Prevalence and Risk Factors for Post-Traumatic Stress in Hospitalized and Non-Hospitalized COVID-19 Patients

Abstract

This population-based study assessed the prevalence and determinants of symptom-defined post-traumatic stress disorder (PTSD) in a cohort of hospitalized and non-hospitalized patients about 1.5–6 months after their COVID-19 onset. The data were acquired from two mixed postal/web surveys in June–September 2020 from patients all aged ≥18 years with a positive polymerase chain reaction for severe acute respiratory syndrome Coronavirus-2 (SARS-CoV-2) until 1 June 2020, comprising both hospitalized and non-hospitalized subjects. The catchment areas of the two included hospitals covers about 17% of the population of Norway. In total, 211 hospitalized and 938 non-hospitalized subjects received invitation. The prevalence of symptom-defined PTSD was assessed using the PTSD checklist for DSM-5 (PCL-5). Determinants of symptom-defined PTSD and PTSD symptoms were analyzed using multivariable logistic and linear regression analysis. In total, 583 (51%) subjects responded at median 116 (range 41–200) days after COVID-19 onset. The prevalence of symptom-defined PTSD was 9.5% in hospitalized and 7.0% in non-hospitalized subjects (p = 0.80). Female sex, born outside of Norway, and dyspnea during COVID-19 were risk factors for persistent PTSD symptoms. In non-hospitalized subjects, previous depression and COVID-19 symptom load were also associated with persistent PTSD symptoms. In conclusion, COVID-19 symptom load, but not hospitalization, was associated with symptom-defined PTSD and PTSD symptom severity.

COVID‑19 and post‑traumatic stress disorder: The perfect ‘storm’ for mental health (Review)

“…Moreover, the precautionary restrictive measures taken to control the spread of the virus, ranging from social distancing to strict lockdown regulations, have created an insecure and stressful environment at all levels, health, economic and social ( 3 ). Stressful situations, such as the intense insecurity of a contagious life-threating virus, fear of being infected or having contracted the virus, being hospitalized with less or more severe COVID-19, being admitted to an intensive care unit (ICU), the loss of a loved one, mandatory and drastic changes to everyday life with uncertain financial and future prospects, alongside insufficient coping skills and stress management strategies ( 4 ), have all contributed to posing a significant burden on the mental health of individuals ( 5-7 ). These situations and may also be perceived as traumatic events ( 8 ).…”

COVID-19-associated PTSD in the elderly—lessons learned for the next global pandemic

“…In a study from Ireland, 1.6% of elderly study subjects had COVID-19-related PTSD [ 14 ]. Either factually or due to the limitation mentioned above, a very consistent finding in the current literature is the resilience to PTSD or other forms of psychiatric distress found in the older age group compared to the younger ones [ 11 – 20 ]. Most of studies link being female to higher incidence of PTSD [ 16 , 19 – 21 ].…”

“…Other factors contributing directly to PTSD-like symptoms are intensive care units (ICU) admissions and non-invasive ventilation [ 12 , 22 ]. Psychological distress at the onset of illness, pre-existing psychological disease, and psychotropic drugs are predictive or elevated distress in patients [ 12 , 14 , 18 – 20 , 24 ]. Another directly contributing factor to COVID-19 related PTSD is negatively self-rating one's wellbeing status and high perceived risk of COVID-19 [ 14 , 16 , 19 , 24 ].…”

“…When patients are concerned about infecting others, especially their loved ones, or are being discriminated against, it leads to a higher possibility of distress [ 24 ]. COVID-19 symptom load and hospitalization define PTSD symptom severity [ 12 , 20 , 25 ].…”

Mental Health and the Symptoms of PTSD in People with Depression and Anxiety Disorders during the COVID-19 Pandemic

“…The aforementioned considerations can contribute to a high level of experienced stress in people who are not being treated for mental illness, as well as in patients with diagnoses of depression and/or anxiety disorders. At the same time, optimism and well-being as a positive assessment of mental health can act as a protective factor against the onset of PTSD symptoms [ 6 , 25 , 26 ]. According to the authors, the records published so far on the matter of PTSD spread throughout the COVID-19 pandemic apply only to healthcare professionals and the general public.…”