Volume 12 - Issue 63
/ March 2023
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DOI: https://doi.org/10.34069/AI/2023.63.03.28
How to Cite:
Mukhina, H., Yakymchuk, I., Oliinyk, Y., Elvizou, M., & Shvalb, A. (2023). The relationship between coping strategies of extreme
job holders and post-traumatic stress disorders. Amazonia Investiga, 12(63), 299-309. https://doi.org/10.34069/AI/2023.63.03.28
The relationship between coping strategies of extreme job holders and
post-traumatic stress disorders
Зв’язок копінг стратегій фахівців екстремальних професій та посттравматичних
стресових розладів
Received: March 15, 2023 Accepted: April 18, 2023
Written by:
Halyna Mukhina1
https://orcid.org/0000-0001-8866-794X
Iryna Yakymchuk2
Web of Science ResearcherID: EHI-3481-2022
https://orcid.org/0000-0002-4627-2066
Yuliia Oliinyk3
Web of Science ResearcherID: HTL-6718-2023
https://orcid.org/0000-0003-3214-0422
Mariia Elvizou4
Web of Science ResearcherID: IAP-5943-2023
https://orcid.org/0000-0002-6092-8164
Anton Shvalb5
https://orcid.org/0000-0002-9729-1099
Abstract
Extreme workers are constantly exposed to
negative impact in the course of their work. Over
time, excessive stress and traumatic events can
cause symptoms of post-traumatic stress disorder
(PTSD). As a result, employees are unable to
fully function as specialists, which manifests in
the destructive coping strategies. The aim of the
study involves determining the symptoms of
PTSD and related coping strategies of extreme
workers. Methods. The study is based on the use
of standardized PTSD diagnostic tests (Screen
PC-PTSD, IES-R, SDS) and coping strategies of
employees (CSI). Data processing was carried
out using quantitative analysis and statistical
methods: descriptive statistics, multiple
regression analysis. Results. The study showed
that the symptoms of intrusion, avoidance,
excitability, high depression, and destructive
coping strategies is observed in emergency
specialists with PTSD symptoms. It was
1
PhD of Pedagogical Sciences, Associate Professor, Department of Social and Humanitarian Disciplines, Donetsk State University
of Internal Affairs, Kropyvnytskyi, Ukraine.
2
PhD of Psychological Sciences, Associate Professor, Department of Psychology, Faculty of Social and Psychological Education,
Pavlo Tychyna Uman State Pedagogical University, Uman, Ukraine.
3
PhD of Medical Sciences, Associate Professor, Department of Hygiene and Ecology No. 1, Kharkiv National Medical University,
Kharkiv, Ukraine.
4
Master’s Degree, Lecturer, Faculty of Linguistics, International School, Vietnam National University, Hanoi, Vietnam.
5
PhD of Psychological Sciences, Lecturer, Department of General Psychology, Social and Psychological Faculty, National University
of Civil Defence of Ukraine, Kharkiv, Ukraine.
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established that specialists with PTSD symptoms
have pronounced “avoidance” coping (p=0.000,
β=0.082), while “problem solving” was
dominant coping of specialists with no PTSD
(p=0.000, β=-0.045). They have pronounced
depression (p=0.000, β=0.25), as well as such
symptoms as avoidance (p=0.000, β=0.27),
excitability (p=0.000, β=0.33) and intrusion (p
=0.000, β=0.31). Conclusions. The relationship
between the PTSD symptoms of emergency
workers and their coping strategies was
empirically found. The avoidance strategy is the
most typical for specialists with PTSD
symptoms. Prospects. The obtained results can
be used in the prevention of PTSD in emergency
workers. They can also be used for building a
model of comprehensive overcoming of the
consequences of PTSD by these specialists.
Keywords: Behavioural strategies, adaptive
behaviour, stress reactions, depression, post-
traumatic symptoms.
