{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T16:45:55Z","timestamp":1790354755710,"version":"4.1.0"},"reference-count":20,"publisher":"BMJ","issue":"10","license":[{"start":{"date-parts":[[2025,10,23]],"date-time":"2025-10-23T00:00:00Z","timestamp":1761177600000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["J NeuroIntervent Surg"],"accepted":{"date-parts":[[2025,9,25]]},"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Complications not only affect patients but also impose a significant psychological burden on physicians. Quantitative data in neurointerventional surgery regarding the \u2018second victim\u2019 phenomenon are lacking. This study aimed to assess the prevalence and severity of post-traumatic stress symptoms among neurointerventionalists after major complications.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A survey was developed by a committee of experienced neurointerventionalists and distributed internationally via multiple platforms. Respondents were anonymous. Demographic information, complication type, and institutional support availability were queried. Psychological distress was measured using the validated Impact of Event Scale-Revised (IES-R), which assesses intrusion, avoidance, and hyperarousal domains. Descriptive statistics and regression analyses were performed to identify factors associated with post-traumatic stress symptoms.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of 1042 invited physicians, 503 responded (48%), with 413 completing the full survey (40%). The most common pathology was cerebral aneurysm, and the most frequent complication was hemorrhage. Overall, 64% scored above the IES-R threshold for possible post-traumatic stress disorder (PTSD) (\u226524), with many reaching levels (\u226537) associated with long-term stress and physiological sequelae. Intrusion was the dominant symptom domain, particularly distressing reminders about the complication. Lack of institutional support was significantly associated with possible PTSD (OR 1.63, 95%\u2009CI 1.1 to 2.5, P=0.02). No differences were observed by specialty, but geographic variations were present. High stress scores persisted long after the index event.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Complications exert a profound emotional and physiological toll on neurointerventionalists, with high rates of possible PTSD and a strong association with inadequate institutional support. Systematic support programs are urgently needed to safeguard physician well-being and patient safety.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/jnis-2025-024288","type":"journal-article","created":{"date-parts":[[2025,10,23]],"date-time":"2025-10-23T17:20:11Z","timestamp":1761240011000},"page":"1990-1996","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Unseen wounds: a multinational investigation of neurointerventionalists on the psychological toll of complications"],"prefix":"10.1136","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9864-4805","authenticated-orcid":false,"given":"Ansaar T","family":"Rai","sequence":"first","affiliation":[{"name":"Interventional Neuroradiology, West Virginia University Rockefeller Neuroscience Institute, Morgantown, West Virginia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6129-8061","authenticated-orcid":false,"given":"Emanuele","family":"Orru","sequence":"additional","affiliation":[{"name":"Neurointerventional Radiology, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8979-1993","authenticated-orcid":false,"given":"Kyle M","family":"Fargen","sequence":"additional","affiliation":[{"name":"Neurological Surgery and Radiology, Wake Forest University, Winston-Salem, North Carolina, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabian Arnberg","family":"Sandor","sequence":"additional","affiliation":[{"name":"Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7195-5806","authenticated-orcid":false,"given":"Ricardo A","family":"Hanel","sequence":"additional","affiliation":[{"name":"Neurosurgery, Baptist Medical Center Jacksonville, Jacksonville, Florida, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3403-2628","authenticated-orcid":false,"given":"James M","family":"Milburn","sequence":"additional","affiliation":[{"name":"Radiology, Ochsner Medical System, New Orleans, Louisiana, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2810-1685","authenticated-orcid":false,"given":"Thanh N","family":"Nguyen","sequence":"additional","affiliation":[{"name":"Neurology, Boston University School of Medicine, Boston, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0982-8341","authenticated-orcid":false,"given":"Nathan","family":"Farkas","sequence":"additional","affiliation":[{"name":"Neurointerventional Surgery, Interventional Neuro Associates, University City, Missouri, USA"},{"name":"Neurology, Washington University in Saint Louis School of Medicine, Saint Louis, Missouri, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0131-5699","authenticated-orcid":false,"given":"Adam A","family":"Dmytriw","sequence":"additional","affiliation":[{"name":"Neuroendovascular Program, Massachusetts General Hospital, Boston, Massachusetts, USA"},{"name":"Neurointerventional & Neuroanalytics Collaboration, Toronto Metropolitan University, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9519-0059","authenticated-orcid":false,"given":"Adnan