Is Higher Subjective Fear Predictive of Post-Traumatic Stress Symptoms in a Sample of the Chinese General Public?

Abstract

Background: COVID-19 has taken a huge toll on medical resources and the economy and will inevitably have an impact on public mental health. Post-traumatic stress disorder (PTSD), as the most common mental illness after an epidemic, must be seriously addressed. This study aimed to investigate the subjective fear of the Chinese general public during COVID-19 and to explore how it affected the development of PTSD.Methods: An online questionnaire survey was conducted among 1,009 people from January 30 to February 14, 2020 (about 1 month after the COVID-19 outbreak). The subjective fear was measured by a self-reported single-choice question. Four items from the Pittsburgh Sleep Quality Index (PSQI) were selected to measure the subjects' sleep quality. Their post-traumatic stress symptoms (PTSS) were measured by the PTSD Checklist for DSM-5 (PCL-5). Pearson correlation, hierarchical multivariate regression analysis, multiple mediator model, and bootstrapping were used in statistical analyses.Results: Different people showed different levels of subjective fear in response to the outbreak. There was a significant positive correlation between subjective fear and the total score of PCL-5 (R = 0.513, P < 0.01), meaning that the higher the degree of subjective fear, the more severe the symptoms of post-traumatic stress are. Subjective fear was an important predictor of PTSS, accounting for 24.3% of the variance. The total effect of subjective fear on PCL-5 scores was significant (total effect = 7.426, SE = 0.405, 95% CI = 6.631–8.221). The total indirect effect of subjective fear on PCL-5 scores through sleep quality was also significant (total indirect effect = 1.945, SE = 0.258, 95% CI = 1.436–2.470).Conclusions: Subjective fear has an important predictive effect on PTSS. In addition to the direct effect, our findings firstly demonstrate the mediating role of sleep quality in the relationship between subjective fear and PTSS.

More fear reduction, better posttraumatic stress symptoms resilience: 1 year longitudinal study based on the psychological trauma recover project-5-6.

“…Gender difference has also been highlighted in studies examining public responses to perceived fear. Females showed greater subjective fear in response to the outbreak of COVID-19 (Guo et al, 2021). In a study of an Internet-based survey conducted among 87 Japanese individuals living in Washington, DC area, about six times that Japanese women more likely to perceive high fear of terrorism than men (Shigemura et al, 2010).…”

“…Fear was measured by a self-reported single-choice question, “How would you rate the level of fear you feel at the moment,” and rated from 1 ( not at all ) to 5 ( extremely ; Guo et al, 2021).…”

“…For instance, it was demonstrated that rats displaying greater fear after conditioning go on to exhibit greater behavioral avoidance over a 4-week period (Chen et al, 2012). During the outbreak of COVID-19, cross-sectional studies had been performed to investigate the relationship between fear and PTSS (Carballo et al, 2021; Guo et al, 2021), but few studies explored the changes and the predictive relationship among them in longitudinal. In addition to personal background factors (such as social support), targeted interventions (such as mindfulness meditation) and medication, fear reduction should also contribute to PTSS resilience.…”

“…For most people, the emotional reaction to a traumatic event would dissipate over days or weeks, while the reaction might not normalize in other individuals and could lead to psychological distress and developed into PTSS (Bonne et al, 2004; Davidson et al, 2004). In addition to PTSS, unfamiliarity with the disease could also increase fear (Guo et al, 2021; Labrague & de Los Santos, 2021; Wu et al, 2005). Excessive fear and anxiety were hallmarks of a variety of disabling anxiety-related disorders that affect millions of people globally, such as PTSD, phobia, and panic disorder.…”