Introduction
The professional activity of certain categories of
specialists has considerably been affected by
significant climatic, political, scientific and
technical changes in society. This impact
determines the effectiveness and prospects of
their activities. The extreme working
environment involves not only physical
overloads, but also in most cases has a psycho-
emotional and psycho-physiological nature
(Campillo-Cruz et al., 2021; Warren-James et al.,
2022). Deviations from normal working
conditions require the specialist to make
voluntary efforts that go beyond the
physiological norm (Thielmann et al., 2022).
Because of extreme conditions, professions of
this type involve difficult working conditions
and, in many cases, a physical threat to life. The
constant stress that such specialists experience is
inevitably reflected in their personality
(Machado et al., 2020) and the quality of their
professional duties (McKeon et al., 2022). At the
same time, each such specialist can experience
strong stressful events in doing the job, which
can cause negative psycho-emotional states and
personality disorders. This results in the
development of post-traumatic stress disorders
(PTSD) in those specialists. Such disorders are
characterized by the experience of anxiety (Loef
et al., 2021), stress (McKeon et al., 2022),
depression (Stevelink et al., 2020),
psychophysiological changes (Lee et al., 2022).
The researchers studied PTSD most often in the
work of servicemen, police officers, rescuers,
and ambulance workers. These professions
involve working in extreme conditions, that is,
those that go beyond normal functioning.
Numerous studies prove the wide-spread PTSD
among ambulance workers. According to
Ntatamala and Adams (2022), the share of
individuals with PTSD symptoms in the studied
population was 30%. At the same time, Petrie et
al., (2018) indicate that this share is 11%, while
it is 10% in the study of Bartzak (2016).
PTSD can develop over many years, and its
symptoms greatly affect the specialist’ well-
being. In such a situation, the specialist begins to
use an avoidance coping strategy trying to
mitigate the negative effect of stress (Hruska &
Barduhn, 2021). This strategy involves
eliminating any contact that can increase anxiety
or stress. Such specialists avoid solving the
problem, grounding it by various factors. The
accumulation of unresolved problems and
unreacted emotions leads to the complication of
PTSD symptoms, personal deformations (Chen
et al., 2021; Vagni et al., 2022), asocial behaviour
(Ciułkowicz et al., 2021). Workers with
Mukhina, H., Yakymchuk, I., Oliinyk, Y., Elvizou, M., Shvalb, A. / Volume 12 - Issue 63: 299-309 / March, 2023
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pronounced symptoms of PTSD are unstable in
their professional activity, often given to
drinking alcohol and smoking (Jovanovic et al.,
2017). This is a maladaptive behaviour, which
reduces their functional capacity to work
effectively (Stevelink et al., 2020).
In view of the foregoing, it should be noted that
the study of the relationship between coping
strategies and PTSD symptoms provides grounds
for more profound research into the issue of
PTSD in extreme workers, in particular,
emergency workers. The aim of the study is to
establish a causal relationship between basic
coping strategies and PTSD symptoms. The aim
involved the following research objectives:
− carry out a comprehensive analysis of
diagnostic tools to ensure the validity and
reliability of diagnostics;
− conduct primary screening to identify PTSD
symptoms in the subjects;
− identify differences in PTSD symptoms and
coping strategies of specialists with PTSD
symptoms and those without PTSD;
− study the relationship between coping
strategies and PTSD symptoms of the
subjects.
The research hypothesis was determined based
on the aim and research objectives: there is a
relationship between the type of coping strategies
and PTSD. Extreme workers with pronounced
PTSD symptoms have a dominant “avoidance”
coping, while “problem solving” coping is
characteristic of specialists with no PTSD.
