HOMEMental Health TopicsPosttraumatic Stress Disorder

Posttraumatic Stress Disorder

Posttraumatic stress disorder (PTSD) is a psychiatric disorder that occurs in people who have experienced or witnessed traumatic events such as natural disasters, serious accidents, terrorist incidents, war, or violent personal assaults. The disorder can be diagnosed in individuals who directly experience or witness a traumatic event but also in those who are indirectly exposed (such as learning that a violent trauma occurred to a loved one) or who repeatedly experience aspects of a traumatic event through their professional work (such as emergency medical technicians and fire and police personnel).

Identifying PTSD

According to the American Psychiatric Association ([APA] 2013), people with PTSD experience a range of symptoms across 4 categories:

  1. Intrusive symptoms related to the event, such as nightmares, flashbacks, or unwanted thoughts about the trauma;

  2. Behaviors designed to help a person avoid people, places, or situations that are reminders of the event;

  3. Negative changes in one’s thoughts and mood, such as blame of self or others, having persistent negative beliefs (“Everyone is out to hurt me.”, “The world is an unsafe place.”), or feeling unable to experience happiness or other positive emotions; and

  4. Feeling hyperaroused or overly reactive, including being irritable or easily startled or having sleep disturbances.

Although most individuals who have the disorder are adults, there are specific criteria for diagnosing PTSD in children aged 6 years and younger (APA, 2013).

Among Americans aged 13 years and older, the risk of developing PTSD is 3.7% in any 12-month period and 5.7% at any point in life (Kessler et al., 2012). However, rates are much higher among certain, more vulnerable groups. For instance, the prevalence among military service persons may be as high as 34%, with female and racial/ethnic minority service personnel being at an increased risk (Xue et al., 2015). PTSD has been estimated to occur in 32% of first responders (McFarlane et al., 2009), including 19% of police officers (Halpern et al., 2009). The risk of a woman having PTSD at any point in life is more than double that of a man’s (Kessler et al.; Sareen, 2014). In men, PTSD is most often associated with military combat exposure and physical injury or assault; in women, it is most often associated with rape, childhood sexual abuse, and domestic violence (Sareen).

Occupational Effects of PTSD

Compared to workers without the disorder, those with PTSD have greater rates of work absenteeism, a higher number of medical visits, an increased likelihood of unemployment or underemployment, lower hourly pay, and increased difficulty meeting work-related demands (Belleville et al., 2012; Clarner et al., 2015; Adler et al., 2011; Ramchaud et al., 2015; Zivin et al., 2011). These outcomes constrain resources and finances, threatening the livelihood of a company as well as its individual employees.

Furthermore, in 80%- 90% of cases, PTSD is accompanied by another mental disorder (Kessler et al., 1995 ), most commonly major depressive disorder, anxiety disorders, borderline personality disorder, and alcohol use disorder. PTSD is also associated with an increased risk of suicide attempt, even after controlling for sociodemographic factors like education level and household income (Nepon et al., 2010; Wilcox et al., 2009). Among one study of workers injured on the job, 44% developed PTSD, and 58% had a second psychiatric diagnosis (most frequently depression) (Hansel et al., 2010). These additional mental illnesses significantly contribute to increased rates of disability, healthcare utilization and spending, and days of work loss (Wise & Beck, 2015; Greenberg et al., 2015; Revicki et al., 2012; el-Guebaly et al., 2007), thus compounding PTSD’s negative effect on workers and their companies.

Several medications and therapies have been shown to be effective in reducing symptoms of PTSD, thereby helping people function more independently and live more fulfilling lives (Friedman et al., 2014). This includes helping patients improve their work life and job satisfaction. For instance, veterans with PTSD who receive mental health treatment are more likely to gain competitive employment, and more quickly, than veterans with PTSD who receive only vocational rehabilitation (Davis et al., 2012). Workers who undergo treatment for PTSD and experience a complete remittance of symptoms tend to have less impairment and greater job-related satisfaction than working adults with PTSD who are still symptomatic (Schnurr & Lunney, 2012).

As with any other medical condition, effective treatment outcomes depend on timely referral and accurate diagnosis from a mental health professional. However, it is important to note that not all people who experience trauma will develop PTSD or need treatment. Most people recover with the support of family, friends, clergy, or other community support systems. But for workers who do struggle with the disorder, employers, human resource personnel, and other organization professionals can make a significant difference in helping them thrive both on and off the job.

What Can Employers Do?

