Posttraumatic stress disorder (PTSD) and work life

Skogstad, M., Skorstad, M., Lau, B., Conradi, H. S., Heir, T., & Weisæth, L. (2011). Posttraumatisk stresslidelse (PTSD) og arbeidslivet [Posttraumatic stress disorder (PTSD) and work life] Norwegian only. (STAMI-rapport Nr. 3).

There has been an increasing demand concerning knowledge about posttraumatic stress disorder (PTSD) that has occurred as a result of exposure at the workplace. The National Institute of Occupational Health, along with the Norwegian Centre for Violence and Traumatic Stress Studies, has therefore prepared a report on the subject. The Norwegian Petroleum Authority and the Norwegian Board of Health Supervision have provided funding for the project.

The diagnosis PTSD is one of the few diagnoses where a triggering event is a necessary diagnostic criterion. A traumatic event is one in which the person experiences, witnesses, or is confronted with an event or events that involve actual or threatened death or serious injury, or threat to the physical integrity of self or others and the person’s response involves intense fear, horror or helplessness. Persons exposed to trauma may temporarily or over time be bothered with re-experiencing of the trauma, avoidance and have a high degree of vigilance. Ever since the diagnosis first was introduced in 1980, there has been considerable disagreement as to what qualifies as a traumatic event. Some argue that people will always respond strongly to traumatic events and that there is no reason to pathologize this. Others, however, believe the PTSD diagnosis facilitates clinical work with people exposed to a severe stressor. An updated diagnostic system will be published in 2013, where it is expected that more objective measures of actual exposure will be emphasized.

In the general population, 1-12 percent qualifies for a PTSD diagnosis during their lifetime and the incidence is generally higher for women than for men. Only a minority of those exposed to traumatic events develop PTSD. In peacetime, it is believed that 1-3 percent of the population at any given time suffers from PTSD.

The degree of seriousness of the traumatic event gives an indication of the risk of PTSD development. Other factors of importance include female gender, previous trauma, individual or familial psychiatric illness and level of education. These factors have been shown to have a significant, but low, predictive value concerning the development of PTSD. Social support is the most important posttraumatic factor, protecting against PTSD development. 

Most people exposed to a single traumatic event do not develop PTSD, and between 62-92% of those with PTSD have other psychiatric disorders at the time of PTSD- diagnosis.

Studies of severe traumatic events show that almost everyone develops PTSD symptoms shortly after the stressful event. Yet, most people exposed to severe trauma recover within days, weeks, a few months. 

The development of PTSD symptoms after a trauma is a normal reaction to an abnormal event. For some people, the experience of the traumatic event can be strengthening, leading to a greater degree of maturity, wisdom, empathy and acceptance.

A consensus conference in Cape Town in 2009 summarizes knowledge from several guidelines when it comes to preventing PTSD. Early intervention is summarized as the four Ps: do not pathologize, do not psychologize, do not pharmacologize, and do not push for professional contact.

Where a high degree of PTSD symptoms persist 1-3 months after the traumatic event, cognitive- behavioral psychotherapy, in particular, has been shown to be effective. Pharmacological treatment with antidepressant medication has also shown to be effective in cases where a high degree of PTSD- symptoms persist. 

In this report we have looked at professional groups who during work have an increased risk of experiencing traumatic events. This may be occupations such as police, employees in the fire department, ambulance service, and in diving or healthcare. 

Many of the studies dealing with PTSD in the workplace are cross-sectional studies based on questionnaires brought home to those participating in the survey. These studies consistently show higher symptom scores among those who have experienced severe stress load than what is the case among the controls. Interpretation of the results must be done with caution as there are several methodological errors, such as risk of misclassification, in which respondents are asked to specify both exposure and effects. In addition, many of the studies have low response rates. 

In studies of workers, where they are followed over time after a severe stress load, the post- traumatic stress symptoms usually decrease with time. 

A good organizational and psychosocial work environment, and follow-up after a serious incident can serve as a protective factor against PTSD-development. Employees, who have no special training in handling potentially traumatizing events, seem to be more susceptible to PTSD than trained personnel. In addition, people who have had mental problems prior to the accident along with poor social support may be particularly prone to develop PTSD. Accordingly, it is important to develop a sound working environment and an organization that follows up its staff, promotes social support from colleagues and managers, and work systematically with the training of employees.

The Researchers