Cumulative trauma, neural circuits, and burnout: an integrative model of healthcare worker post-traumatic stress syndromes

Abstract

Background: Frontline healthcare workers (HCWs) experience unique patterns of repeated, chronic, and unpredictable traumatic event exposure, coupled with physiologic stress in the setting of shift-work circadian rhythm disruption, contributing to high rates of post-traumatic stress syndromes (PTSS) and substantial workforce and economic burden. The neurobiology underlying HCW-specific risk remains incompletely understood. Objective: To synthesise epidemiological, neuroimaging, physiological, and interventional evidence into a mechanistic model of HCW PTSS and to identify priorities for biomarker-guided prevention and care. Method: Literature for this narrative review was identified through a comprehensive search of peer-reviewed articles in PubMed, PsycINFO, and Google Scholar up to May 2025. Studies were included if they addressed (1) the epidemiology of PTSD in healthcare settings, (2) risk and protective factors specific to occupational trauma exposure, (3) neural, physiological, or molecular mechanisms associated with stress-related disorders in trauma-exposed personnel, or (4) interventions targeting PTSD/PTSS in HCWs and first responder populations. Results: Across studies, PTSS prevalence among HCWs is variable (≈15–74%). Repeated, chronic, and unpredictable occupational trauma, exacerbated by circadian disruption, appears to destabilise frontal-limbic circuits and systemic stress pathways, culminating in allostatic overload. Converging data suggest that multimodal biomarkers, including resting-state and task-evoked fMRI metrics, MR spectroscopy, heart rate variability, sleep architecture, cortisol and inflammatory indices can identify prodromal dysregulation and define risk stratification. Conclusions: Longitudinal, multimodal cohort designs are critically needed to track trajectories and evaluate neuroscientifically-informed treatment modalities for PTSS in this population. Framing HCW PTSS as an occupational neurobiological injury highlights the need to identify and prevent functional decline. A biomarker-guided strategy that links brain-circuit measures with autonomic, sleep, and molecular indices may offer a path to earlier identification, precision interventions, and improved outcomes for a critically at-need population that is essential to our workforce.