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

Individuals 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. Behaviours 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.

Among individuals 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. 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. PTSD has been estimated to occur in 32% of first responders, including 19% of police officers. The risk of a woman having PTSD at any point in life is more than double that of a man’s. 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.

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. 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, 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. Among one study of workers injured on the job, 44% developed PTSD, and 58% had a second psychiatric diagnosis (most frequently depression). These additional mental illnesses significantly contribute to increased rates of disability, healthcare utilization and spending, and days of work loss, thus compounding PTSD’s negative effect on workers and their companies.

Not all people who experience trauma will develop PTSD or need treatment. Most people recover with the support of family, friends 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 individuals 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.
  • 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. Because of this, debriefing should not be routinely used as a workplace intervention in response to trauma or critical incidents. 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. 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 co-workers 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.
  • Talking with employees suffering from PTSD 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.

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