Literature review
In 2013, the American Psychiatric Association
(APA) revised the diagnostic criteria for PTSD in
the fifth edition of The Diagnostic and Statistical
Manual of Mental Disorders, Fifth Edition, Text
Revision (DSM-5-TR). In the new version of
DSM-5-TR, PTSD is included into the new
category “Trauma- and Stressor-Related
Disorders”. This category involves the impact of
a traumatic or stressful event as a diagnostic
criterion. The following main criteria are
distinguished: intrusion, avoidance of thoughts
and unwanted behaviour, negative changes in
thoughts and moods, changes in excitement and
reactivity. In addition, each criterion has its own
symptoms that characterize the state of PTSD.
The main criterion in diagnosing PTSD among
those listed in DSM-5 is the impact of one or
more traumatic events characterized by a real
threat to the life and health of specialists. Such an
event can be experienced both directly and
indirectly (in the case of emergency workers),
while the PTSD symptoms will be the same for
them.
When determining the psychological essence of
PTSD, attention should be paid to the main
condition of this disorder: post-development. It is
implied that this disorder is the result of a certain
traumatic event that had a significant psycho-
emotional impact on the individual (Horowitz et
al., 1979). This results in the gradual disturbance
of the cognitive, emotional and mental spheres of
a person. In some cases, this leads to psychiatric
disorders (Chatzea et al., 2017).
Arebo et al., (2022) note that PTSD is a disorder
arising as a result of a traumatic event and
characterized by re-experiencing, avoidance,
negative cognitive state, psychophysiological
arousal for at least one month. Berger et al.,
(2011) determined that PTSD syndrome is most
characteristic of rescuers and emergency
workers. The authors note that rescuers are at
high risk for PTSD because the risk of
developing PTSD increases with the number of
experienced traumatic events. Bartzak (2016)
believes that PTSD is an anxiety disorder caused
by experiencing a traumatic event. The latter
refers to the threat of death or physical injury that
causes feelings of fear, helplessness, or terror.
Chen et al. (2021) state that PTSD can occur not
only in direct participants of traumatic events,
but also in witnesses and indirect participants.
However, traumatic events have a significant
impact on mental health, in particular, their
experience is manifested in arousal and
emotional changes.
PTSD can manifest itself with many psychiatric
symptoms. The main ones are intrusion,
avoidance, and hyperarousal, which occur after
experiencing a traumatic event. Psychiatric
symptoms of PTSD negatively affect the
cognitive sphere of specialists, in particular, a
negative impact on attention and executive
function is noted (Lee et al., 2022).
It is noted that the ability to respond in a certain
way to stressful and traumatic events is
associated with behavioural coping strategies
(Oliveira et al., 2019). In particular, positive
coping strategies help prevent the development
of PTSD symptoms in some cases (Ciułkowicz et
al., 2021).
Coping strategies are defined as an individual’s
ability to overcome certain stressful situations
and stabilize the psycho-emotional state (Freire
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et al., 2020). Coping is considered as a
behavioural, cognitive, and emotional response
to situations that require adaptation (Loef et al.,
2021). Coping strategies reduce psychological
stress and anxiety (Freire et al., 2020). Coping
strategies consist of coping acts, while strategies
determine coping styles of behaviour. They can
be functional and dysfunctional, that is adaptive
or maladaptive (Rojas et al., 2022).
Coping strategies provide psycho-emotional
stability and resistance to traumatic events in
ambulance workers Loef et al., (2021). It was
proved that the development of psychological
resilience and adaptive coping skills contribute to
effective coping with stress, thereby reducing its
psychological impact. This provides primary
PTSD prevention (Bilsker et al., 2019).
According to Shepherd and Wild (2014)
emergency medicine workers who frequently use
problem-solving strategies usually have low
PTSD rates. This may indicate the importance of
developing adaptive coping strategies in
mitigating PTSD and its symptoms.
Research analysis shows that PTSD is a
consequence of a traumatic event in the work of
emergency medical workers. At the same time,
PTSD contributes to the development of many
negative changes in the employee’s personality
and health. The use of maladaptive coping
worsens the workers’ condition and leads to its
exacerbation. Therefore, it is advisable to
conduct an empirical study to identify the
relationship between the coping strategies of
ambulance workers and the PTSD.