H","family":"Siddiqui","sequence":"additional","affiliation":[{"name":"Neurosurgery and Radiology and Canon Stroke and Vascular Research Center, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA"},{"name":"Neurosurgery, Gates Vascular Institute, Buffalo, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2025,10,23]]},"reference":[{"key":"2026091402151529000_18.10.1990.1","doi-asserted-by":"crossref","first-page":"1169","DOI":"10.1111\/codi.15021","article-title":"Impact of surgical complications on the operating surgeon","volume":"22","author":"Biggs","year":"2020","journal-title":"Colorectal Dis"},{"key":"2026091402151529000_18.10.1990.2","doi-asserted-by":"crossref","DOI":"10.1186\/s40001-024-02084-z","article-title":"Beyond the operating room: addressing the \u201csecond-victim\u201d phenomenon in surgical practice","volume":"29","author":"Awuah","year":"2024","journal-title":"Eur J Med Res"},{"key":"2026091402151529000_18.10.1990.3","doi-asserted-by":"crossref","first-page":"471","DOI":"10.1111\/inr.12694","article-title":"Coping strategies in health care providers as second victims: a systematic review","volume":"68","author":"Kappes","year":"2021","journal-title":"Int Nurs Rev"},{"key":"2026091402151529000_18.10.1990.4","doi-asserted-by":"crossref","first-page":"1048","DOI":"10.1016\/j.jamcollsurg.2016.12.039","article-title":"The Surgeon as the Second Victim? Results of the Boston Intraoperative Adverse Events Surgeons\u2019 Attitude (BISA) Study","volume":"224","author":"Han","year":"2017","journal-title":"J Am Coll Surg"},{"key":"2026091402151529000_18.10.1990.5","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.320.7237.726"},{"key":"2026091402151529000_18.10.1990.6","doi-asserted-by":"crossref","first-page":"181","DOI":"10.1055\/s-0043-1767830","article-title":"Complication Is Inevitable, but Suffering is Optional-Psychological Aspects of Dealing with Complications in Surgery","volume":"33","author":"Le","year":"2023","journal-title":"Eur J Pediatr Surg"},{"key":"2026091402151529000_18.10.1990.7","article-title":"The psychosocial impact of surgical complications on the operating surgeon: a scoping review","volume":"67","author":"Siddaiah-Subramanya","year":"2021","journal-title":"Ann Med Surg (Lond)"},{"key":"2026091402151529000_18.10.1990.8","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjsurg.2014.06.018"},{"key":"2026091402151529000_18.10.1990.9","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0143763","article-title":"Surgeons\u2019 Emotional Experience of Their Everyday Practice - A Qualitative Study","volume":"10","author":"Orri","year":"2015","journal-title":"PLoS One"},{"key":"2026091402151529000_18.10.1990.10","doi-asserted-by":"publisher","DOI":"10.1016\/j.janxdis.2007.02.007"},{"key":"2026091402151529000_18.10.1990.11","doi-asserted-by":"publisher","DOI":"10.1007\/s11606-021-06737-1"},{"key":"2026091402151529000_18.10.1990.12","doi-asserted-by":"publisher","DOI":"10.1097\/00006842-197905000-00004"},{"key":"2026091402151529000_18.10.1990.13","doi-asserted-by":"crossref","unstructured":"Weiss DS . The impact of event scale: revised. In: Wilson JP , Tang C , eds. Cross-cultural assessment of psychological trauma and PTSD. Boston, MA: Springer US, 2007: 219\u201338.","DOI":"10.1007\/978-0-387-70990-1_10"},{"key":"2026091402151529000_18.10.1990.14","doi-asserted-by":"publisher","DOI":"10.1016\/j.brat.2003.07.010"},{"key":"2026091402151529000_18.10.1990.15","doi-asserted-by":"publisher","DOI":"10.1037\/0033-2909.130.4.601"},{"key":"2026091402151529000_18.10.1990.16","doi-asserted-by":"crossref","first-page":"127","DOI":"10.1177\/000313481908500217","article-title":"The Crossroads of Posttraumatic Stress Disorder and Physician Burnout: A National Review of United States Trauma and Nontrauma Surgeons","volume":"85","author":"Jackson","year":"2019","journal-title":"Am Surg"},{"key":"2026091402151529000_18.10.1990.17","doi-asserted-by":"crossref","first-page":"207","DOI":"10.1016\/j.thorsurg.2024.04.009","article-title":"Wellness Strategies Among Bad Outcomes and Complications","volume":"34","author":"Bostock","year":"2024","journal-title":"Thorac Surg Clin"},{"key":"2026091402151529000_18.10.1990.18","doi-asserted-by":"crossref","first-page":"555","DOI":"10.1016\/j.wneu.2019.07.154","article-title":"Burnout: Separating Fact from Fiction","volume":"130","author":"Wolfe","year":"2019","journal-title":"World Neurosurg"},{"key":"2026091402151529000_18.10.1990.19","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0b013e3181bfdab3"},{"key":"2026091402151529000_18.10.1990.20","doi-asserted-by":"publisher","DOI":"10.1016\/j.jamcollsurg.2011.08.005"}],"container-title":["Journal of NeuroInterventional Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/jnis-2025-024288","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T09:15:52Z","timestamp":1789377352000},"score":1,"resource":{"primary":{"URL":"https:\/\/jnis.bmj.com\/lookup\/doi\/10.1136\/jnis-2025-024288"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,23]]},"references-count":20,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2026,9,14]]},"published-print":{"date-parts":[[2026,10]]}},"alternative-id":["10.1136\/jnis-2025-024288"],"URL":"https:\/\/doi.org\/10.1136\/jnis-2025-024288","relation":{},"ISSN":["1759-8478","1759-8486"],"issn-type":[{"value":"1759-8478","type":"print"},{"value":"1759-8486","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,23]]}}}