PTSD can affect any person regardless of gender, age, or vocation. Workplace settings are not treatment settings, and organizations should not try to replicate the role of a mental health service provider. However, by creating an environment of awareness, support, and tolerance, companies can help ensure the approximately 8 million Americans living with PTSD succeed in attaining healthy, productive lives. Ways to help workers with PTSD include the following:

  • Workplace accommodations can help people with PTSD better manage any physical, cognitive, or emotional limitations they may be experiencing. Examples of low-burden, easy-to-implement accommodations include:

    • Providing instructions or job-related responsibilities in writing to aid with memory difficulties.

    • Allowing workers to maintain more flexible schedules to take time off for treatment appointments.

    • Permitting extra time to complete non-urgent tasks.

    • Letting employees wear noise-cancelling headphones to reduce distractions while working.

    • Increasing the amount of light in the working environment to help maintain alertness and improve concentration.

    • Where possible, removing environmental triggers that remind the employee of the trauma and are upsetting.

    • Making sure parking areas are well-lit or that security personnel (or another company employee) is available to accompany anyone to their car who feels unsafe walking alone after dark.

    • Allowing an employee to rearrange his or her office furniture so that the doorway, and therefore any approaching individual, is clearly visible.

Make sure that procedures for requesting these and other job accommodations are clearly articulated in writing and posted in easily accessible locations (e.g., public areas in the workplace, the company’s intranet).

  • Referral to the company’s employee assistance program (EAP) is essential in providing workers with access to a mental health professional for accurate diagnosis and timely treatment. EAPs also can aid with stress management and coping skills in general. If an EAP is not included in the company’s health care plan, make sure to have local or national resources on hand so workers can easily access mental health services in their area. For instance, the National Center for PTSD maintains a web page on how to locate a therapist who specializes in treating persons with PTSD. (See Resources, below, for more information.)

  • It is reasonable to want to provide workplace support in response to large-scale traumatic events—especially ones involving violence or mass causalities, like acts of terrorism or natural disasters. Such incidents have the potential to negatively affect a large swath of people. However, research findings on the use of debriefing—where individuals exposed to trauma share their emotional reactions and discuss the event and its impact—are mixed. Although it is still often used, scientific evidence indicates that debriefing does not prevent or reduce the severity of PTSD, and in fact in several studies, debriefing has been shown to be harmful by increasing PTSD symptoms (Gartlehner et al., 2013). Because of this, debriefing should not be routinely used as a workplace intervention in response to trauma or critical incidents (Joyce et al., 2016). The National Center for PTSD notes that if debriefing is used, it should only be conducted under the guidance of an experienced and appropriately trained mental health professional, and that attendance to debriefing sessions should be optional (National Center for PTSD, 2016). In general, organizations should resist the urge to strongly encourage or require employees to formally discuss recent traumas by participating in workplace support groups. Instead, company-wide dissemination of EAP referral information and community mental health resources is preferable and gives workers the necessary information for accessing help without making them feel obligated to participate in an activity that could be potentially detrimental to their well-being.

  • Understand that many people with PTSD may not ask for help, but there is much a company can do to set the tone that asking for assistance is okay. Sensitivity training for coworkers and managers creates a culture of understanding and awareness. Providing break rooms or group relaxation activities (e.g., meditation, gentle yoga, stretching) conveys the message that an organization values the emotional as well as physical health of its employees.

  • For privacy reasons, do not ask employees if they have PTSD; and legally, you cannot ask applicants whether they have PTSD or any other medical condition. But if a worker has volunteered this information and you are unsure how to help, ask them. Specifically, talking with them about their individual triggers can help ensure effective accommodations are in place. Nobody likes to be patronized, but asking someone in a respectful and direct manner what can be done to make their work life more productive and comfortable is likely be met with appreciation. Demonstrating compassion can go a long way in helping employees feel safe to pursue treatment, if needed.

Resources

Americas Heroes at Work
This program provides information about PTSD and accommodations in the workplace, including employer toolkits.

Equal Employment Opportunity Commission (EEOC)
The EEOC provides information about the employment provisions of the Americans with Disabilities Act.

How to Find Treatment for PTSD
The National Center for PTSD provides guidance for individuals with PTSD on types of treatments and how to locate a therapist.

United States Department of Labor’s Job Accommodations Network (JAN)
The JAN provides employers with guidance on employing people with disabilities, including PTSD.

United States Department of Veteran Affairs’ National Center for PTSD
The National Center for PTSD provides information about the disorder for veterans, the general public, providers, and researchers.

References

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