Methods
Research Procedure
The study was conducted from May 2022 to July
2022 in several stages. The first stage involved
the study of the academic background and
methodological framework of diagnostics and
sampling. The diagnostic criteria and methods
were selected, and the research programme was
determined. The sample size, which ensures
representativeness, was justified. The second
stage provided for an empirical diagnostics of the
selected respondents according to the aim and
objectives of the research. The time distribution
of the selected methods was carried out in
accordance with the possibilities of surveying the
respondents. The third stage involved processing
of diagnostic data and interpreting the results.
Quantitative, qualitative and statistical analyses
were used. The fourth stage consisted in the
analysis of the obtained data, identification of
shortcomings and research prospects. A
comparative analysis of the obtained data with
existing studies was carried out, the differences
were determined, and unestablished facts were
substantiated.
The research was conducted on different days
and hours in order to cover as many specialists as
possible, as they work in shifts.
Sampling
Ambulance workers were chosen for the study
among the extreme workers. This job is quite
stressful and traumatic, and poorly studied at the
same time. Most research examines PTSD in
rescuers, servicemen, and police officers, but
little attention has been paid to the study of PTSD
symptoms in emergency medicine workers. In
order to ensure representativeness, the study
provided for a randomized sample of 230
respondents who reflect the characteristics of the
general population. All subjects worked in the
Emergency Department of Kyiv. They included
103 male and 127 female. The selected sample
was uniform. The inclusion criterion was the age,
as it was necessary to select respondents with 5
or more years of work experience to identify
PTSD symptoms. Therefore, the sample included
employees from 30 to 50 years old.
Methods
The methods of surveying, testing, and statistical
analysis were used in order to achieve the aim of
the research. Standardized methods of
psychological diagnostics were used as
diagnostic tools. The PTSD in the subjects was
determined using the Primary Care PTSD Screen
for DSM-5 (PC-PTSD-5). The PC-PTSD-5 is a
5-item screener designed to identify individuals
with probable PTSD in primary care facilities.
The diagnostic process involved answers to 5
questions. In particular, the first question was to
identify a traumatic event in the respondent’s
life. If this answer is negative, the test ends
automatically with a score of 0 and this indicates
the complete absence of PTSD in the subject. If
the answer is positive, the subject is asked to
answer additional questions that describe
concomitant symptoms of PTSD during the last
month. The result is positive if the subject
answered ‘yes’ to any three or more proposed
options. However, we considered positive
answers to one or two questions as partial PTSD
symptoms, which could have arisen under the
influence of personal problems or nervous
overstrain and are not trauma-related. That is
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why an additional diagnostics of PTSD
symptoms and depression as the main symptom
of this disorder was carried out.
The Impact of Event Scale (IES-R) was used to
diagnose PTSD symptoms and their severity.
This technique was published by Horowitz in
1979 (Horowitz et al., 1979). Horowitz
distinguished two specific reactions of the
individual to stressors in the structure of the
method: “intrusion” and “avoidance”. The author
attributed nightmares, obsessive thoughts and
emotions to the symptoms of intrusion.
Symptoms of intrusion included decreased
activity and retreat from problem solving. The
method was adapted in 2001 by Tarabrina in the
study of PTSD in people who have experienced
traumatic events. The method consists of 22
items, the answers to which enable determining
the level of PTSD on three scales: “intrusion”,
“avoidance” and “excitability". The calculation
of points on the scales is based on the method
key. The total score for trauma was determined
by summing the scores of the three scales. The
results were processed separately by scales,
followed by the calculation of the total indicator.
Zung Self-Rating Depression (SDS). This scale
was developed by Zung for diagnosing
depressive states. The method was adapted in the
Department of Narcology of Bekhterev
Psychoneurological Institute. The scale includes
20 items that determine the respondent’s well-
being and are aimed at identifying depression
symptoms. The level of depression is determined
based on the calculation. The absence of
depression is diagnosed if the subject who scored
no more than 50 points. A score of 50 to 59
indicates mild depression. A total of 60 to 69
points indicate hidden depression. A depressive
state is determined when 70 or more points are
scored.
