Traumatic Stress, Psychological Well-being, and Sociodemographic Correlates in High-stress Environments among Healthcare Professionals

1. INTRODUCTION

Healthcare providers are essential to society because of their impact on people's health and quality of life. The effects of traumatic stress on healthcare professionals can have significant implications for the quality of patient care. Therefore, this study is an effort to explore the association of traumatic stress, psychological well-being (PWB), and sociodemographic characteristics among healthcare professionals working in high-stress conditions across several hospital departments related to emergency, ambulance, and intensive care. According to a systematic review and meta-analysis conducted in twenty-one countries, studies represent a high percentage of depression (21.7%), anxiety (22.1%), and post-traumatic stress disorder (PTSD) (21.5%) among healthcare pro- fessionals during the COVID-19 pandemic [1]. Some other studies confirmed the psychological distress and traumatic stress among HCWs [2, 3]. This high prevalence of mental disorders among healthcare professionals may affect their PWB.

Traumatic stress is a well-established theoretical concept in the field of the psychosocial model, which refers to the psychological response to a traumatic event that is perceived as life-threatening or poses a serious threat to one's physical or psychological integrity [4]. Experiencing traumatic stress has been associated with various unfavorable consequences, such as depression, anxiety, and post-traumatic stress disorder (PTSD). The variable of traumatic stress is drawn from Philip and Cherian's psychosocial stress model [5]. This model suggests that stress arises when people perceive a discrepancy between their goals and the resources available to achieve them. Therefore, healthcare workers (HCWs) can face stress if there is a discrepancy in providing optimal care and available resources. Simultaneously, psychosocial models facilitate under- standing the impact of stressful situations on people. Traumatic stress has been studied as an antecedent or outcome variable. Furthermore, as a predictor variable, exposure to traumatic events may affect an individual's mental health or other outcomes of interest [6]. In addition, studies suggest that people who have been through traumatic experiences are more likely to have concerns with their physical health, such as hypertension, and engage in risky behaviors, such as substance addiction [7]. Traumatic stress may also be seen as an outcome variable, reflecting how traumatic experiences have altered a person's life [8].

Healthcare professionals are often exposed to traumatic events, such as dealing with critically ill patients, experiencing patient deaths, or working in high-stress environments like emergency departments. Traumatic stress may have severe consequences for those working in the medical field, including but not limited to burnout, emotional weariness, depression, anxiety, and PTSD. A study of the relationship between secondary traumatic stress (STS) and occupation found that 53.8% of paramedics, 62.5% of health officers, 67.7% of physicians, 59.3% of emergency medical technicians, 30% of nurses, and 80% of anesthesiologists were affected by trauma experienced by the person being treated or cared for [9]. A cross-sectional study conducted in 2019 among HCWs in Jeddah, Saudi Arabia, found a high prevalence of psychological distress among healthcare workers, with 45.2% of the respondents reporting symptoms of anxiety and 47.6% reporting symptoms of depression [10]. These consequences may affect patient outcomes, work satis- faction, professional progression chances, and general well-being.

On the other hand, PWB is a concept that has received increasing attention in positive psychology research. It is optimal functioning, including positive emotions, engagement, meaning, positive relationships, and accom- plishment [11]. PWB has been linked to various positive outcomes, including better physical health, higher job satisfaction, and greater resilience to stress. Trudel-Fitzgerald et al. [12] describe PWB as a multifaceted construct encompassing objective and subjective elements that incorporate external and tangible factors and internal and subjective experiences. Therefore, the absence of psychological distress and traumatic stress signifies PWB. Traumatic stress and other sociodemographic factors can lead to deteriorated PWB [13]. While PWB is not only an issue of discussion among healthcare professionals in Saudi Arabia [14]. Different factors expose HCW to traumatic stress alongside sociodemographic factors. According to Franzen et al. [15], psychological distress mainly affects psychological well-being.

In this study, we aim to explore how traumatic stress, PWB, and sociodemographic factors interact among healthcare workers (HCWs) in high-stress environments. Specifically, we will examine how sociodemographic factors and traumatic stress predict PWB. By doing so, we hope to better understand the factors that contribute to the PWB of HCWs in high-stress environments and identify potential interventions that can improve their mental health and well-being.

