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The forgotten victims—and their invisible injuries

Wahlberg et al. found that 7% of obstetricians and 5% of midwives surveyed, reported symptoms that fulfilled PTSD criteria, and 15% of both of these groups showed partial PTSD symptoms. Considering that the Swedish governmental spending on healthcare (as a share of GDP) is the third highest in the world (OECD Health Statistics 2015) and ranks very highly in neonatal mortality and maternal mortality (eighth and second internationally, respectively, when ranked densely; World Bank 2015), it is perhaps surprising that Sweden has a relatively high incidence of PTSD amongst obstetricians and midwives. Although the survey had a response rate of 47% among obstetricians and 40% amongst midwives, and may be regarded as selfselective and thus over-representative, this does not negate from the significance of the issue. This survey comes at a time when the UK workforce faces many challenges, especially in light of the result of the EU referendum, the looming imposition of the new junior doctor contract, and a recently published RCOG survey which suggested that 44% of respondents were the victims of persistent bullying or harassment, which represents 14% of the Obstetrics and Gynaecology consultant workforce (Shabazz et al. BMJ Open 2016; 6:e011462). In a survey of 421 UK midwives, 33% had experienced symptoms consistent with PTSD (Sheen et al. Int J Nurs Stud 2015; 52:578–87). Although the study only had a response rate of 15% and may be self-selective, it is useful to observe the impact of traumatic events on the workforce. Occupational psychological challenges are not just a European problem or just an obstetric problem, but an international one that affects a range of specialities. A 2014 study with a sample of 6880 American physicians from all specialities found that 54.4% of physicians reported at least one symptom of burnout in 2014, 8.9% more than in 2011. The study also found that 39.8% of physicians reported symptoms of depression and, of even greater concerning, 6.4% had experienced suicidal ideation in the last 12 months. Physicians aged 29–65 experienced higher rates of burnout than a sample of the US population of the same age (48.4 versus 28.4%; Shanafelt et al. Mayo Clin Proc 2015; 90:1600–13). The first step is to accept that doctors and midwives face a variety of different psychological challenges and that to let them suffer these ‘invisible injuries’ in silence and without enough support is dangerous. There is evidence to suggest that mental health issues could affect quality of care, patient safety and patient satisfaction (Shanafelt et al. Mayo Clin Proc 2015;90:1600– 613). Emotional resilience training is a step in the right direction but is not the only solution. The NHS should start to take care of the physical and mental wellbeing of its staff in the same way it takes care of its patients. The BMA, RCOG, RCM and GMC should act in the interests of its members and tackle hostile working environments that often compound existing mental health pressures and may have a negative impact on patient safety, which is of course, our first concern as a profession.