The Coping Strategy Indicator (CSI) by
Amirkhan. The technique involves the diagnosis
of basic coping strategies that are used to
overcome stressful situations. The author singles
out the following among the basic coping
strategies: problem solving, seeking social
support, and avoidance. According to the author
of the technique, the avoidance strategy describes
a destructive-type maladaptive behaviour. The
technique was adapted at t Bekhterev
Psychoneurological Institute by Sirota and
Yaltonsky in 1994-1995. The structure of the
technique includes 33 statements with which the
subject can agree or disagree. The results are
evaluated according to the test key.
Data processing was carried out using
qualitative, quantitative and statistical analyses.
Calculations were performed in Microsoft Excel
and SPSS 22.0. Descriptive statistics was used to
analyse the mean values of the surveyed for the
techniques. Multiple regression analysis was
used to identify the relationship between coping
strategies and PTSD in emergency medicine
workers.
Ethical Criteria of the Research
The survey participants gave their informed
consent for the diagnosis before the start of the
study. The aim and objectives of the study were
indicated. The respondents were informed that
the study is completely anonymous, voluntary
and will not affect them in any way. It was also
stated that all data are confidential and will not
be disclosed in relation to an individual subject.
The research was conducted with due regard to
the principles of the Declaration of Helsinki,
which ensured its propriety.
Results
The obtained results showed there are persons
with existing PTSD symptoms among the
subjects (Figure 1).
Figure 1. PTSD indicators in ambulance workers
52%
39%
9%
no symptoms some PTSD symptoms PTSD
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The first screening showed that there were
specialists with PTSD symptoms among the
studied ambulance workers. This indicates that
this category of workers has experienced a
stressful traumatic event. Such experience
caused obvious or hidden negative emotional
states that have a destructive effect on the
worker’s personality. At the same time, they
continue to work without focusing on their
condition, which worsens their psycho-
emotional state. Such workers need urgent help
from specialists to improve their functional
condition.
The scale for assessing the impact of a traumatic
event revealed the average indicators of PTSD
symptoms in emergency medicine workers
(Table 1).
Table 1.
Average indicators of PTSD symptoms among emergency medicine workers (р≤0.001)
PTSD level
PTSD symptoms
IES-R
intrusion
avoidance
excitability
M
SD
M
SD
M
SD
M
SD
No PTSD symptoms (n=120)
7.83
0.27
7.08
0.23
6.51
0.19
21.41
0.39
Some PTSD symptoms (n=89)
8.48
0.22
9.54
0.25
8.52
0.21
24.54
0.55
PTSD (n=21)
20.14
1.83
18.14
1.90
19.15
1.73
57.42
5.14
The data provided in Table 1 reflect varying
degrees of severity of PTSD symptoms in the
studied emergency medicine workers. It was
found in the first screening that workers with no
PTSD symptoms have almost the same average
indicators of PTSD symptoms as workers with
mild PTSD symptoms. At the same time, workers
who have been diagnosed with PTSD have
significantly higher rates. The “intrusion”
symptom in workers with no PTSD symptoms
and workers with mild PTSD symptoms is within
the normal range, while this symptom is very
pronounced in workers with PTSD. This
indicates that workers diagnosed with PTSD
have obsessive feelings and thoughts, night
terrors, sleep disorders and normal lifestyle
disturbances. The “avoidance” symptom
corresponds to the norm in workers without
PTSD symptoms and workers with mild PTSD
symptoms. It is quite clearly pronounced in
workers diagnosed with PTSD. This symptom
demonstrates the respondents’ attempts to avoid
the repeated action of the stressor, to mitigate
traumatic events, to switch attention, and in some
cases to delve into alternative
activities (excessive enthusiasm for sports, active
recreation, etc.). The “excitability” symptom is
characteristic within the normal range for
workers with no PTSD symptoms and workers
with mild PTSD symptoms. This symptom is
clearly pronounced in specialists with PTSD
symptoms, which indicates their neuro-psychic
stress, irritability, anger, and poor concentration.
