Reflections on the ebola public health emergency of international concern, part 2: The unseen epidemic of posttraumatic stress among health-care personnel and survivors of the 2014–2016 Ebola outbreak

Paladino, Lorenzo; Sharpe, Richard P; Galwankar, Sagar; Sholevar, Farhad; Marchionni, Christine; Papadimos, Thomas J.; Paul, Élisabeth; Hansoti, Bhakti; Firstenberg, Michael S.; Garg, Manish; Watson, Mindy; A.Baxter, Ric; Stawicki, Stanislaw P.

doi:10.4103/jgid.jgid_24_17

Cited by 51 publications

(30 citation statements)

References 60 publications

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“…[ 640 ] Such phenomena were observed on a large scale in Africa following the 2014–2016 Ebola outbreak. [ 641 ] In similar fashion, early reports from China indicate that the COVID-19 outbreak has resulted in significant number of new PTSD cases. [ 642 ] It should be expected that PTSD will be increasingly evident across the affected areas of the globe, and it will be equally important to ensure that local resources are available to help individuals cope with the immense emotional stress of a pandemic.…”

Section: P Sychological a Spects Of The mentioning

confidence: 88%

The 2019–2020 novel coronavirus (severe acute respiratory syndrome coronavirus 2) pandemic: A joint american college of academic international medicine-world academic council of emergency medicine multidisciplinary COVID-19 working group consensus paper

Stawicki

Jeanmonod

Miller

et al. 2020

J Global Infect Dis

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332

356

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What started as a cluster of patients with a mysterious respiratory illness in Wuhan, China, in December 2019, was later determined to be coronavirus disease 2019 (COVID-19). The pathogen severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a novel Betacoronavirus , was subsequently isolated as the causative agent. SARS-CoV-2 is transmitted by respiratory droplets and fomites and presents clinically with fever, fatigue, myalgias, conjunctivitis, anosmia, dysgeusia, sore throat, nasal congestion, cough, dyspnea, nausea, vomiting, and/or diarrhea. In most critical cases, symptoms can escalate into acute respiratory distress syndrome accompanied by a runaway inflammatory cytokine response and multiorgan failure. As of this article's publication date, COVID-19 has spread to approximately 200 countries and territories, with over 4.3 million infections and more than 290,000 deaths as it has escalated into a global pandemic. Public health concerns mount as the situation evolves with an increasing number of infection hotspots around the globe. New information about the virus is emerging just as rapidly. This has led to the prompt development of clinical patient risk stratification tools to aid in determining the need for testing, isolation, monitoring, ventilator support, and disposition. COVID-19 spread is rapid, including imported cases in travelers, cases among close contacts of known infected individuals, and community-acquired cases without a readily identifiable source of infection. Critical shortages of personal protective equipment and ventilators are compounding the stress on overburdened healthcare systems. The continued challenges of social distancing, containment, isolation, and surge capacity in already stressed hospitals, clinics, and emergency departments have led to a swell in technologically-assisted care delivery strategies, such as telemedicine and web-based triage. As the race to develop an effective vaccine intensifies, several clinical trials of antivirals and immune modulators are underway, though no reliable COVID-19-specific therapeutics (inclusive of some potentially effective single and multi-drug regimens) have been identified as of yet. With many nations and regions declaring a state of emergency, unprecedented quarantine, social distancing, and border closing efforts are underway. Implementation of social and physical isolation measures has caused sudden and profound economic hardship, with marked decreases in global trade and local small business activity alike, and full ramifications likely yet to be felt. Current state-of-science, mitigation strategies, possible therapies, ethical considerations for healthcare workers and policymakers, as well as lessons learned for this evolving global threat and the eventual return to a “new normal” are discussed in this article.

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Section: P Sychological a Spects Of The mentioning

confidence: 88%

The 2019–2020 novel coronavirus (severe acute respiratory syndrome coronavirus 2) pandemic: A joint american college of academic international medicine-world academic council of emergency medicine multidisciplinary COVID-19 working group consensus paper

Stawicki

Jeanmonod

Miller

et al. 2020

J Global Infect Dis

Self Cite

332

356

View full text Add to dashboard Cite

show abstract

“…In China, approximately 1700 healthcare personnel have been reported as infected with the COVID-19 disease (14.8% severely or critically ill, and 5% associated with deaths) [17]. Considering previous experience, we could assume that the COVID-19 outbreak will generate psychological reactions, which will lead to psychological disorders such as acute stress disorder, post-traumatic stress disorder, depression, and, in some cases, unfortunately, even suicide [4,[6][7][8][9]. Different individuals may experience different levels of psychological reactions.…”

Section: Discussionmentioning

confidence: 99%

“…Wu and colleagues showed, in 2009, during the SARS epidemic, the necessity of understanding the possible psychosocial impacts of an outbreak with an easily transmitted, rapidly spreading infectious disease among health care professionals [5]. In the previous pandemic, it was emphasized that health care professionals were under intense stress from fear of becoming ill, spreading the infection to their families, and the heavy workload [2,[6][7][8]. During outbreaks, health care providers must balance the fundamental "duty to treat" with their parallel duties to family and loved ones.…”

Section: Introductionmentioning

confidence: 99%

“…During outbreaks, health care providers must balance the fundamental "duty to treat" with their parallel duties to family and loved ones. Health caretakers were forced to deal with the loss of life while processing their survival in the setting of significantly decreased social support [7]. Studies of the last SARS outbreak found the enormous emotional burden for those health care workers who were on the first lines of the battle against the disease [2,4].…”

Section: Introductionmentioning

confidence: 99%

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Disease Perception and Coping with Emotional Distress During COVID-19 Pandemic: A Survey Among Medical Staff