Finally, the relevance of sociodemographic factors is based on the biopsychosocial model, which suggests that social and economic factors strongly influence health outcomes and PWB. For instance, research has indicated that these factors play a role in determining an individual's PWB [16]. Sociodemographic factors such as age, gender, education, and income have been shown to influence both traumatic stress and PWB among HCWs [17]. Some researchers found that nurses in intensive care units in Saudi Arabia experience high-stress levels and tend to be less healthy and less productive [18]. In addition, studies suggest that older individuals, females, and those with lower socioeconomic status may be more likely to experience poorer PWB [19]. According to Philip [5], age plays a significant role in how HCWs evaluate their mental health and PWB. Shamsan and colleagues investigated the occurrence of depression and stress among HCWs in Saudi Arabia [20]. The study revealed that senior HCWs have a significantly increased risk of experiencing isolation, loneliness, despair, and burnout symptoms.

All the existing literature differs from the context of the current investigation. Some studies evaluate only two variables: burnout and PWB or traumatic stress and PWB. A research question has been formulated, ‘Is there a relationship between traumatic stress, psychological well-being, and sociodemographics in high-stress environments among healthcare in different medical units?’ After reviewing the literature, this study proposed the hypothesis, “Sociodemographic variables and traumatic stress will predict psychological well-being among health- care workers who work in high-stress environments.” Furthermore, it is expected that the findings from this research will reveal a difference in responses based on sociodemographic factors, “There will be a difference in responses based on age, gender, experience, education level, or other demographic characteristics when it comes to experiencing traumatic stress and psychological well-being among HCWs.”

2. MATERIALS AND METHODS

3. RESULTS

This section describes the various sociodemographic characteristics of study subjects, their psychological well-being and traumatic stress levels, and their interaction and differences according to sociodemographic factors. The alpha coefficient of STS and BIT scales were found as α= 0.843 and α = 0.842 for healthcare professionals in Saudi Arabia.

3.1. Demographic and General Information

The study included 290 participants, with a slightly increased proportion of female representation, with 160 (55.2%) participants. The composition of study subjects was mainly of younger population as those aged 20-29 and 30-39 years represented 43.1% and 34.5% of the study participants, respectively. Moreover, the most significant % of participants (60.7%) had a bachelor’s degree or educational qualification or were doing their internship. Regarding work-related information of the study participants, 39% were health professionals, and more than one-third (39.3%) of the study subjects reported having 1-4 years of experience. Participants working in the emergency, inpatient, and outpatient departments constituted nearly half of the study subjects jointly, representing 25.1% and 22.6%, respectively. Moreover, approximately the proportions of the study subjects were working in the central, western, and eastern regions of Saudi Arabia, with 33.8%, 35.5%, and 27.9%, respectively (Table 1).

Table 1.

Variables	Categories	f	Percentage
Age in years	20-29	125	43.1%
	30-39	100	34.5%
	40-49	40	13.8%
	50-59	23	7.9%
	60 or more	2	0.7%
Gender	Female	160	55.2%
	Male	130	44.8%
Occupation	Health professional	113	39.0%
	Nursing	89	30.7%
	Trainee	81	27.9%
	Others	7	2.4%
Educational Qualification	High school/Diploma	50	17.2%
	Bachelor's degree/ Internship	176	60.7%
	Master's degree/ Residency	37	12.8%
	Doctorate degree/ Fellowship	27	9.3%
Years of work in specialization	1-4	114	39.3%
	5-8	69	23.8%
	9-12	55	19.0%
	13 or more	52	17.9%
What is your working unit?	Ambulance	42	14.8%
	Emergency department	71	25.1%
	Surgery	8	2.8%
	Inpatient and outpatient unit	64	22.6%
	Intensive care unit	47	16.6%
	Palliative care	8	2.8%
	Rotating trainee	34	12.0%
	Others	9	3.2%
In which region of KSA are you working?	Central Region	98	33.8%
	Western Region	103	35.5%
	Eastern Region	81	27.9%
	Northern Region	5	1.7%
	Southern Region	3	1.0%

Table 2.

Sub-scales of STS	Mean	SD	Minimum	Maximum
Intrusion subscale	11.1	2.8	5.0	24.0
Avoidance subscale	17.9	2.1	7.0	31.0
Arousal subscale	14.0	2.3	5.0	23.0
Secondary traumatic stress scale	42.9	2.9	17.0	70.0
BIT scale Total Score	35.5	2.4	13.0	50.0

4. DISCUSSION

This study examined how traumatic stress, psycho- logical well-being, and demographic factors affect healthcare workers. It is hypothesized that HCWs who work in high-stress environments such as emergency, critical care, and ambulance units may experience trauma or distress that can have adverse effects on their mental health and overall well-being. These workers are exposed to various types of stress and trauma that can cause emotional pain and distress, leading to secondary traumatic stress, which can impact their ability to cope and carry out their responsibilities effectively.