The data of the general scale of the impact of a
traumatic event are within the normal range for
workers with no PTSD symptoms and workers
with mild PTSD symptoms. This indicator is
quite pronounced in workers diagnosed with
PTSD. This demonstrates dysfunctional
emotional features, which developed as a result
of the traumatic event.
The dominance of various strategies in selected
groups of specialists was identified using the
Coping Strategy Indicator (CSI) by Amirkhan.
Table 2.
Average indicators of coping strategies among emergency medicine workers (р≤0.001)
PTSD level
PTSD symptoms
problem solving
seeking social
support
avoidance
M
SD
M
SD
M
SD
No PTSD symptoms (n=120)
25.6
0.73
22.15
0.77
21.64
0.58
Some PTSD symptoms (n=89)
27.44
0.84
23.87
0.80
22.75
0.69
PTSD (n=21)
14.38
1.57
29.14
1.9
31.14
1.56
The data in Table 2 indicate that the “problem
solving” strategy is the dominant strategy for
workers with no PTSD symptoms and workers
with mild PTSD symptoms. This strategy is aimed
at solving the problem situation that has arisen.
Therefore, the workers who use it are quite active
in dealing with stressful situations, which
improves their adaptive capabilities. The
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avoidance strategy dominates in the group of
workers with some PTSD symptoms. This
indicates a style of behaviour aimed at reducing
contact with stressful situations, conflicts or
people. Such workers try to avoid traumatic events
under any circumstances.
The strategy of “seeking social support” is
equally used by workers with some PTSD
symptoms and those without PTSD. However, in
the latter use it more often. Such data describe
low attempts to resort to external help from
relatives and specialists in resolving a problem
situation. Zung Self-Rating Depression (SDS)
technique made it possible to detect signs of
depression in the studied emergency medicine
workers with different PTSD levels (Table 3).
Table 3.
Average indicators of coping strategies among emergency medicine workers (р≤0.001)
PTSD level
Depression
M
SD
No PTSD symptoms (n=120)
39.06
1.20
Some PTSD symptoms (n=89)
40.39
1.39
PTSD (n=21)
65.23
4.11
The obtained results demonstrate a low level of
depression in subjects without PTSD and in
subjects with some PTSD symptoms. A high
level of depression was found in workers who
has pronounced PTSD symptoms. Depressive
states not only have a negative impact on the
personality, but can also provoke other more
serious emotional disorders and diseases.
Therefore, overcoming PTSD symptoms must
necessarily include working with depression.
A linear regression analysis was performed to
establish the relationship between coping
strategies and the PTSD symptoms of emergency
medicine workers, which revealed the
dependence between the variables. The
dependent variable was the indicator of the PTSD
among emergency medicine workers, the
independent variables were PTSD symptoms, the
level of depression, and coping strategies. The
relationship between the PTSD and PTSD
symptoms was studied during the analysis (Table
4).
Table 4.
Regression analysis of the relationship between the PTSD and the PTSD symptoms of emergency medicine
workers
PTSD symptoms
β
SD
r (р)
R²
F
P
intrusion
0.27
0.026
0.514 (р≤0.001)
0.353
41.17
0.000
avoidance
0.33
0.032
0.519 (р≤0.001)
excitability
0.31
0.017
0.564 (р≤0.001)
The figures in Table 4 indicate a statistically
significant effect of the PTSD on PTSD
symptoms. Subjects diagnosed with PTSD have
such symptoms as intrusion (β=0.31±0.017,
r=0.514, p≤0.001), avoidance (β=0.33±0.032,
r=0.519, p≤0.001) and excitability
(β=0.25±0.026, r=0.564, p≤0.001). Therefore,
the regression model confirms the existence of a
relationship between PTSD signs and PTSD
symptoms (R2 = 0.353, F = 41.17, p<0.001).
