Type D personality and post-traumatic stress disorder symptoms among intensive care unit nurses: The mediating effect of resilience
April
Type D personality and post-traumatic stress disorder symptoms among intensive care unit nurses: The mediating effect of resilience
Geum-Jin Cho 0 1
Jiyeon Kang 1
0 Neurological Intensive Care Unit, Dong-A University Medical Center , Busan , South Korea , 2 Department of Nursing, Dong-A University , Busan , South Korea
1 Editor: Soraya Seedat, Stellenbosch University , SOUTH AFRICA
The purpose of this study was to investigate the relationship between Type D personality and post-traumatic stress disorder (PTSD) symptoms of intensive care unit (ICU) nurses and to determine the mediating effect of resilience on this relationship. A cross-sectional survey was performed with 179 ICU nurses from 7 hospitals in Gyeong-Nam province, South Korea. The Type D personality, resilience, and PTSD symptoms of subjects were measured using a self-report questionnaire. The mediating effect was analyzed by a series of hierarchical multiple regressions. A total of 38.6% of the study participants turned out to have Type D personality. The Type D personality was positively correlated with PTSD symptoms, and negatively correlated with resilience. There was a negative correlation between resilience and PTSD symptoms. The indirect effect of Type D personality on PTSD symptoms via resilience (β = .51, p < .001) was smaller than the direct effect (β = .58, p < .001). Based on the above results, it can be concluded that resilience had a partial mediating effect on the relationship between Type D personality and PTSD symptoms of ICU nurses. Further studies need to be done to develop interventions for enhancing resilience in ICU nurses.
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Data Availability Statement: All relevant data are
within the paper and its Supporting Information
files.
Funding: The authors received no specific funding
for this work.
Competing interests: The authors have declared
that no competing interests exist.
Introduction
Working in a stressful setting such as intensive care unit (ICU) may have detrimental effects
on nurses' psychological health. ªPost mortem care, seeing patients die, involvement with
endof-life care, open surgical wounds, massive bleeding, trauma-related injuries, and performing
cardiopulmonary resuscitationº are a few examples of traumatic events that ICU nurses
confront at their workplace [
1
]. Some of these traumatic events such as witnessing the death or
serious injury may cause post-traumatic stress disorder (PTSD) in ICU nurses.
PTSD is a psychological problem that develops in certain people who have experienced
traumatic or life threatening events [
2
]. There has been much controversy about the definition
and diagnostic criteria of PTSD. The scope of traumatic events in the fourth edition of
Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) was broad, but the newest
edition, DSM-5 narrowed it to ªactual or threatened death, serious injury, or sexual violenceº.
This limited definition of ªtrauma exposureº led to a substantial reduction in the incidence of
PTSD [
3
]. Nevertheless, most ICU nurses are still witnessing those traumatic events of DSM-5
on a daily basis, and they may be at increased risk for developing PTSD symptoms. Indeed,
20±30% of ICU nurses had symptoms of PTSD, and 70% of those experienced PTSD
symptoms for more than 3 months [
1, 4
]. PTSD symptoms directly impact the health of ICU nurses,
and eventually influence outcomes for both the nursing workforce and patients [5].
Meanwhile, not all people who experience traumatic events will develop PTSD. The Type of
symptoms and the severity of PTSD are expressed variably according to the victim's subjective
response to the traumatic event [
6
]. Specially, in situations of chronic stress, individual factors
or vulnerability have a greater impact on the development of PTSD than the severity of the
traumatic event itself [
7
]. One of the individual factors that affect PTSD is Type D personality
[
8
]. The Type D personality consists of negative affectivity and social isolation, and is
characterized by a depressive, anxious, and inappropriately worrying personality [
9
]. The proportion
of Type D personality among clinical nurses is higher than that of general population, reaching
at 36±38%, and nurses with Type D personality experience more compassion fatigue, burnout,
and job stress than those with non-Type D personality [
10, 11
]. Previous studies have observed
that Type D personality was positively correlated with PTSD in a group of violence victims
[12] and firefighters [
13
].
Additional related factors linked to PTSD include resilience. Resilience is a psychological
factor that mitigates the negative effects of trauma and promotes post-traumatic growth
following the impacting events [
14
]. Luthar and colleagues [
15
] pointed out resilience as one of
the most important factors that affects post-traumatic adaptation. As an individual
characteristic, resilience refers to a positive ability to overcome stress or a (...truncated)