reports suggest that many frontline healthcare workers (HCWs) suffer from mental health problems, including posttraumatic stress symptoms (PTSS). Previous studies have identified several key factors associated with short-term PTSS in pandemic HCWs, yet limited data is available on factors associated with long-term PTSS. Understanding the psychological impact of the pandemic on HCWs is important in planning for future outbreaks of emerging infectious diseases. In the current study, we look to findings from a highly relevant subsection of the trauma field, the military domain. Objective: Pandemic HCWs and military peacekeepers may experience similar stressors in the line of duty. This study investigated whether factors linked to short-term PTSS in pandemic HCWs were also associated with long-term PTSS in military peacekeepers. Materials and Methods: Peacekeepers who reported pandemic-relevant stressors during deployment to a UN peacekeeping mission were included in the study (N = 1,627). PTSS was self-reported using the Posttraumatic Stress Disorder Checklist-Military Version. Descriptive instruments were used to assess possible factors associated with PTSS. A multiple linear regression analysis was performed to explore associations between these factors and PTSS. Results: Our model accounted for 50% of the variance in PTSS, F(1503,11) = 139.00, p < 0.001. Age, relationship and employment status, preparedness, working environment, social support after deployment, barriers to disclose, recognition, and loneliness were all significantly associated with PTSS on average 30 years after

How do you see me? The impact of perceived societal recognition on PTSD symptoms amongst Norwegian peacekeepers

“…The correlations between cumulative exposure to military trauma, morally conflictual experiences and resulting presence of psychopathology, even after a span of three decades post-deployment, were notably significant. Indeed, figures in the current cohort (Gjerstad, Bøe, Falkum, Martinsen, et al, 2020 ; Gjerstad, Bøe, Falkum, Nordstrand, et al, 2020 ) indicated a greater prevalence of PTSD amongst peacekeeper veterans than those previously reported in short term studies of this population group (Forbes et al, 2016 ; Maguen et al, 2004 ). The current sample reported similar levels of self and other perpetrated PMIEs to those reported in American combat samples (Jordan et al, 2017 ).…”

Emotions, Stress and Coping among Healthcare Workers in a Reproductive Medicine Unit during the First and Second COVID-19 Lockdowns

“…From a clinical perspective, all these findings support the relevance of developing targeted interventions to protect HCWs' mental health because, as evidenced by the literature [53,54], poor mental health due to the impact of the pandemic might affect the quality of care provided by HCWs, and could lead to long-term psychological difficulties. These considerations are strengthened by the results of an interesting study [37] where mental health professionals (MHPs) reported better overall mental health and lower post-traumatic symptoms than the symptoms observed in other kinds of HCWs during the pandemic.…”

UN peacekeeper health and risk factors --- a systematic scoping review

“…Totally 47 articles reported mental health problems, including PTSD [ 13 – 15 , 17 – 24 , 26 – 37 ], stress [ 38 – 45 ], anxiety and depression [ 35 , 39 , 46 – 60 , 62 , 63 ], and psychiatric disorders [ 13 , 33 , 46 ]. PTSD: Two studies reported the high prevalence of PTSD and symptoms among UN peacekeepers [ 13 , 14 ], ranging from about 5to 20% in a short time after service.…”

“… Region of the Americas: Brazil, U.S. Haiti, Kosovo, Bosnia Questionnaire, Cohort study Social environmental factors (work-to-family enrichment support, family stressors and financial difficulties, differences in support structures). Psychological factors Bramsen et al 2000 [ 15 ], Dirkzwager et al 2005 [ 124 ], Ippolito et al 2005 [ 47 ], Maguen et al 2006 [ 121 ], Souza et al 2008 [ 24 ], Jia et al 2009 [ 49 ], Proctor et al 2009 [ 125 ], Shao et al 2011 [ 53 ], Britt et al 2011 [ 42 ], Orme et al 2014 [ 128 ], Silva et al 2015 [ 129 ], Zhou et al 2016 [ 104 ], Lamb et al 2018 [ 126 ], Zhao et al 2019 [ 62 ], Gjerstad et al 2020 [ 37 ] Western Pacific Region: China, Australia Timor-Leste or the Solomon Islands, The Democratic Republic of the Congo, Lebanon, Multination Questionnaire, Retrospective study Psychological factors (higher hardiness scores are associated with lower levels of reported psychological distress and physical ill-health, resilience, life stress events and emotional experiences, lack of patience, loss of emotional control, longing for family members, instability state of mind). European Region: Netherlands, Norway, U.K. Lebanon, Yugosla, Multination Cross-sectional study, Questionnaire, Interview Psychological factors (personal barriers to disclose experiences and current unemployment, vulnerabilities and exposure to traumatic events, confidence and team cohesiveness to build personnel’s resilience).…”