Post-traumatic Stress Disorder Among COVID-19 Survivors at 3-Month Follow-up After Hospital Discharge

Abstract

Background Post-traumatic stress disorder (PTSD) is a severe but treatable mental disorder that develops after a life-threatening traumatic event. Coronavirus disease 19 (COVID-19) hospitalisation is a potentially traumatic experience, especially in severe cases. Furthermore, the unprecedented context of the severe acute respiratory syndrome coronavirus 2 pandemic, with daily media bombardment about COVID-19 mortality, may have amplified life-threatening perception also in patients with moderate infection. The aim of this study was to assess the prevalence and risk factors of PTSD at 3-month follow-up in patients hospitalised for COVID-19 infection. Design In this cohort follow-up study conducted in a large Italian academic COVID-19 hospital, 115 recruited survivors were contacted by telephone 3 months after discharge to home care. The Posttraumatic Stress Disorder Checklist for DSM-5 was administered. Multivariate logistic regression models were used to analyse risk factors for the development of PTSD. Key Results A total of 10.4% of the sample received a PCL-5-based diagnosis of PTSD. Other 8.6% of the sample received a diagnosis of subthreshold PTSD, which leads to significant levels of distress and impairment. Multivariate regression analysis indicated that previous psychiatric diagnosis (odds ratio (OR) = 6.3, 95% confidence interval (CI): 3.7–78.6, p < 0.001) and obesity (OR = 3.51, 95% CI: 1.4–857.9, p = 0.03) were risk factors for developing PTSD. Chronic pulmonary diseases approached significance as a risk factor (OR = 6.03, 95% CI: 1.0–37.1, p = 0.053). Male sex was a protective factor (OR=0.04, 95% CI: 0.0–0.041, p = 0.007). Conclusions PTSD and subthreshold PTSD rates in patients hospitalised for COVID-19 are worrying. Female sex and pre-existing mental disorders are established risk factors for PTSD, while the prospective association with obesity needs further investigation. Clinicians treating COVID-19 should consider screening for PTSD at follow-up assessments in patients discharged from the hospital.

Risk of Developing Post-traumatic Stress Disorder in Severe COVID-19 Survivors, Their Families and Frontline Healthcare Workers: What Should Mental Health Specialists Prepare For?

“…Among COVID-19 individuals, those with a severe course of the disease are particularly at risk of developing PTSD (6)(7)(8). Patients who had to undergo medical interventions to maintain or restore vital functions experience particularly intense traumatic stress (13,14).…”

“…The effects of the current as well as of past epidemics on the mental health of survivors can help predict the psychopathological consequences of a severe life-threatening viral disease. Two Italian studies on recovered severe COVID-19 survivors reported that the prevalence of PTSD is 10.4% ( 8 ) and 30.2% ( 7 ), respectively. Additionally, in survivors of the severe acute respiratory syndrome (SARS) during the epidemic that covered 29 countries in 2002/2003, infecting 8,096 individuals, of whom 774 died PTSD was present in 39% of patients 10 months after discharge ( 18 ), and over time the frequency of PTSD even increased, ranging from 42 to 54.5% after 31–51 months from discharge ( 18 – 20 ).…”

“…For example, non-symptomatic individuals who test positive for COVID-19 are not at risk and should not be screened for PTSD, although they may develop other mental disorders such as depressive or anxiety disorder ( 35 ). Co-occurrence of PTSD and other disorders [see ( 7 , 8 )] is associated with high levels of distress, burden and reduced quality of life ( 11 , 12 ), thus special clinical attention should be paid to individuals with PTSD experiencing additional mental health problems.…”

“…Death rate also increases in patients with pre-existing comorbid conditions, such as history of metastatic solid tumor (57%), myocardial infarction (47%), cerebrovascular disease (39%), congestive heart failure (37%), hemiplegia (34%), malignant neoplasm (27%), diabetes (20%), dementia (20%), chronic pulmonary disease (16%), hyperlipidemia (11%), and hypertension [8.4%; (3)(4)(5)]. Given the high COVID-19 mortality, the severe disease may be life-threatening and as such may be considered a traumatic event, especially for individuals at high risk of complications and death (6)(7)(8).…”

Impact of the Covid-19 Pandemic on Mental Health

“…Constant fighting for breath, the beeping of the instruments, people dying in the nearby beds give them a near-death experience which may cause post-traumatic stress disorder and depression, and other psychiatric disorders after recovery. 5 The fifth impact relates to economic losses, unemployment, food security, and uncertainty about the future. A considerable number of people relying on daily earning lost their livelihood because of quarantine.…”