The hypothesis of this study is partially accepted as it identified associations among demographic character- istics, traumatic stress, or psychological well-being. Regarding traumatic stress levels, the current study indicated that a significant proportion (80%) of the participants experienced moderate to severe levels of secondary traumatic stress. These findings align with a previous study conducted between July 2021 and July 2022, which reported that approximately 65.4% of HCWs experienced traumatic stress in Saudi Arabia [9]. In line with this study, a recent study by Orrù et al. obtained information on the demographic characteristics and levels of mental distress among healthcare workers from 45 countries [27]. The study found that over 40% of the participants showed signs of moderate to severe secondary traumatization, indicating a high prevalence of this condition among the respondents.

Regarding the association between sociodemographic factors and traumatic stress, the present study found significant differences in secondary traumatic stress scores according to gender, occupation, working unit, and region. Females had higher secondary traumatic stress scores compared to males. Additionally, participants working in the ambulance unit and the emergency department reported higher secondary traumatic stress scores compared to other units [28]. The central region had the highest secondary traumatic stress scores among the regions, further requires more support from the human resource department. Concerning the years of work in specialization and age for secondary traumatic stress scores, analysis could not be performed due to non-normal score distribution.

For psychological well-being, the study found a significant difference in participants' brief inventory of thriving (BIT) scores according to occupation and working unit. This finding is related to previous studies that confirm that health professionals have higher psychological well-being. The HCWs working in palliative care units tend to possess higher levels of psychological resilience [29]. Matua et al. found that healthcare workers in palliative care settings had higher psychological well-being levels than in other healthcare settings [30]. The factors contributing to their well-being included having a supportive work environment, a sense of purpose and meaning in their work, and adequate training and support to manage emotional stress and burnout. The study of Zhang et al. also showed that healthcare professionals who work in palliative care settings experienced high levels of job satisfaction and personal fulfillment [31]. They also reported increased psychological well-being, empathy, and communication skills. On the other hand, the HCWs working in the ambulance unit reported a lower level of psychological well-being which is consistent with a recent study by Mohebbi et al. ambulance workers had a lower level of psychological well-being than the general population [32]. Jennings et al. found that healthcare workers working in ambulances had lower psychological well-being compared to workers in other healthcare settings [33]. This study indicates that potential factors contributing to this phenomenon could be experiencing traumatic incidents, facing excessive work pressure, and receiving insufficient assistance from co-workers and managers.

The findings of high secondary traumatic stress levels and their negative impact on psychological well-being among healthcare workers in this study align with the broader literature on mental health challenges faced by healthcare professionals, particularly during the COVID-19 pandemic. A systematic review and meta-analysis conducted in twenty-one countries reported a high pre- valence of depression (21.7%), anxiety (22.1%), and post-traumatic stress disorder (PTSD) (21.5%) among healthcare professionals during the pandemic [1]. Similarly, Shamsan et al. (2021) [20] found high levels of depression and stress among healthcare workers in Saudi Arabia during the same period. In addition, a literature review conducted by Ulfa et al. [3] showed that traumatic stress was prevalent among healthcare workers globally during the peak of the pandemic, indicating that the negative impact on psychological well-being noted in this study is not limited to healthcare workers in Saudi Arabia but rather a worldwide phenomenon.

Overall, the negative relationship of traumatic stress was found to be a predictor of lower level of psychological well-being. This conceptualization agrees with the evidence that the PWB of healthcare workers is affected by factors such as traumatic stress and sociodemographic characteristics, burnout, and low psychological well-being, as revealed in a systematic review by Van Hoy and Rzeszutek [13], indicated that there is a possibility of the negative influence of traumatic stress on both the mental health and well-being of healthcare professionals. In addition, the mental health symptoms of healthcare workers in this study are congruent with the findings of Pappa et al. [14], a systematic review and meta-analysis of mental health symptoms during the COVID-19 pandemic in Southeast Asia, suggesting that the adverse effects on healthcare workers' mental health are not only present in the context of Saudi Arabia.

CONCLUSION

There is evidence demonstrating that HCWs, especially those working in high-stress environments such as ambulances, suffer from higher STS. Surgeons have a higher psychological wellbeing level as compared to other professionals. The less experienced HCWs have considerably more traumatic stress than their older, more experienced counterparts. HCWs need to be supported and cared for to cope with their work's mental and emotional toll. This can be performed by creating a positive and supportive environment in the hospital. It is essential to alleviate the emotional, cognitive, and physical distress experienced by healthcare workers to boost their motivation and enable them to develop resilience. This will help them to adopt a more positive outlook toward caring for their patients with empathy and kindness.

AUTHOR'S CONTRIBUTION

It is hereby acknowledged that all authors have accepted responsibility for the manuscript's content and consented to its submission. They have meticulously reviewed all results and unanimously approved the final version of the manuscript.

REFERENCES