Associations between trauma and substance use among healthcare workers and public safety personnel during the SARS-CoV-2 (COVID-19) pandemic: the mediating roles of dissociation and emotion dysregulation

Abstract

Background: Given the highly stressful environment surrounding the SARS-CoV-2 pandemic, healthcare workers (HCW) and public safety personnel (PSP) are at an elevated risk for adverse psychological outcomes, including posttraumatic stress disorder (PTSD) and alcohol/substance use problems. As such, the study aimed to identify associations between PTSD severity, related dissociation and emotion dysregulation symptoms, and alcohol/substance use problems among HCWs and PSP. Methods: A subset of data ( N = ; HCWs = ; PSP = ) was extracted from a larger study examining psychological variables among Canadian HCWs and PSP during the pandemic. Structural equation modelling assessed associations between PTSD symptoms and alcohol/substance use-related problems with dissociation and emotion dysregulation as mediators. Results: Among HCWs, dissociation fully mediated the relation between PTSD and alcohol-related problems (indirect effect β = .133, p = .03) and emotion dysregulation partially mediated the relation between PTSD and substance-related problems (indirect effect β = .151, p = .046). In PSP, emotion dysregulation fully mediated the relation between PTSD and alcohol-related problems (indirect effects β = .184, p = .005). For substance-related problems among PSP, neither emotion dysregulation nor dissociation ( p s >.05) had any effects. Conclusion: To our knowledge, this is the first study examining associations between PTSD severity and alcohol/substance use-related problems via mediating impacts of emotion dysregulation and dissociation among HCWs and PSP during the SARS-CoV-2 pandemic. These findings highlight dissociation and emotion dysregulation as important therapeutic targets for structured interventions aimed at reducing the burden of PTSD and/or SUD among Canadian HCWs or PSP suffering from the adverse mental health impacts of the SARS-CoV-2 pandemic.

On the path to recovery: traumatic stress research during the COVID-19 pandemic 2021–2023

“…Not surprisingly, therefore, studies, including in this Special Issue (Greene et al, 2021 ; Patel et al, 2023 ), have documented how healthcare workers, especially those on the front-line caring for patients with severe coronavirus infections, have reported a plethora of psychological problems (e.g., anxiety, depression, somatisation, obsession/compulsions, insomnia) (Greene et al, 2021 ), primary and secondary traumatic stress symptoms (Greene et al, 2021 ; Hegarty et al, 2022 ), burnout (Alkhamees et al, 2023 ; Long et al, 2023 ; Rossi et al, 2023 ), and severe impairment and danger due to addiction and suicidality (Patel et al, 2023 ; Ryan et al, 2023 ; Uvais, 2021 ). Almost half of a sample of front-line healthcare workers assessed by structured interview during the pandemic met criteria for PTSD, and nearly 40% for major depressive disorder, with pandemic-related traumatic stressors appearing directly related to depression and to exacerbate the effects of pre-pandemic trauma exposure when PTSD occurred (Wild et al, 2022 ).…”

“…While the mental health impact of the COVID-19 pandemic on healthcare workers has been a focal point of investigation, other at-risk populations including students (Ali et al, 2021 ; Bountress et al, 2022 ; Essadek et al, 2022 ; Pat-Horenczyk et al, 2021 ), refugees (Akhtar et al, 2021 ; Liddell, Murphy, et al, 2021 ; Liddell, O'Donnell, et al, 2021 ), persons exposed to violence (Birkeland et al, 2021 ; Gibert et al, 2021 ) or past childhood adversity (Clemens et al, 2021 ), and military personnel (Richardson et al, 2022 ) have also been a nidus for research on mental health outcomes. A multitude of studies and reviews have highlighted the ubiquitous negative mental health effects of the pandemic (Nochaiwong et al, 2021 ; Zhao et al, 2021 ) and lockdowns (Chen et al, 2022 ), including PTSD (Bonati et al, 2022 ; (Laurent et al, 2022 ) Yuan, et al, 2021 ), adjustment disorders (Ajdukovic et al, 2021 ; Dragan et al, 2021 ; Liddell, O'Donnell, et al, 2021 ; Lotzin et al, 2021 ; Shiffman et al, 2023 ), substance use disorders (Patel et al, 2023 ), and even transient psychoses (Loehde & Novakovic, 2021 ).…”

“…During the pandemic, frontline health workers including nurses and physicians (Ford et al, 2022 ), but also professionals and paraprofessionals from a wide variety of allied health fields such as respiratory therapists (D'Alessandro-Lowe et al, 2023 ), public safety personnel (Rodrigues et al, 2023 ), and social care workers (Zerach & Levi-Belz, 2021 ) were exposed to extreme hazards (e.g., viral transmission, insufficient PPE) and workplace stressors (e.g., medical crises, patients and families separated and in distress, deaths of patients and co-workers, moral dilemmas) (Adams et al, 2023 ; Berkhout et al, 2022 ; Laurent et al, 2022 ). It is important to remember that no one-size-fits-all in the experiences, adaptations, and difficulties experienced by front-line workers based on differences in the pandemic-related stressors that confronted workers of different occupational backgrounds and responsibilities, in their stress-related reactions, and their life contexts (Tekin et al, 2022 ) (Patel et al, 2023 ; Qureshi et al, 2022 ).…”

“… 34. Patel et al ( 2023 ). Associations between trauma and substance use among healthcare workers and public safety personnel during the SARS-CoV-2 (COVID-19) pandemic: the mediating roles of dissociation and emotion dysregulation Among healthcare workers, dissociation fully mediated the relation between PTSD and alcohol-related problems and emotion dysregulation partially mediated the relation between PTSD and substance-related problems.…”

Factors associated with suicide in physicians: a silent stigma and public health problem that has not been studied in depth

“…Although the working scenario for physicians varies across different regions of the world, generally, this is one of the professions that is most exposed to long working hours, a high academic workload, a lifestyle dependent on time availability, low salaries, lack of guarantees of fair contract access, disorders related to alcohol and drug consumption, exposure to various emotions triggered by approaching frustration, fear, illness, death, among others (8)(9)(10). Specifically, due to social and work stigma, physicians tend not to seek psychological or psychiatric assistance in case of presenting suicidal ideation or a mental disorder (6,7), increasing the risk of suicide due to symptom intensification by the lifestyle (The intensification is a result of the persistence of stressors, which can be accompanied by burnout occurring at the physician's work, personal, or academic level, leading to the onset of a psychiatric disorder).…”