Physician PTSD levels rose during COVID

News brief

Physicians are known to have higher levels of posttraumatic stress disorder (PTSD) than the general population due to handling patient deaths, medical emergencies, and high workloads, and researchers who examined patterns during the COVID pandemic found that PTSD levels spiked and varied by different groups.

healthcare workers — *Francisco Àvia, Hospital Clínic / Flickr cc*

In their meta-analysis, Canadian researchers reviewed 57 studies in the topic published between December 2019 and November 2022, which included nearly 59,000 participants across 25 countries. The team published its findings today in JAMA Network Open.

Earlier studies have estimated the level of PTSD in physicians at 15%, notably higher than 4% to 5% for the general population. The COVID pandemic put an unprecedented strain on the health system with high patient volumes, overflowing hospital and intensive care unit populations, work burnout, and infections among physicians themselves.

The team noted that assessing PTSD prevalence in doctors is challenging due to wide variation in study methods, which preclude making a definitive estimate. Their findings suggest that 18.3% of doctors reported PTSD symptoms during the pandemic.

Higher levels in female doctors, residents, front-line specialties

When they examined the studies for possible risk factors, they found higher PTSD levels in female, older, and trainee doctors. The group also found higher levels in emergency medicine and family medicine.

Though PTSD levels are higher in women in the general population, more research is needed to explore why female doctors have higher levels than their male peers, the team wrote. Regarding higher levels in medical residents, they said longer work hours may contribute to great exposure to traumatic events.

They said the findings can be used to guide interventions to prevent PTSD during traumatic events such as pandemics. "The high prevalence of PTSD suggests that system level changes may be indicated to support physician health, which can include wellness supports and specific interventions to target and alleviate root causes," the team wrote.

Preoperative Staph aureus colonization linked to increased risk of postoperative infections

News brief

Chris Dall, MA

Preoperative carriage of Staphylococcus aureus, especially in the nose, is associated with increased risk of S aureus surgical-site and postoperative bloodstream infections (SA SSI/BSI), researchers reported yesterday in Open Forum Infectious Diseases.

Higher bacterial load in the nose and S aureus colonization at other body sites further increased the risk, researchers with the ASPIRE-SSI study group found. ASPIRE-SSI was a prospective observational cohort study that followed adult surgical patients at 33 European hospitals for up to 90 days after surgery to assess the occurrence of and risk factors for postoperative S aureus infections.

S aureus is known to colonize 20% to 30% of the human population at different body sites, particularly the nose but also the throat, axilla, and perineal region, and previous studies have shown that it causes approximately 30% of SSIs. This study aimed to determine the effects of S aureus nasal carriage alone, carriage at multiple sites, and bacterial load on the risk of developing SA SSI/BSI.

Findings support decolonization strategies

Of the 5,004 patients included in the study cohort, 3,369 (67.3%) were S aureus carriers. Of the 100 SA SSI/BSIs that occurred, 86 occurred in S aureus carriers. Both S aureus nasal carriage (adjusted hazard ratio [aHR], 4.2; 95% confidence interval [CI], 2.0 to 8.6) and S aureus carriage at any body site (aHR, 4.6; 95% CI, 2.1 to 10.0) were independently associated with an increased risk of developing SA SSI/BSI within 90 days of surgery.

The risk increased as the number of preoperatively colonized bodily sites increased (aHR, 3.5 to 8.5) as the number of colonized sites increased from one to three) and as the S aureus bacterial load in the nose increased (aHR, 1.8 to 3.4). But extranasal carriage only was not independently associated with increased SA SSI/BSI risk.

The study authors say the findings are in line with previous studies and provide further evidence in support of S aureus decolonization strategies.

"Such interventions have been shown to be efficacious, effective, and cost-effective," they wrote.

Study finds ME/CFS not more likely from COVID than from other infections

News brief

Lisa Schnirring

Levels of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), a disabling chronic multisystem illness from an unknown cause, is largely the same in people who were sick with COVID-19 and those who had other acute illness, a team led by researchers at the University of California-Los Angeles reported today.

tired patient on couch — *m-gucci / iStock*

For the study, the group conducted the study in English and Spanish using the INSPIRE (Innovative Support for Patients with SARS-CoV-2 Infections Registry), a project funded by the US Centers for Disease Control and Prevention (CDC). They published their findings today in the latest edition of JAMA Network Open.

They examined data from 4,700 participants who had COVID symptoms between December 11, 2020, and August 29, 2022. Sixty-eight percent of the participants were female.

No difference, even at 12-month follow-up

Participants with ME/CFS at 3 months made up 3.4% of those who tested positive for COVID compared to 3.7% of people who tested negative for the virus. Researcher found no significant difference in prevalence through 12-month follow-ups.

Researchers noted some limitations of the study, including differences in patient characteristics at baseline, such as new COVID infections in people who initially tested negative. They also said ME/CFS assessment is based on self-reported symptoms and may result in recall bias.

ME/CFS, marked by the inability to easily do activities patients did before they got sick, can be disabling due to extreme fatigue, trouble with cognition, and other symptoms. The trigger isn't known, but researchers suspect that it might be due to infection, because many patients with the condition report illnesses directly before their ME/CFS symptoms began.