A new University of Liverpool led study, published in BJOG: An International Journal of Obstetrics and Gynaecology today (Tuesday, 28 January 2020), has revealed the prevalence of work-related post-traumatic stress disorder (PTSD) among obstetricians and gynaecologists.
The study, funded by medical research charity Wellbeing of Women and the Royal College of Gynaecologists (RCOG), highlights the need for a system of care for front-line staff and mental health in the profession as a global concern.
The impact of doctors' work on their mental health is a major global concern. Doctors can be exposed at work to events that they find traumatic, and obstetricians and gynaecologists may be particularly at risk. Whilst the majority of births proceed straightforwardly to positive outcomes, adverse events in which a previously healthy mother or her baby is suddenly at risk of serious injury or death will occur.
Exposure to trauma through the provision of care can lead to work-related post-traumatic stress disorder (PTSD). This is defined as a psychological response to exposure to an event involving actual (or threatened) death or serious injury and characterised by four symptom groups: intrusions (e.g. intrusive thoughts or images, flashbacks); avoidance of reminders; arousal (e.g. feeling 'on edge') and negative alterations to beliefs or mood (e.g. anger, guilt).
These symptoms cause distress, impairment in the individual's social interactions, capacity to work or in other important areas of functioning.
To explore Obstetricians' and Gynaecologists'(O&G) experiences of work-related traumatic events researchers, led by Professor Pauline Slade, conducted a study to measure the prevalence and predictors PTSD, any impacts on personal and professional lives, and any support needs.
In collaboration with the Royal College of Obstetricians and Gynaecologists (RCOG) a survey was sent to 6300 fellows, members and trainees of RCOG. 1095 people responded. Then 43 in-depth interviews with trauma-exposed participants were completed and analysed by the researchers from University of Liverpool, University of Nottingham and Liverpool John Moores University.
Two thirds of participants reported exposure to traumatic work-related events. Of these, 18% of both consultants and trainees reported clinically significant PTSD symptoms. Staff of black or minority ethnicity were at increased risk of PTSD. Clinically significant PTSD symptoms were associated with lower job satisfaction, emotional exhaustion and depersonalisation which means treating people like objects. Organisational impacts included sick leave, and 'seriously considering leaving the profession'. 91% wanted a system of care. The culture in obstetrics and gynaecology was identified as a barrier to trauma support. A strategy to manage the impact of work-place trauma is proposed.
Work related posttraumatic stress in obstetricians and gynaecologists is a significant and hidden problem.
It leads to high levels of distress for the individual staff members. It also affects women having their babies as it can lead staff to practise more defensively, intervening earlier because of their own anxieties. It also affects the sensitivity care staff can provide. If women have less sensitive care they, themselves are more at risk of PTSD after childbirth.
PTSD also has an impact on maternity services as it is linked to staff thinking of leaving the speciality and 30% of trainee obstetricians do leave during their seven-year training. It also leads to staff taking sick leave with disruption and extra costs for the NHS.
Professor Pauline Slade, said: "Exposure to trauma in obstetrics and gynaecology is a work place hazard and employers have a duty of care. There is no adequate system of care and staff report a culture of stigma and blame. We need to look after staff so they can look after women and their families."
Professor Janice Rymer, Consultant Gynaecologist, and Spokesperson for the Royal College of Obstetricians and Gynaecologists (RCOG), said:
"It is extremely concerning that two thirds of O&G doctors, including both consultants and trainees, who responded to this survey experience traumatic events in the workplace, and of these nearly 20% report post-traumatic stress disorder (PTSD) symptoms.
"The RCOG takes the welfare of doctors extremely seriously. It is only with a healthy and sustainable O&G workforce that the safest quality of care can be provided to women and their babies.
"This study provides even more compelling evidence that urgent action is needed to improve the workplace environment for doctors and ensure they are supported as well as possible.
"System-wide pressures are adversely impacting the wellbeing of healthcare professionals and we must understand how to overcome these and make the necessary improvements. In addition to our ongoing hard work, this paper makes a number of important recommendations on what future support care plans for doctors should include."
>Vital support needed
Jeremy Barratt, Head of Research at Wellbeing of Women, said: "The mental health and wellbeing of our doctors is so important yet can sometimes be neglected - well supported and motivated staff are better equipped to provide the very best care for women.
"This research has highlighted the worrying numbers of obstetricians and gynaecologists who are exposed to trauma at work and trainees who are driven to leave the profession. It is vital that we adequately support our doctors to cope with the impact of work-based trauma so that they in turn can ensure they are ready to give the best possible care for women and their babies."
The full paper, entitled 'Work-related post-traumatic stress symptoms in obstetricians and gynaecologists: findings from INDIGO a mixed methods study with a cross-sectional survey and in-depth interviews', will be available on the BJOG website once the embargo lifts.
BJOG An International Journal of Obstetrics & Gynaecology