Associations between trauma and substance use among healthcare workers and public safety personnel during the SARS-CoV-2 (COVID-19) pandemic: the mediating roles of dissociation and emotion dysregulation

ABSTRACT Background: Given the highly stressful environment surrounding the SARS-CoV-2 pandemic, healthcare workers (HCW) and public safety personnel (PSP) are at an elevated risk for adverse psychological outcomes, including posttraumatic stress disorder (PTSD) and alcohol/substance use problems. As such, the study aimed to identify associations between PTSD severity, related dissociation and emotion dysregulation symptoms, and alcohol/substance use problems among HCWs and PSP. Methods: A subset of data (N = 498; HCWs = 299; PSP = 199) was extracted from a larger study examining psychological variables among Canadian HCWs and PSP during the pandemic. Structural equation modelling assessed associations between PTSD symptoms and alcohol/substance use-related problems with dissociation and emotion dysregulation as mediators. Results: Among HCWs, dissociation fully mediated the relation between PTSD and alcohol-related problems (indirect effect β = .133, p = .03) and emotion dysregulation partially mediated the relation between PTSD and substance-related problems (indirect effect β = .151, p = .046). In PSP, emotion dysregulation fully mediated the relation between PTSD and alcohol-related problems (indirect effects β = .184, p = .005). For substance-related problems among PSP, neither emotion dysregulation nor dissociation (ps >.05) had any effects. Conclusion: To our knowledge, this is the first study examining associations between PTSD severity and alcohol/substance use-related problems via mediating impacts of emotion dysregulation and dissociation among HCWs and PSP during the SARS-CoV-2 pandemic. These findings highlight dissociation and emotion dysregulation as important therapeutic targets for structured interventions aimed at reducing the burden of PTSD and/or SUD among Canadian HCWs or PSP suffering from the adverse mental health impacts of the SARS-CoV-2 pandemic. HIGHLIGHTS Among healthcare workers, dissociation mediated relation between posttraumatic stress disorder (PTSD) severity and alcohol-related problems and emotion dysregulation mediated relation between PTSD severity and substance-related problems. Among public safety personnel, emotion dysregulation mediated relation between PTSD severity and alcohol-related problems. Neither dissociation nor emotion dysregulation mediated relation between PTSD severity and substance-related problems. Results underscore dissociation and emotion dysregulation as potential key therapeutic targets for intervention for healthcare workers and public safety personnel struggling with PTSD and comorbid alcohol/substance use-related problems.

• Publication year

  2023

• Venue

  European Journal of Psychotraumatology

• Publication date

  2023-03-17

• Fields of study

  Medicine, Psychology

• Identifiers
  DOI 10.1080/20008066.2023.2180706PMID 36930578PMCID 10026820
• External record

  Open on Semantic Scholar

• Source metadata

  Semantic Scholar, PubMed

• No claims are published for this paper.

• No concepts are published for this paper.

• Physician Health Care Visits for Mental Health and Substance Use During the COVID-19 Pandemic in Ontario, Canada

  2022cited by this paper
• Latent Typologies of Psychiatric Symptom Comorbidity With Substance Use: Associations With Adverse Childhood Experiences.

  2022cited by this paper
• Posttraumatic stress disorder symptoms, work-related trauma exposure, and substance use in first responders.

  2022influential reference
• Dissociative symptomatology mediates the relation between posttraumatic stress disorder severity and alcohol‐related problems

  2022cited by this paper
• Stress and substance abuse among workers during the COVID-19 pandemic in an intensive care unit: A cross-sectional study

  2022cited by this paper
• Student Burnout and PTSD Symptoms: The Role of Existential Anxiety and Academic Fears on Students during the COVID 19 Pandemic

  2022cited by this paper
• Posttraumatic Stress Disorder Symptomatology and Substance Use in an Outpatient Concurrent Disorders Sample

  2021cited by this paper
• Global prevalence of mental health problems among healthcare workers during the Covid-19 pandemic: A systematic review and meta-analysis

  2021influential reference
• The impact of the COVID-19 pandemic on intensive care unit workers: a nationwide survey

  2021cited by this paper
• The occurrence of post-traumatic stress disorder (PTSD), job burnout and its influencing factors among ICU nurses.

