Psychiatric stress on caregivers is an area of mental health care that is often overlooked. In particular, caregivers in high-pressure medical settings, such as ICUs, can suffer from high levels of stress. As part of a larger review of psychiatric problems in critically ill medical patients published in the January issue of The American Journal of Medicine, Stuart J. Eisendrath, MD, and J. Jewel Schim, MD, of the University of California at San Francisco, examined the effect of psychological stress on ICU staff.

The unique character of the ICU can magnify anxiety, depression, and substance abuse, all of which are well documented among ICU staff. In addition, many suffer from burnout, resulting in emotional exhaustion, diminished empathy for patients, and decreased productivity. ICUs tend to be chaotic and noisy and to have a continual stream of medical personnel at all hours, all of which can contribute to stress levels.

Those who seek ICU jobs are often perfectionists who set very high expectations for themselves. As a result of such expectations (eg, saving every patient), even realistic achievements may be perceived as failures. Sleep deprivation, long work hours, and changing schedules, particularly for residents, may add to the stress levels of ICU personnel. This stress may manifest in a number of ways, such as avoiding patients or their families, conflicts with other caregivers over treatment plans, anger, or pursuing life-saving treatments that are ultimately futile.

Despite these difficulties, researchers have made progress in identifying ways to reduce ICU staff stress. Support groups, consultation with trusted colleagues, and identification of staff emotions can all help in normalizing reactions and improving patient-caregiver relations. Adjustments to the physical ICU environment, such as noise reduction, better scheduling, and consistent leadership can also help improve ICU staff morale.

The researchers concluded, “Having a forum to express difficulties, stress management programs, and ongoing review of policies and procedures can also be implemented as key features enhancing prevention and early identification of burnout.”