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Neurological Effects of Traumatic Stress in Healthcare Workers During the Coronavirus Pandemic

With the world taken off of its course due to the coronavirus pandemic and rising cases of the virus in regions all throughout the world, it comes as no surprise that there is much evidence of the psychological impact of traumatic events related to the pandemic, leading to cases of traumatic stress in healthcare professionals.


Image is courtesy of European Pharmaceutical Manufacturer.


According to a study conducted by Peking University in May 2020 through a systematic review of survey submissions of more than 33, 000 participants, 50% of healthcare workers treating patients with COVID-19 reported elevated rates of depression, 45% reported anxiety, 34% reported cases of insomnia and 72% reported distress. These medical professionals actively undertake responsibility for the diagnosis, treatment and care of patients with suspected or confirmed cases of COVID-19 and other health issues. During these unprecedented times, occupational stressors in the health field are often unpredictable. These include a shortage of Personal Protective Equipment (PPE), an increased workload, inadequate training and infection control practices, pandemic fatigue, and guilt and stigma associated with this virus. Increased work demands, little control over the work environment, and the fear of affecting their loved ones with the virus may further worsen the effects of chronic stress.


Strikingly, the pandemic’s burden on healthcare systems was much greater in low and middle-income countries, as the lack of equipment and resources caused the formulation of difficult triage decisions. It is a widely known fact in the medical community that triage – the assigning of urgency to patients and their conditions, results in moral injury. This results in deaths that may not have occurred during normal circumstances and a high healthcare professional burnout rate because they may be mentally unprepared for such instances of acute and chronic stress.


Factors that increase a healthcare worker’s susceptibility to traumatic stress


There are various factors that increase the stress susceptibility of a health care worker, which include:

  • Being younger in age

  • Having low work experience

  • Having a heavy workload

  • Working in unsafe settings

  • Having a lack of training (usually disaster training) and social support

  • Having maladaptive coping strategies

Additionally, women are generally more susceptible to traumatic stress than men. In the hospital setting, nurses are more susceptible than physicians, and during the pandemic, frontline workers who are directly caring for those diagnosed with COVID-19 are more susceptible than those who are caring for patients with other health issues.


What happens to the brain during periods of stress?

The term “stress” describes any demand that is placed on the body, whether it be mental or physical. Whether positive or negative, stress is one of the most palpable demonstrations of the connections between mind and body. During many “stressful” events, the associated bodily reactions are not only unhelpful, but they can also be quite destructive—especially if there is no immediate physical release or the psychological resolution of the situation.


It is important to note that the physiological responses we have to various stressors (ie. any event that provokes stress) depend on the amount of challenge we are comfortable with; this varies from individual to individual. Stressors come in numerous forms—some events are very sudden and require immediate reactions and others present a more ongoing challenge and call for a more prolonged response. Luckily, humans have developed two different systems—one described as “fast” and the other as “slow”—which together give us remarkable flexibility when it comes to dealing with different stressors.


Fast Pathway


The “fast” pathway is often referred to as our fight-or-flight response, or more formally, the Sympathetic Adrenomedullary (SAM) system. When we perceive an emergency, a signal is passed on to the hypothalamus, the small region in the middle of the brain that controls the Autonomic Nervous System (ANS). The sympathetic branch of the ANS sends nerve impulses down to the adrenal glands, just above the kidneys, which in turn releases the hormone adrenaline. Once in the bloodstream, adrenaline sends immediate, targeted messages to various organs, preparing the body for urgent action. This is a short-acting solution to acute stress under normal conditions. We come to believe that we are out of danger when the levels fall again.


Slow Pathway


Whenever there is a stressor that lasts for more than a few minutes, the “slow” system, which is the slower and longer-acting Hypothalamic-pituitary-adrenal (HPA) system kicks into action. Once again, the stressor is processed in the brain by the hypothalamus, but in this case, it causes the direct release of the hormone into the bloodstream, via the pituitary gland. This sets off a cascade of chemical reactions; most importantly, the hormone cortisol is released through the adrenal glands. Cortisol, or the “stress hormone”, plays an extremely important role in the body, regulating many daily physiological functions from glucose levels, electrolyte levels, blood pressure, immune response, bone density, and even memory. As a result, abnormal levels of this glucocorticoid hormone have a particularly significant effect on the brain; dysfunction has been linked with memory impairment, depression, burnout, PTSD and psychosis, to name a few. These continued high levels can cause the human body to remain in a prolonged state of readiness and high alert, negatively affecting both physical and mental health.


Image is courtesy of Biology Dictionary.


Mental Health Services’ Response to the Pandemic


In order to combat these negative effects, healthcare policies must establish preventative strategies towards the now alarmingly common instances of post-traumatic stress. We must understand both their challenges and their needs in order to effectively support these valuable frontline workers. Education, self-care and support systems must become a part of these preventative measures. Psychological first aid must be administered in situations of psychological distress. By de-stigmatizing the frightening rate of these mental health issues, we can surely help make the lives of these heroic healthcare workers easier, if only slightly!


References


Benfante, A., Di Tella, M., Romeo, A., & Castelli, L. (2020, September 25). Traumatic stress in healthcare workers during covid-19 pandemic: A review of the immediate impact. Retrieved February 22, 2021, from https://www.frontiersin.org/articles/10.3389/fpsyg.2020.569935/full

D'Ettorre, G., Ceccarelli, G., Santinelli, L., Vassalini, P., Innocenti, G., Alessandri, F., . . . Tarsitani, L. (2021, January 12). Post-Traumatic stress symptoms in healthcare workers dealing with the COVID-19 PANDEMIC: A systematic review. Retrieved February 22, 2021, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7828167/

Jianbo Lai, M. (2020, March 23). Mental health outcomes among health care workers exposed to covid-19. Retrieved February 22, 2021, from https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2763229

The mind and mental health: How stress affects the brain. (2020, June 09). Retrieved February 22, 2021, from https://www.tuw.edu/health/how-stress-affects-the-brain/

Post-covid stress disorder: Another emerging consequence of the global pandemic. (n.d.). Retrieved February 22, 2021, from https://www.psychiatrictimes.com/view/post-covid-stress-disorder-emerging-consequence-global-pandemic

Yaribeygi, H., Panahi, Y., Sahraei, H., Johnston, T., & Sahebkar, A. (2017, July 21). The impact of stress on body function: A review. Retrieved February 22, 2021, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5579396/



Article Author: Aneri Buch

Article Editors: Olivia Ye, Valerie Shirobokov

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