Posttraumatic Stress Among Pediatric Critical Care Physicians in the United States in Association with Coronavirus Disease 2019 Patient Care Experiences

Background: Pediatric critical care physicians have played an active role in the care of critically ill patients including adults with coronavirus disease 2019 (COVID-19). Our objective was to assess the prevalence of posttraumatic stress (PTS) and its association with COVID-19 patient care experiences among pediatric critical care physicians during the SARS-CoV-2 pandemic.

Methods: The study is a cross-sectional study of pediatric critical care physicians working in the US. The study was conducted from August 26, 2020 to October 26, 2020 using a web-based online survey platform (Qualtrics, Provo, Utah).

Results: We measured PTS which included posttraumatic stress disorder (PTSD) and subthreshold posttraumatic stress disorder (SubPTSD) using validated PTSD Checklist- 5 survey tool. Association of PTS with COVID-19 patient care experiences was analyzed using regression analysis. Prevalence of PTS was noted in 120 among 294 pediatric critical care physicians (41%; 95% CI, 35-47%) with predominance of hyperarousal symptoms and feelings of negative cognition and mood. Among our physicians with PTS, 19% had PTSD and 81% had SubPTSD. Female physicians and those with children had statistically significant increase in posttraumatic stress (p < 0.05). Posttraumatic stress was significantly associated with physicians testing positive or taking time off for COVID-19 illness, self-isolation, fear of infecting their loved ones, families scared of being infected, feeling helpless, patients expressing fears of dying, having pre-existing depression, anxiety or insomnia, working beyond comfort level of training and having thoughts of quitting (p < 0.05). Thoughts of quitting was associated with the highest significant increase in PTS scores (coefficient:11.643; 95% CI:8.551,14.735; P<0.01) followed by feeling of helplessness (coefficient:11.055; 95% CI: 8.484,13.624; P<0.01) and need for additional medications for depression, anxiety and insomnia (coefficient: 10.980; 95% CI: 4.970, 16.990; P<0.01).

Conclusion: Posttraumatic stress is high in pediatric critical care physicians especially in female physicians and those with children and is associated with various COVID-19 patient care experiences. Thoughts of quitting was associated with highest increase in posttraumatic stress score and this could have major implications for the workforce in the future. Subthreshold posttraumatic stress disorder should be identified and mental health issues of pediatric critical care physicians addressed.