Regression analysis also revealed the
dependence of PTSD symptoms and the
depression level of ambulance medicine
specialists (Table 5).
Table 5.
Regression analysis of the relationship between the PTSD and depression level in emergency medicine
workers
PTSD symptoms
β
SD
r (р)
R²
F
P
depression
0.25
0.04
0.389 (р≤0.001)
0.245
38.55
0.000
According to the data in Table 5, high depression
rates were found in workers diagnosed with PTSD (β=0.25±0.04, r=0.389, p≤0.001).
Accordingly, the regression model shows that
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emergency medicine workers diagnosed with
PTSD have severe depression (R2 = 0.245, F =
38.55, p < 0.001). A relationship between the
PTSD and the coping strategies of emergency
medicine workers was established in the course
of the regression analysis (Table 6).
Table 6.
Regression analysis of the relationship between the PTSD and the coping strategies of emergency medicine
specialists
PTSD symptoms
β
SD
r (р)
R²
F
P
problem solving
-0.45
0.011
-0.174 (р≤0.01)
0.335
23.11
0.000
seeking social support
-0.021
0.011
Avoidance
0.82
0.011
0.276 (р≤0.01)
It was found that emergency medicine workers
with PTSD symptoms use an avoidance coping
strategy (β=0.82±0.011, r=0.276, p≤0.001).
Problem solving is a basic coping strategy typical
for emergency medicine workers who have not
been diagnosed with PTSD (β=-0.45±0.011, r=-
0.174, p≤0.001). The obtained regression
coefficients testify to the relationship between
coping strategies and the PTSD in emergency
medicine workers (R2 = 0.335, F = 23.11, p <
0.001). A direct relationship shows the intensity
of avoidance in workers diagnosed with PTSD,
an inverse relationship indicates the intensity of
coping with problem solving in workers without
PTSD.
The obtained results statistically proved that
emergency medicine workers diagnosed with
PTSD use avoidance as a coping strategy for
resolving stressful situations. The workers who
have not been diagnosed with PTSD use a
problem-solving coping strategy that is more
adaptive and promotes effective functioning.
Discussion
The conducted study involved the identification
of the relationship between coping strategies and
PTSD in emergency medicine workers as
extreme workers. It can be noted based on the
results that the workers diagnosed with PTSD
have pronounced symptoms of intrusion,
avoidance, and excitability. They are
characterized by obsessive feelings, emotions
about a traumatic event, nightmares (Alshahrani
et al., 2022; Bovin et al., 2021; Schäfer et al.,
2019). At the same time, such workers avoid any
contact with the stressor, avoid talking about the
traumatic event and look for ways to avoid
experiences. According to the data obtained by
Thielmann et al., (2022), the workers diagnosed
with PTSD have anxiety, anger, decreased
concentration, behavioural disorders,
hyperexcitability against the background of a
decreasing general psycho-emotional well-being.
According to the general trauma scale, the
studied emergency medicine workers have
unfavourable emotional and personal
characteristics that arose against the background
of subjective perception of a traumatic event. The
same results were obtained in the study of
Soravia et al., (2021), who diagnosed PTSD
symptoms and signs in emergency medicine
workers. Their study showed that regardless of
profession, the main prognostic factors of PTSD
are symptoms of avoidance and distraction,
alcohol consumption, self-destructive behaviour,
excessive physiological excitability, irritability
and aggressiveness.
