• Burnout
• DSM-5
• emergency personnel
• gender
• mental health
• PTSD
• TALS-SR

Background: Post-Traumatic Stress Disorder (PTSD) is a severe psychiatric disorder typically occurring after exposure to a traumatic event, causing chronic psychological suffering and leading to an often chronic and invalid course. Increasing evidences show that healthcare personnel employed in emergency situations is frequently exposed to high stressful work-related situations, which can influence mental state and general well-being leading to PTSD onset. Burnout, defined as a syndrome resulting from a stress-causing process that affects people in the workplace and brings a loss of job motivation, is characterized by emotional exhaustion, depersonalization and reduction of personal abilities, which derives from an imbalance between professional requests and the individual ability to face them. PTSD and Burnout are frequent conditions among emergency healthcare operators exposed to repeated work-related traumatic experiences, both sharing similar risk factors and symptomatic manifestations. The aim of the present thesis is to investigate PTSD, Post-Traumatic Stress Spectrum and Burnout in a sample of emergency operators of a major University Hospital of Italy, with particular attention to possible gender or occupational differences, in order to analyze global functioning in this personnel.

Material and method: The study sample included 137 emergency operators of the “Azienda Ospedaliero-Universitaria Pisana (AOUP)” University Hospital, Pisa, Italy. Subjects were consecutively recruited from 2013 to 2019 in the “Emergency Department”, including Emergency Room and Intensive Care Unit medical and nursery personnel. The assessment was performed by using the Trauma and Loss Spectrum - Self Report (TALS-SR), to investigate PTSD and post-traumatic stress spectrum symptoms related to the work activity, the Professional Quality of Life Scale - Revision IV (ProQOL R-IV), to examine Compassion satisfaction, Burnout and Compassion fatigue related to work activities, and the Work and Social Adjustment Scale (WSAS) to examine the impact of post-traumatic and Burnout symptoms on global functioning of these subjects.

Results: Forty-nine subjects reported a full (14.3%) or partial (24.6%) symptomatological PTSD, with higher rates of post-traumatic stress symptoms in females rather than males. Further, the ProQOL Compassion satisfaction subscale mean score resulted to be significantly higher in Nurses rather than Medical Doctors, while the opposite emerged for the Burnout subscale that resulted to be significantly higher in Medical Doctors with respect to Nurses. Operators with PTSD reported higher Burnout and Compassion Fatigue scores with respect to individuals without PTSD. Pearson’s linear correlation between the TALS-SR domains and total symptomatological scores, and the ProQOL subscales as well as the WSAS scores, in the total sample, highlighted mean to good significant relationships between almost all the TALS-SR domains. Significant moderate to good relationships also emerged between the Burnout and the Compassion Fatigue ProQOL subscales and all WSAS items.

Conclusions: This work underline a positive correlation between Burnout and post-traumatic stress spectrum symptoms in Emergency Department operators, shedding new light on the complex overlap between Burnout, Secondary Traumatic Stress and PTSD. Data from this study support not only the possible lacking recognition of symptomatic post-traumatic stress spectrum manifestations, but also their clinical relevance, when investigating work-related stress in emergency personnel. A deeper assessment of work-related trauma and post-traumatic stress spectrum in these subjects could reveal a great potential in terms of clinical implications, also in term of well-being and Burnout prevention. In this regard, we argue that TALS-SR may comprehend a broader approach on Burnout and Compassion Fatigue dimensions, more associated to work-related post-traumatic reactions.