This month, we interviewed Dr. Chris Feehan, a PGY-4 resident in Neurology. Dr. Feehan caught our attention with an article he co-authored last year on the topic of pre-traumatic stress in healthcare workers in relation to COVID-19. We chatted with him about the topic of pre-traumatic stress, his work with Neuroethics Canada, and the different landscape surrounding pre-traumatic stress and COVID-19 now, versus May 2020.
In May of 2020, you co-authored an article titled “The Hidden Risks of Pre-Traumatic Stress” in relation to COVID-19 and healthcare staff. Can you tell us more about what pre-traumatic stress is? Was this a field of interest for you prior to COVID-19?
Through my experiences in medical school and residency, I developed an interest in supporting the mental health of healthcare workers. Myself, and many of my friends and colleagues, have struggled with issues related to anxiety, depression, burnout, substance abuse and PTSD. In my experience, healthcare workers are proud and incredibly dedicated and often suffer in silence, with their mental health unexamined and unsupported.
When the COVID-19 pandemic hit, I became worried about healthcare workers and how we would weather the coming storm, given our already precarious position. I saw that many people were focused, quite reasonably, on the trauma which would be experienced by those healthcare workers on the front-lines — making triage decisions, risking their lives and dealing with the death and suffering of their patients with limited tools and support. I wanted to bring some attention to the stressors experienced by healthcare workers who may not be on the frontlines, but nevertheless are left waiting for the other shoe to drop, with their families and lives on hold, the future uncertain and inundated with a constant stream of disturbing news. I felt that there needed to be attention drawn to this phenomenon, so it could better be appreciated and studied. For this reason, pre-traumatic stress is a term developed to refer to the significant, and perhaps underappreciated, psychological effects of anticipating a severe stressor which may or may not ever arrive. For example, the expectation of, and preparation for, surges of patients of unknown size and location. This is in contrast to PTSD, which is defined as occurring after a severe stressor.
You have been working with Neuroethics Canada regarding pre-traumatic stress disorder in healthcare workers during the pandemic. What has the experience been like?
Prior to this project, I have been lucky to have Dr. Judy Illes, the director of Neuroethics Canada, as a mentor and teacher. However, my time working officially with Neuroethics Canada has so far been entirely during the COVID-19 pandemic. This has been a very positive and productive experience overall. One thing I particularly enjoy is the diversity of academic backgrounds among my peers in the lab. There are many projects spanning the social sciences, medicine and even law. I missed out on some of the informal, in-person interactions with my peers in the lab that COVID has removed from all of our lives, but I am looking forward to that ending eventually.
Lastly, it is almost a year to the date of your article’s publication. How have views on the topic evolved as the pandemic has progressed?
Fortunately, the COVID-19 pandemic has not been as deadly, or our health system as overwhelmed, as it seemed like it would be one year ago. Many of the anticipated stressors that were contributing to the pre-traumatic stress I was seeing did not come in the way they were anticipated to. As a result, mental health outcomes in healthcare workers are not likely to be as bad as they might have been if the pandemic had been worse. This presents an opportunity to identify and support those who have suffered the effects of pre-traumatic stress, since presumably many of Canada’s healthcare workers were not on the frontlines but still nonetheless suffered psychologically.
During this pandemic there has been an explosion of research and it will be many years before the ideas are fully digested and refined by the academic community. I believe the concept of pre-traumatic stress will inform our thinking about supporting the mental health of healthcare workers in the future.