Man

Toma

Motoc

et al. 2020

IJERPH

111

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The novel coronavirus disease, COVID-19, is a highly contagious infectious disease declared by the World Health Organization to be a pandemic and a global public health emergency. During outbreaks, health care workers are submitted to an enormous emotional burden as they must balance the fundamental “duty to treat” with their parallel duties to family and loved ones. The aims of our study were to evaluate disease perceptions, levels of stress, emotional distress, and coping strategies among medical staff (COVID-19 versus non-COVID-19 departments) in a tertiary pulmonology teaching hospital in the first month after the outbreak of COVID-19. One hundred and fifteen health care workers completed four validated questionnaires (the brief illness perception questionnaire, perceived stress scale, the profile of emotional distress emotional, and the cognitive coping evaluation questionnaire) that were afterwards interpreted by one psychologist. There was a high level of stress and psychological distress among health care workers in the first month after the pandemic outbreak. Interestingly, there were no differences between persons that worked in COVID-19 departments versus those working in non-COVID-19 departments. Disease perceptions and coping mechanisms were similar in the two groups. As coping mechanisms, refocusing on planning and positive reappraisal were used more than in the general population. There is no difference in disease perceptions, levels of stress, emotional distress, and coping strategies in medical staff handling COVID-19 patients versus those staff who were not handling COVID-19 patients in the first month after the pandemic outbreak.

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“…Elevated rates of depression and anxiety have been documented following stressors such as disease outbreaks, including the 2014-2016 Ebola crisis in West Africa, among caretakers, survivors, their immediate contacts, and others [ 7 , 8 ]. In addition, epidemics such as SARS and HIV have been associated with depression and other mental health concerns among various groups [ 9 - 14 ].…”

Section: Introductionmentioning

confidence: 99%

Mental Health During the COVID-19 Pandemic in the United States: Online Survey

Jewell¹,

Farewell²,

Welton‐Mitchell³

et al. 2020

JMIR Form Res

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Background The COVID-19 pandemic has had numerous worldwide effects. In the United States, there have been 8.3 million cases and nearly 222,000 deaths as of October 21, 2020. Based on previous studies of mental health during outbreaks, the mental health of the population will be negatively affected in the aftermath of this pandemic. The long-term nature of this pandemic may lead to unforeseen mental health outcomes and/or unexpected relationships between demographic factors and mental health outcomes. Objective This research focused on assessing the mental health status of adults in the United States during the early weeks of an unfolding pandemic. Methods Data was collected from English-speaking adults from early April to early June 2020 using an online survey. The final convenience sample included 1083 US residents. The 71-item survey consisted of demographic questions, mental health and well-being measures, a coping mechanisms checklist, and questions about COVID-19–specific concerns. Hierarchical multivariable logistic regression was used to explore associations among demographic variables and mental health outcomes. Hierarchical linear regression was conducted to examine associations among demographic variables, COVID-19–specific concerns, and mental health and well-being outcomes. Results Approximately 50% (536/1076) of the US sample was aged ≥45 years. Most of the sample was White (1013/1054, 96%), non-Hispanic (985/1058, 93%), and female (884/1073, 82%). Participants reported high rates of depression (295/1034, 29%), anxiety (342/1007, 34%), and stress (773/1058, 73%). Older individuals were less likely to report depressive symptomology (OR 0.78, P<.001) and anxiety symptomology (OR 0.72, P<.001); in addition, they had lower stress scores (–0.15 points, SE 0.01, P<.001) and increased well-being scores (1.86 points, SE 0.22, P<.001). Individuals who were no longer working due to COVID-19 were 2.25 times more likely to report symptoms of depression (P=.02), had a 0.51-point increase in stress (SE 0.17, P=.02), and a 3.9-point decrease in well-being scores (SE 1.49, P=.009) compared to individuals who were working remotely before and after COVID-19. Individuals who had partial or no insurance coverage were 2-3 times more likely to report depressive symptomology compared to individuals with full coverage (P=.02 and P=.01, respectively). Individuals who were on Medicare/Medicaid and individuals with no coverage were 1.97 and 4.48 times more likely to report moderate or severe anxiety, respectively (P=.03 and P=.01, respectively). Financial and food access concerns were significantly and positively related to depression, anxiety, and stress (all P<.05), and significantly negatively related to well-being (both P<.001). Economy, illness, and death concerns were significantly positively related to overall stress scores (all P<.05). Conclusions Our findings suggest that many US residents are experiencing high stress, depressive, and anxiety symptomatology, especially those who are underinsured, uninsured, or unemployed. Longitudinal investigation of these variables is recommended. Health practitioners may provide opportunities to allay concerns or offer coping techniques to individuals in need of mental health care. These messages should be shared in person and through practice websites and social media.

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Reflections on the ebola public health emergency of international concern, part 2: The unseen epidemic of posttraumatic stress among health-care personnel and survivors of the 2014–2016 Ebola outbreak

Cited by 51 publications

References 60 publications

The 2019–2020 novel coronavirus (severe acute respiratory syndrome coronavirus 2) pandemic: A joint american college of academic international medicine-world academic council of emergency medicine multidisciplinary COVID-19 working group consensus paper

The 2019–2020 novel coronavirus (severe acute respiratory syndrome coronavirus 2) pandemic: A joint american college of academic international medicine-world academic council of emergency medicine multidisciplinary COVID-19 working group consensus paper

Disease Perception and Coping with Emotional Distress During COVID-19 Pandemic: A Survey Among Medical Staff

Mental Health During the COVID-19 Pandemic in the United States: Online Survey

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