Transtorno de Estresse Pós-Traumático em profissionais de saúde atuantes em unidades de terapia intensiva pediátrica durante a pandemia de COVID-19

Abstract

Background: professionals in Intensive Care Units (ICU) are at increased risk of developing mental health disorders, such as Posttraumatic Stress Disorder (PTSD). The COVID-19 pandemic has exacerbated this issue, particularly concerning adult ICU burdened with a high influx of critically ill patients. However, Pediatric ICU (PICU) have also received adult patients, their staff dealt with redeployment, and have faced the unfamiliar Pediatric Multisystem Inflammatory Syndrome associated with COVID-19. Previously, the estimated prevalence of PTSD in these professionals ranged from 13 to 24%, and since the extent of the impact on PICU workers remains unknown, the aim of this study is to the aim of this study is to estimate the prevalence of PTSD in PICU healthcare workers, determine this prevalence in specific subgroups based on demographic and occupational characteristics, and assess its relationship with social support and resilience. Methods: an observational, cross-sectional, multicenter study was conducted. Twenty-nine public and private PICU from across Brazil were invited to participate, comprising a total of 1,506 physicians, nurses, nursing technicians, and physical therapists. Demographic and occupational variables were collected, as well as organizational variables from each PICU. The outcome PTSD was assessed using the Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5) and defined as present when meeting DSM-5 diagnostic criteria. Results: with 1,084 respondents (a response rate of 72%), the prevalence of PTSD was 13%, with a median PCL-5 score of 14 (interquartile range [IQR] 7–23), although 26% to 53% of professionals exhibited some kind of symptomatology of posttraumatic stress, mainly intrusive symptoms. Their levels of resilience and social support were lower in those with more posttraumatic symptoms (p < 0.001 for all). Thirty-two percent of participants cared for adult COVID19 patients, with no difference in the prevalence of PTSD compared to others. Subgroups with higher PTSD prevalence included females (median 14 [IQR 7-24], p<0.01) and those with a previous history of mental health disorders (median 17 [IQR 10 12-26), p<0.001). Workers in public units also had more PTSD (14.8% vs. 10% in private units, p=0.03), with no differences in levels of resilience or social support. When asked about distressing professional events, such as a lack of resources or personal protective equipment, the PTSD subgroups and those in public units reported higher levels of distress. Conclusions: The prevalence of PTSD in PICU workers is comparable to that suggested by previous studies in adult ICU workers during the first peak of the COVID-19 pandemic in Brazil. Those with more symptoms had lower levels of social support and resilience, as well as more distress when reporting professional events. This suggests that organizational factors related to the institution also play a role beyond personal factors. Furthermore, certain subgroups, such as those with a history of mental health disorders, had a higher prevalence of PTSD, suggesting a focus on these subgroups to identify those in need of institutional support