Center for Disease Control and Prevention. WISQARS data visualization. In: WISQARS database. 2022. https://wisqars.cdc.gov/data/lcd/home. Accessed 19 Oct 2022.

National Center for Health Statistics. National Hospital Ambulatory Medical Care Survey: 2018 Emergency Department Summary Tables. 2018. https://ftp.cdc.gov/pub/Health_. Accessed 10 Oct 2022.

Velopulos CG, Enwerem NY, Obirieze A, Hui X, Hashmi ZG, Scott VK, et al. National cost of trauma care by payer status. J Surg Res NIH Public Access. 2013;184:444.

Google Scholar 

Peterson C, Miller GF, Barnett SBL, Florence C. Economic cost of injury — United States, 2019. MMWR Morb Mortal Wkly Rep. Centers Disease Control MMWR Office. 2021;70:1655–9.

Google Scholar 

Wilson LC. A systematic review of probable posttraumatic stress disorder in first responders following man-made mass violence. Psychiatry Res Elsevier Ireland Ltd. 2015;229:21–6.

Google Scholar 

•• Joseph B, Pandit V, Hadeed G, Kulvatunyou N, Zangbar B, Tang A, et al. Unveiling posttraumatic stress disorder in trauma surgeons: a national survey. Journal of Trauma and Acute Care Surgery. Lippincott Williams and Wilkins. 2014;77:148–54. (PTSD symptoms and diagnostic criteria were assessed among AAST and EAST members. Forty percent of patients had PTSD symptoms, and 15% met diagnostic criteria for PTSD. On multivariable regression, male sex, working at a center with 24h resident coverage, operating 15 or more times a month, taking seven or more calls, having 4 or fewer hours of relaxation per day, and having 2 weeks or less vacation were likely to be associated with symptoms of PSTD.)

Google Scholar 

Scott WJ. PTSD in DSM-III: A case in the politics of diagnosis and disease. Soc Probl Oxford University Press (OUP). 1990;37:294–310.

Google Scholar 

Crocq M-A, Crocq L. From shell shock and war neurosis to posttraumatic stress disorder: a history of psychotraumatology. Dialogues Clin Neurosci. 2000;2:47–55.

Article  CAS  PubMed  PubMed Central  Google Scholar 

Center for Substance Abuse Treatment. TIP 57 trauma-informed care in behavioral health services. Rockville, MD: Substance Abuse and Mental Health Services Administration; 2014.

Zoellner LA, Bedard-Gilligan MA, Jun JJ, Marks LH, Garcia NM. The evolving construct of posttraumatic stress disorder (PTSD): DSM-5 criteria changes and legal implications. Psychol Inj Law. 2013;6:277–89.

Substance Abuse and Mental Health Services Administration. Impact of the DSM-IV to DSM-5 changes on the national survey on drug use and health. Rockville, MD: Substance Abuse and Mental Health Services Administration; 2016.

Bryant RA, Friedman MJ, Spiegel D, Ursano R, Strain J. A review of acute stress disorder in DSM-5 focus Madison. American Psychiatric Publishing Inc. 2011;9:335–50.

Google Scholar 

Figley CR. Compassion fatigue: toward a new understanding of the costs of caring. In: Stamm BH, editor. Secondary traumatic stress: self-care issues for clinicians, researchers, and educators. Derwood, MD: Sidran Press; 1995. pp. 3–28.

Rauvola RS, Vega DM, Lavigne KN. Compassion fatigue, secondary traumatic stress, and vicarious traumatization: a qualitative review and research agenda Occupational Health Science 2019 3:3. Springer. 2019;3:297–336.

Google Scholar 

Held P, Klassen BJ, Brennan MB, Zalta AK. Using prolonged exposure and cognitive processing therapy to treat veterans with moral injury-based PTSD: two case examples. Cogn Behav Pract Elsevier Inc. 2018;25:377–90.

Article  Google Scholar 

Schorr Y, Stein NR, Maguen S, Ben Barnes J, Bosch J, Litz BT. Sources of moral injury among war veterans: a qualitative evaluation. J Clin Psychol. 2018. https://doi.org/10.1002/jclp.22660.

Barnes HA, Hurley RA, Taber KH. Moral injury and PTSD: often co-occurring yet mechanistically different. J Neuropsychiatry Clin Neurosci. 2019;31:98–103.

Article  Google Scholar 

Koenig HG, Youssef NA, Pearce M. Assessment of moral injury in veterans and active duty military personnel with PTSD: a review. Front Psychiatry. 2019;10:1–15.

Google Scholar 

Kruger LE. Is there more to the experience of war trauma than PTSD? The development of moral injury and its impact on soldiers. Journal of Military and Government Counseling. 2014;2:136–45.

Currier JM, Holland JM, Drescher K, Foy D. Initial psychometric evaluation of the moral injury questionnaire-military version. Clin Psychol Psychother. 2013;22:54–63.

Article  PubMed  Google Scholar 

Schorr Y, Stein NR, Maguen S, Ben Barnes J, Bosch J, Litz BT. Sources of moral injury among war veterans: a qualitative evaluation. J Clin Psychol. 2018;74:2203–18.

