This is Part One of a two part thread about the psychological effects COVID-19 will have on some health service staff. Part-one is about trauma, what it is and what it isn’t, and how we react to it. I drafted this thread last week and then it disappeared from my twitter drafts!

I know a little bit about the mental health of health service staff. During the CervicalCheck crisis I had the privilege of looking after the well-being of the staff involved.

I also teach this stuff, most of this content comes from my teaching slides. No, you can’t have them.

First let’s differentiate between between stress and trauma. It’s important health service staff know the difference so that they can accurately describe their experiences. This is also important for thread two, which will follow tomorrow or Tuesday.

My favourite definition of stress is “a particular relationship between the person and the environment that is appraised by the person as taxing or exceeding his or her resources and endangering his or her well-being” (Lazarus and Folkman, 1984).

Stress builds over time. It’s like holding a bottle of water up in the air. At first it’s easy, but over time your arm gets tired. Bear in mind that the COVID pandemic hit a health service whose staff were already struggling.

A traumatic event is one which effects our previously held beliefs about the self, the future and the world. Trauma is the distress caused when a persons appraised meaning of situations is discrepant with their global beliefs and goals.

So, trauma occurs when an event or situation challenges a person’s representation or schema of the world based on previous experiences, and their learned knowledge of how things “should” be.

Experiencing a trauma isn’t normal, but it does happen to most people at least once. Estimates suggest that between 75%-89% of adults will be exposed at some point in their lives to a traumatic event. The experience of trauma is as old as the human race, it’s a part of life.

Although lots of people have traumatic experiences, only about 8% of people will develop PTSD. Most people who are exposed to a traumatic event do not develop any type of long term consequences. This makes sense, our brains are evolved to process traumatic experiences.

In the aftermath of a traumatic event, a person exposed directly or vicariously to the event all likely develop some constellation of psychological and behavioural symptoms, referred to as a post-traumatic stress reaction.

Post traumatic stress symptoms are present in almost all people in the days and weeks following trauma exposure, this is normal and reflects a universal response. Even amongst individuals who develop PTSD the most common trajectory is spontaneous remission.

Another important psychological reaction that’s likely to become more common in health service staff as a result of the COVID pandemic is Moral Injury, this occurs when a person commits, fails to prevent, or witnesses an act that is against their moral beliefs.

Moral injury is commonly mistaken for burnout in health service professionals. It’s something that we’re going to see more of in the coming weeks.

I’ll try get part 2 finished tomorrow night. As I’ve said, the purpose of this thread is to differentiate the different ways that experiences can impact on health service professionals, and put language on them.