A high level of depression was found in
specialists with PTSD signs. Depression is a
consequence of the long-term impact of a
traumatic event. Emergency medicine workers
with signs of depression are ineffective
specialists, unable to respond constructively in
difficult and stressful situations, need help. They
are characterized by low adaptive potential and
problems with behavioural regulation, a certain
inclination to neuro-psychical breakdowns, lack
of adequacy of self-esteem and real perception of
reality; possible manifestations of antisocial
behaviour, difficulties in building contacts with
others (Vagni et al., 2022; Warren-James et al.,
2022). Stevelink et al., (2020) determined that
depression is a characteristic symptom of
emergency workers and negatively affects their
professional activity. Petrie et al., (2018) reached
the same conclusion, who found a high level of
anxiety and depression in emergency medicine
workers with PTSD. Despite the findings of
Bjørn et al., (2022), who report that emergency
medicine workers have low manifestations of
PTSD, anxiety, and depression, this study
provides evidence that depression is a typical
symptom of PTSD.
In a linear regression model, avoidance coping
was a significant predictor among workers
diagnosed with PTSD. Whereas problem-solving
coping was predominant in workers with no
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PTSD. It follows that emergency medicine
workers diagnosed with PTSD use a
dysfunctional avoidance strategy in their
behaviour. As Vicente et al., (2021) noted, the
avoidance strategy involves the aggravation of
the post-traumatic stress state due to the refusal
to solve the problem, the unwillingness to think
about it and react appropriately. Chen et al.,
(2021) also determined that the avoidance
strategy is positively related to PTSD, and is
characterized by distancing from problems,
switching to another activity, avoiding direct
contact with the stressor.
The failure to identify the traumatic event and its
consequences leads to deterioration of the
condition, causes complex personal changes and
reduces work capacity. Moreover, as Jovanovic
et al., (2017), showed in their study, this strategy
leads to addictive behaviour. When PTSD is
acute, avoidance coping causes alcohol and
tobacco addiction.
Ciułkowicz et al., (2021) concluded in their study
that healthcare workers who frequently use
maladaptive avoidance strategies have more
negative psychopathological symptoms. Among
them, the authors primarily single out depression
and social dysfunction, which, according to
them, disrupt the adaptive potential of emergency
medicine workers.
As a summary, attention should be paid to the
data of Campillo-Cruz et al., (2021), who found
the impact of routine work-related stressors on
the development of PTSD among emergency
medicine workers. According to their data, the
more developed PTSD and avoidance strategies,
the more likely the worker’s condition will
deteriorate under the impact of new stressors. In
other words, the failure to treat PTSD will
negatively affect the professional duties.
At the same time, Ntatamala and Adams (2022)
identified factors that affect the occurrence of
PTSD in emergency workers. Among these
factors, they name age, gender, educational level,
marital status. The following areas of research
identified by Oliveira et al., (2019) are also
important. They included sources of stress,
coping strategies and means of prevention. On
these grounds, the inclusion of such factors in
further research can be considered appropriate
and justified.
Conclusions
This study showed that emergency medicine
workers with PTSD signs have dominant
avoidance coping, which involves conscious
resistance to traumatic events and is destructive
to the individual. Workers with such coping are
unable to cope with stressful situations in the
course of performing professional duties. The
gradual accumulation of PTSD symptoms leads
to emotional distress and negative emotional
states. Considering the peculiarities of the
extreme type of activity, emergency medicine
workers need special attention to their psycho-
emotional state. Many of them ignore the PTSD
signs and do not take any measures.
The limitations of the study include the complex
work schedule of emergency medicine workers,
which does not allow excluding all external
factors influencing the diagnostic process. In
some cases, workers may work two or three
shifts, which worsens their condition and may
give false results. At the same time, one of the
limitations is the lack of control over the
dynamics of PTSD development. The course of
this disorder is individual and many specialists
do not recognize the problem, which complicates
its treatment and control.
The research prospects involve the study of the
consequences of PTSD for workers, as
destructive coping in stressful situations
provokes the occurrence of PTSD and can cause
such negative emotional states as anxiety,
depression, and fear. It is appropriate to further
study the corrective possibilities of the
development of adaptive coping strategies of
emergency medicine workers in reducing PTSD.
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