  2021cited by this paper
• Changes in Alcohol Habits Among Workers During the Confinement of COVID-19: Results of a Canadian Cross-Sectional Survey

  2021influential reference
• Mental health during the first wave of COVID-19 in Canada, the USA, Brazil and Italy

  2021cited by this paper
• Post-traumatic stress disorder, burnout and their impact on global functioning in Italian emergency healthcare workers.

  2021cited by this paper
• The effect of the COVID-19 pandemic on healthcare workers' mental health.

  2020cited by this paper
• Burnout and Posttraumatic Stress Disorder in the Coronavirus Disease 2019 (COVID-19) Pandemic: Intersection, Impact, and Interventions

  2020cited by this paper
• Mental health status of medical staff in emergency departments during the Coronavirus disease 2019 epidemic in China

  2020cited by this paper
• Emotion dysregulation across levels of substance use.

  2020cited by this paper
• Mental health problems among healthcare workers involved with the COVID-19 outbreak

  2020cited by this paper
• Health Care Workers' Mental Health and Quality of Life During COVID-19: Results From a Mid-Pandemic, National Survey.

  2020influential reference
• Post-traumatic stress disorder symptoms in healthcare workers: a ten-year systematic review

  2020cited by this paper
• Psychometric properties of the PCL-5 in a sample of first responders.

  2020cited by this paper
• Psychometric property study of the posttraumatic stress disorder checklist for DSM-5 (PCL-5) in Chinese healthcare workers during the outbreak of corona virus disease 2019

  2020cited by this paper
• PTSD symptoms in healthcare workers facing the three coronavirus outbreaks: What can we expect after the COVID-19 pandemic

  2020influential reference
• Mental health of healthcare workers during the COVID-19 pandemic in Italy.

  2020cited by this paper
• Exposures to Potentially Traumatic Events Among Public Safety Personnel in Canada

  2019cited by this paper
• Suicidal Ideation, Plans, and Attempts Among Public Safety Personnel in Canada

  2018influential reference
• Unpacking the impact of adverse childhood experiences on adult mental health.

  2017cited by this paper
• Multiple imputation as a flexible tool for missing data handling in clinical research.

  2017cited by this paper
• Emotion Dysregulation in Comorbid Posttraumatic Stress Disorder and Substance Use Disorders: A Narrative Review

  2017influential reference
• PTSD, burnout and well-being among rescue workers: Seeking to understand the impact of the European refugee crisis on rescuers.

  2017cited by this paper
• Mental Disorder Symptoms among Public Safety Personnel in Canada

  2017cited by this paper
• Relationship between burnout and PTSD symptoms in firefighters: the moderating effects of a sense of calling to firefighting

  2017cited by this paper
• The relationship between burnout, PTSD symptoms and injuries in firefighters.

  2016cited by this paper
• Posttraumatic Stress Disorder

  2015cited by this paper
• The Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5): Development and Initial Psychometric Evaluation.

  2015cited by this paper
• Associations Between Police Stress and Alcohol Use: Implications for Practice

  2013cited by this paper
• Role of emotion dysregulation in the relationship between childhood abuse and probable PTSD in a sample of substance abusers.

  2013cited by this paper
• Diagnostic and Statistical Manual of Mental Disorders

  2013cited by this paper
• Symptom overlap in posttraumatic stress disorder and major depression.

  2012cited by this paper
• A latent class analysis of dissociation and posttraumatic stress disorder: evidence for a dissociative subtype.

  2012cited by this paper
• Impulsive behaviors as an emotion regulation strategy: examining associations between PTSD, emotion dysregulation, and impulsive behaviors among substance dependent inpatients.

  2012cited by this paper
• DIVIDED CONSCIOUSNESS: DISSOCIATION IN DSM‐5

  2012cited by this paper
• Prevalence and Axis I comorbidity of full and partial posttraumatic stress disorder in the United States: results from Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions.

  2011cited by this paper
• Functional impairment in adults with past posttraumatic stress disorder: findings from primary care

  2011influential reference
• Emotion Generation and Emotion Regulation: One or Two Depends on Your Point of View

  2011cited by this paper
• The prevalence and impact of post traumatic stress disorder and burnout syndrome in nurses

  2009cited by this paper
• Research electronic data capture (REDCap) - A metadata-driven methodology and workflow process for providing translational research informatics support

  2009cited by this paper
• Hospital social workers and indirect trauma exposure: an exploratory study of contributing factors.

