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
Open accessAbstract
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.
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Emergency responders were disproportionately impacted by the COVID-19 pandemic and experienced an increase in mental health challenges during the pandemic.
“emergency responders were disproportionately impacted by the COVID-19 pandemic and, in turn, experienced an increase in mental health challenges during the pandemic (8–10).”
From 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 (2025) · cites this paper as [9]
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Research works printed but not linked: 2
- Carleton, N. R., Afifi, T. O., Turner, S., Taillieu, T., Duranceau, S., LeBouthillier, D. M., Sareen, J., Ricciardelli, R., MacPhee, R. S., Groll, D., Hozempa, K., Brunet, A., Weekes, J. R., Griffiths, C. T., Abrams, K. J., Jones, N. A., Beshai, S., Cramm, H. A., Dobson, K. S., … Asmundson, G. J. G. (2018b). Mental disorder symptoms among public safety personnel in Canada. The Canadian Journal of Psychiatry, 63(1), 54– 64. 10.1177/0706743717723825 28845686 PMC5788123 · DOI · Paper page
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Meyer, E. C., Roth, S. G., Coe, E., Taylor, D. J., & Gulliver, S. B. (2025) · Frontiers in Health Services · doi:10.3389/frhs.2025.1452976 · Cited by 2 · see citing works
- Authors
- Patel, H., Easterbrook, B., D'Alessandro-Lowe, A. M., Andrews, K., Ritchie, K., Hosseiny, F., Rodrigues, S., Malain, A., O’Connor, C., Schielke, H., McCabe, R. E., Nicholson, A. A., Lanius, R., & McKinnon, M. C.
- Affiliations
- McMaster University (CA)
- Department of Psychology, Neuroscience, and Behaviour, McMaster University, Hamilton, Canada
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Canada
- The Atlas Institute for Veterans and Families, Ottawa, Canada
- Homewood Health Centre (CA)
- St. Joseph’s Healthcare Hamilton (CA)
- Homewood Research Institute (CA)
- Western University (CA)
- Corresponding author
- McKinnon, Margaret C.
- ORCID
- Venue
- European Journal of Psychotraumatology
- Publisher
- Informa UK Limited
- Published
- 2023-03-17
- Volume
- 14
- Issue
- 1
- Pages
- 2180706-2180706
- ISSN
- 2000-8066 (ISSN-L)
- PMC
- PMC10026820
- OpenAlex
- W4327682203
- Cited by
- 27
- References
- 60
- Citations by year
- 2026: 7 · 2025: 7 · 2024: 8 · 2023: 5
- FWCI
- 7.87
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- European Journal of Psychotraumatology (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- eScholarship (California Digital Library) (submittedVersion, cc-by-nc)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- Canadian Institutes of Health Research
- McMaster University Atlas Institute for Veterans and Families
- Homewood Research Institute
- Western University
- Topics
- Social Sciences › Psychology › Clinical Psychology › COVID-19 and Mental Health
- Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
- Social Sciences › Psychology › Clinical Psychology › Migration, Health and Trauma
- Keywords
- post-traumatic stress disorder, dissociation, emotional dysregulation, alcohol use problems, substance use disorders, healthcare workers, public safety personnel, COVID-19 pandemic, occupational stress, mediation, mental health
- MeSH terms
- COVID-19, SARS-CoV-2, Canada, Emotions, Health Personnel, Humans, Substance-Related Disorders, Pandemics
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