Article  PubMed  Google Scholar 

Currier JM, Farnsworth JK, Drescher KD, McDermott RC, Sims BM, Albright DL. Development and evaluation of the Expressions of Moral Injury Scale-Military Version. Clin Psychol Psychother Clin Psychol Psychother. 2018;25:474–88.

Article  PubMed  Google Scholar 

Currier JM, Mcdermott RC, Farnsworth JK, Borges LM. Temporal associations between moral injury and posttraumatic stress disorder symptom clusters in military veterans. J Trauma Stress. 2019;32:382–92.

Article  PubMed  Google Scholar 

Papazoglou K, Blumberg DM, Chiongbian VB, Tuttle BMQ, Kamkar K, Chopko B, et al. The role of moral injury in PTSD among law enforcement officers: a brief report. Front Psychol Frontiers Media SA. 2020;11:310.

Article  Google Scholar 

Stein NR, Mills MA, Arditte K, Mendoza C, Borah AM, Resick PA, et al. A scheme for categorizing traumatic military events. Behav Modif. 2012;36:787–807.

Article  PubMed  Google Scholar 

Maslach C. A multidimensional theory of burnout. In: Cooper C, editor. Theories of organizational stress. Oxford, NY: Oxford University Press; 1998. pp. 68–85.

• Joseph B, Parvaneh S, Swartz T, Haider AA, Hassan A, Kulvatunyou N, et al. Stress among surgical attending physicians and trainees: a quantitative assessment during trauma activation and emergency surgeries Journal of Trauma and Acute Care Surgery. Lippincott Williams and Wilkins. 2016;81:723–8. (Examines mental strain in attending, senior residents, and junior residents on trauma call using heart rate variability. In general, residents feel stress about 70% of their shift, while attendings feel it ~15%. In general, the level of stress/mental strain is highest during emergency general surgery over trauma activations.)

Google Scholar 

Jackson T, Provencio A, Bentley-Kumar K, Pearcy C, Cook T, McLean K, et al. PTSD and surgical residents: everybody hurts… sometimes. Am J Surg Am J Surg. 2017;214:1118–24.

Article  PubMed  Google Scholar 

• Smith JM, Boe EA, Will R. Physician wellness in orthopedic surgery: challenges and solutions. Orthop Clin North Am Orthop Clin North Am. 2021;52:41–52. (Review the four main components of wellness—physical, mental, emotional, and spiritual—through individual techniques, as well as developing community/peer support and the use of professional coaching. In addition, this article highlights the need for organizational and cultural change at the institutional level, as 80–90% of what drives burnout, low satisfaction, and physician unwellness is the result of institutional policies or procedures that do no promote wellness. •)

Article  PubMed  Google Scholar 

Flannery RB. Psychological trauma and the trauma surgeon. Psychiatric Quarterly Springer. 2020;93:27–33.

Article  Google Scholar 

Kent J, Thornton M, Fong A, Hall E, Fitzgibbons S, Sava J. Acute provider stress in high stakes medical care: implications for trauma surgeons. J Trauma Acute Care Surg. Lippincott Williams and Wilkins. 2020;88:440–5.

Google Scholar 

• O’Neill KM, Shultz BN, Lye CT, Ranney ML, D’Onofrio G, Coupet E. Physicians on the frontlines: understanding the lived experience of physicians working in communities that experienced a mass casualty shooting. J Law Med Ethics J Law Med Ethics. 2020;48:55. (66Qualitative assessments of physicians who worked at a hospital in a community that experienced a mass casualty shooting and significant media attention from 2012 to 2018. Recurrent themes included the emotional and psychological impact on physicians, increased desire for preparedness, the effect of massive media attention, and increased commitment to advocacy for a public health approach to firearm injury.)

Article  PubMed  Google Scholar 

• James MK, Robitsek RJ, McKenzie K, Valenzuela JY, Esposito TJ. COVID-19 induced PTSD: stressors for trauma and acute care surgeons. Am J Surg. 2022. https://doi.org/10.1016/j.amjsurg.2022.02.060. PTSD screening tool was distributed to EAST to assess for PTSD. Overall, 16% of providers screened positive for PTSD with regars to recent COVID pandemic. Risk factors for more severe PTSD including those that were unmarried had experienced COVID through someone close to them personally, experienced family issues due to COVID, worked in a rural or suburban practices, and had no access to mental health resources at work.

Ashby JS, Rice KG, Kira IA, Davari J. The relationship of COVID-19 traumatic stress, cumulative trauma, and race to posttraumatic stress disorder symptoms. J Community Psychol John Wiley and Sons Inc. 2022;50:2597–610.

Article  Google Scholar 

Maddaus M. The resilience bank account: skills for optimal performance. Annals Thoracic Surg Elsevier USA. 2020;109:18–25.

Article  Google Scholar 

Boscarino JA. Posttraumatic stress disorder and mortality among U.S. Army veterans 30 years after military service. Ann Epidemiol Ann Epidemiol. 2006;16:248–56.