  2008cited by this paper
• Multidimensional Assessment of Emotion Regulation and Dysregulation: Development, Factor Structure, and Initial Validation of the Difficulties in Emotion Regulation Scale

  2008cited by this paper
• Profiling Posttraumatic Functional Impairment

  2007influential reference
• Reporting Structural Equation Modeling and Confirmatory Factor Analysis Results: A Review

  2006influential reference
• Is dissociation a multidimensional construct? Data from the Multiscale Dissociation Inventory.

  2005cited by this paper
• Associations Between Alcohol Use and PTSD Symptoms among American Red Cross Disaster Relief Workers Responding to the 9/11/2001 Attacks

  2005cited by this paper
• Evaluation of the Drug Use Disorders Identification Test (DUDIT) in Criminal Justice and Detoxification Settings and in a Swedish Population Sample

  2004cited by this paper
• Working with the psychological effects of trauma: consequences for mental health-care workers--a literature review.

  2003cited by this paper
• Trauma and substance abuse: Causes, consequences, and treatment of comorbid disorders.

  2003cited by this paper
• The Self‐Medication Hypothesis of Substance Use Disorders: A Reconsideration and Recent Applications

  1997cited by this paper
• The robustness of test statistics to nonnormality and specification error in confirmatory factor analysis.

  1996cited by this paper
• The structure of negative emotional states: comparison of the Depression Anxiety Stress Scales (DASS) with the Beck Depression and Anxiety Inventories.

  1995cited by this paper
• Development of the Alcohol Use Disorders Identification Test (AUDIT): WHO Collaborative Project on Early Detection of Persons with Harmful Alcohol Consumption--II.

  1993cited by this paper

• A Qualitative Evaluation of the Before Operational Stress Program: A Pan‐Canadian Study of Mental Health Training for Frontline Public Safety Personnel and Healthcare Providers

  2025cites this paper
• Moral injury, coping strategies, and supports among Canadian public safety personnel

  2025cites this paper
• Pilot outcomes and exploration of treatment mechanisms using a culturally adapted version of the unified protocol for transdiagnostic treatment of emotional disorders to improve mental health symptoms, alcohol misuse, functional outcomes, and sleep quality in emergency responders

  2025cites this paper
• Evaluating the Before Operational Stress On-Demand asynchronous online training for public safety and healthcare personnel

  2025cites this paper
• Dissociation and Emotion Dysregulation: New Findings and Nuances

  2025cites this paper
• Trauma exposure, post-traumatic stress disorder and alcohol and other drug use among Australian public safety personnel

  2025cites this paper
• Exploring the association between moral injury and posttraumatic stress symptoms among Canadian public safety personnel

  2024cites this paper
• Emotion Regulation in the Association Between Posttraumatic Stress Disorder and Substance Use: A Systematic Review With Narrative Synthesis

  2024cites this paper
• Dissociation in Long-Term Care Home Staff During COVID-19: Challenges and Promising Practices.

  2024cites this paper
• Effect of Anti-Interleukin-6 Agents on Psychopathology in a Sample of Patients with Post-COVID-19 Syndrome: An Observational Study

  2024cites this paper
• The independent and combined impact of moral injury and moral distress on post-traumatic stress disorder symptoms among healthcare workers during the COVID-19 pandemic

  2024cites this paper
• Evaluating the before operational stress program: comparing in-person and virtual delivery

  2024cites this paper
• Why Are Healthcare Providers Leaving Their Jobs? A Convergent Mixed-Methods Investigation of Turnover Intention among Canadian Healthcare Providers during the COVID-19 Pandemic

  2024cites this paper
• Putative risk and resiliency factors after an augmented training program for preventing posttraumatic stress injuries among public safety personnel from diverse sectors

  2024cites this paper
• A Qualitative Approach to Understanding Canadian Healthcare Workers’ Use of Coping Strategies during the COVID-19 Pandemic

  2023cites this paper
• On the path to recovery: traumatic stress research during the COVID-19 pandemic 2021–2023

  2023influential citation
• Coping, Supports and Moral Injury: Spiritual Well-Being and Organizational Support Are Associated with Reduced Moral Injury in Canadian Healthcare Providers during the COVID-19 Pandemic

  2023cites this paper
• Factors associated with suicide in physicians: a silent stigma and public health problem that has not been studied in depth

  2023cites this paper