The majority of psychiatric staff report exposure to critical events including threats, assaults, and death, according to study results published in Psychiatric Services. Such exposure is related to elevated post-traumatic stress disorder (PTSD) symptoms.

Investigators reviewed cross-sectional survey data from 761 psychiatric professionals (69% women), including nurses, physicians, therapists, clinical managers, and psychologists, at 3 psychiatric hospital inpatient units in Canada. Overall, 57% of respondents worked as nurses and 64% had more than 5 years of experience in mental health services.

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Survey questions focused on exposure to critical events using the diagnostic criteria for PTSD. Events included threats, physical assaults, violent or accidental deaths, and suicide attempts, either successful or near fatal. Staff indicated whether they directly experienced, witnessed, or learned second-hand about critical events. Clinical stressors were defined as disturbing behaviors exhibited by patients; eg, using threatening or abusive language, screaming, damaging the inpatient room, self-injury, physically resisting care, and engaging in violence. Lastly, symptoms and impairments in function were measured with the 20-item PTSD Checklist-5 and the Diagnostic Interview for Adjustment Disorder, respectively.

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Almost all staff (n=733; 96%) reported having been exposed to at least 1 critical event, and 67% (n=5123) reported at least 1 direct exposure. Physical assault without injury, injury while restraining a patient, and threat of death or serious injury were reported most frequently. A high number of patients (n=655; 86%) reported exposure to at least 1 chronic stressor, most commonly verbal abuse, constant screaming, or physical resistance to care. According to the results from the self-reported PTSD Checklist-5, 16% (n=125) of the cohort met a screening cutoff score, 49% (n=370) indicated that they experienced PTSD symptoms for more than a month, and 9% (n=71) met the full criteria for PTSD.

In addition, the critical event score correlated positively with PTSD symptoms (r=0.405, P =.001). The regression analysis found that critical event score (t, 5.41; P <.001) and chronic stressor count (t, 8.26; P <.001) significantly influenced the variance of PTSD symptoms, while gender and professional discipline did not.

“The contribution of both critical events and chronic stressors to PTSD symptoms suggests that workplace interventions may be needed to address cumulative effects of multiple stressors,” the investigators wrote. “Environmental changes to reduce patients’ behavioral challenges, combined with access for staff to mental health professionals qualified to assess and treat PTSD, could benefit both staff and patients.” Future research may also evaluate barriers to the use of mental health support services.


Hilton NZ, Ham E, Rodrigues NC, Kirsh B, Chapovalov O, Seto MC. Contribution of critical events and chronic stressors to PTSD symptoms among psychiatric workers [published online December 4, 2019]. Psychiatr Serv. doi:10.1176/