Article  PubMed  Google Scholar 

Davidson JRT. Trauma: the impact of post-traumatic stress disorder. J Psychopharmacol. 2000;14:269–8811.

Article  Google Scholar 

Konjevod M, Tudor L, SvobStrac D, NedicErjavec G, Barbas C, Zarkovic N, et al. Metabolomic and glycomic findings in posttraumatic stress disorder. Prog Neuropsychopharmacol Biol Psychiatry Elsevier. 2019;88:181–93.

Article  CAS  Google Scholar 

Wang Z, Young MRI. PTSD, a disorder with an immunological component. Front Immunol Frontiers Media SA. 2016;7:219.

Google Scholar 

Boscarino JA. Diseases among men 20 years after exposure to severe stress: implications for clinical research and medical care. Psychosom Med Psychosom Med. 1997;59:605–14.

Article  CAS  PubMed  Google Scholar 

Rodney T, Heidari O, Miller HN, Thornton CP, Jenkin E, Kang HK. Posttraumatic stress disorder in nurses in the United States: prevalence and effect on role. J Nurs Manag. 2022. https://doi.org/10.1111/jonm.13478.

Frost ND, Laska KM, Wampold BE. The evidence for present-centered therapy as a treatment for posttraumatic stress disorder. J Trauma Stress J Trauma Stress. 2014;27:1–8.

Article  PubMed  Google Scholar 

Kearney DJ, McDermott K, Malte C, Martinez M, Simpson TL. Association of participation in a mindfulness program with measures of PTSD, depression and quality of life in a veteran sample. J Clin Psychol J Clin Psychol. 2012;68:101–16.

PubMed  Google Scholar 

Polusny MA, Erbes CR, Thuras P, Moran A, Lamberty GJ, Collins RC, et al. Mindfulness-based stress reduction for posttraumatic stress disorder among veterans: a randomized clinical trial. JAMA American Medical Association. 2015;314:456–65.

Article  CAS  Google Scholar 

Surís A, Link-Malcolm J, Chard K, Ahn C, North C. A randomized clinical trial of cognitive processing therapy for veterans with PTSD related to military sexual trauma. J Trauma Stress J Trauma Stress. 2013;26:28–37.

Article  PubMed  Google Scholar 

Watkins LE, Sprang KR, Rothbaum BO, Javanbakht A, Duval ER, Steenkamp M. Treating PTSD: a review of evidence-based psychotherapy interventions. Front Behav Neurosci. 2018;12:1–9.

Article  Google Scholar 

Ehret M. Treatment of posttraumatic stress disorder: focus on pharmacotherapy. Mental Health Clinician. 2013;96:373–82.

Google Scholar 

Feder A, Rutter SB, Schiller D, Charney DS. The emergence of ketamine as a novel treatment for posttraumatic stress disorder. Adv Pharmacol Academic Press. 2020;89:261–86.

Article  CAS  Google Scholar 

Williams T, Phillips NJ, Stein DJ, Ipser JC. Pharmacotherapy for post traumatic stress disorder (PTSD). In: Cochrane Database of Systematic Reviews. 2022. http://doi.wiley.com/10.1002/14651858.CD002795.pub3. Accessed 30 Mar 2023.

Dyrbye LN, West CP, Sinsky CA, Goeders LE, Satele DV, Shanafelt TD. Medical licensure questions and physician reluctance to seek care for mental health conditions. Mayo Clin Proc Elsevier. 2017;92:1486–93.

Article  Google Scholar 

Haugen PT, McCrillis AM, Smid GE, Nijdam MJ. Mental health stigma and barriers to healthcare for first responders: a systematic review and meta-analysis. J Psychiatr Res Elsevier Ltd. 2017;94:218–29.

Article  Google Scholar 

Smith JR, Workneh A, Yaya S. Barriers and facilitators to help-seeking for individuals with posttraumatic stress disorder: a systematic review. J Trauma Stress. 2020;33:137–50.

Article  PubMed  Google Scholar 

Wallace JE. Mental health and stigma in the medical profession. Health N Hav. 2010;16:3–18.

Google Scholar 

AMA advocates for support of physician mental health needs. In: American Medical Association. 2023. https://www.ama-assn.org/practicemanagement/physician-health/ama-advocates-support-physician-mental-health-needs. Accessed 30 Mar 2023.

Gerber MR, Elisseou S, Sager ZS, Keith JA, Gerber M. Trauma-informed telehealth in the COVID-19 era and beyond. Federal Practitioner. Front Med Commun. 2020;37:302.

Google Scholar 

Stewart RW, Orengo-Aguayo RE, Cohen JA, Mannarino AP, De Arellano MA. A pilot study of trauma-focused cognitive-behavioral therapy delivered via telehealth technology. Child Maltreat. 2017;22:324–33.

Article  PubMed  Google Scholar 

Biggs S, Waggett HB, Shabbir J. Impact of surgical complications on the operating surgeon. Colorectal Disease Blackwell Publishing Ltd. 2020;22:1169–74.