COVID-19 Increases Risk of PTSD

Researchers are now worried post-traumatic stress disorder (PTSD) rates may rise in patients infected with the coronavirus disease 2019 (COVID-19).

A team, led by Delfina Jahiri, MD, Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, examined whether PTSD rates increased in patients who were hospitalized with COVID-19, but ultimately recovered.

In past coronavirus epidemics, researchers found PTSD was associated with the post-illness stage, with meta-analytic findings showing a prevalence of 32.2% (95% CI, 23.7-42.0).

The Patients

The investigators examined 381 consecutive patients who presented to the emergency department with SARS-CoV-2 and recovered. Each patient was referred to a post-recovery health check at the Fondazione Policlinico Universitario Agostino Gemelli IRCCS in Rome, which included a comprehensive and interdisciplinary medical and psychiatric assessment. Each patient recovered from a COVID-19 infection within 30-120 days.

The mean age was 55.26 and 43.6% of the patients were women.

During acute COVID-19 illness, 309 (81.1%) of the patients were hospitalized, with a mean length of hospital stay of 18.41 days.

The researchers obtained data on demographic, clinical, psychopathological, and COVID-19 characteristics for each patient.

The Diagnosis

PTSD was diagnosed using the criterion-standard Clinician-Administered PTSD Scale for DSM-5 (CAPS-5), reaching a Cohen κ interrater reliability of 0.82.

To meet this criteria, patients must have at least 1 DSM-5 criterion B and C symptoms and at least 2 criterion D and E symptoms to go along with exposure to a traumatic event and criteria F and G.

The researchers made additional diagnoses through the Structured Clinical Interview for DSM-5.

The investigators compared the data for patients with and without PTSD with the x² test for nominal variables and one-way analysis of variance for continuous variables.

The factors significantly linked to PTSD were subjected to a binary logistic regression.

In addition, P values were 2-tailed, and significance was set at a P value less than .05, while analyses were performed using R version 4 0.0 (The R Foundation).

Risk Factors

Overall, PTSD was identified in 115 patients (30.2%), with an additional diagnoses of depressive episodes in 66 patients (17.3%). In addition, there were 3 cases of a hypomanic episode (0.7%), 27 instances of generalized anxiety disorder (7.0%), and 1 case of a psychotic disorder diagnosis (0.2%).

Women (n = 64; 55.7%) were more likely to suffer from PTSD and reported higher rates of a history of psychiatric disorders (n = 40; 34.8%) and delirium or agitation during acute illness (n = 19; 16.5%).

Women also presented more persistent medical symptoms in the post-illness stage (more than 3 symptoms, n = 72; 62.6%).

Using logistic regression, the team identified sex (Wald₁ = 4.79; P = 0.02), delirium or agitation (Wald₁ = 5.14; P = 0.02), and persistent medical symptoms (Wald₂ = 12.46; P = 0.002) as factors associated with PTSD.

“This cross-sectional study found a PTSD prevalence of 30.2% after acute COVID-19 infection, which is in line with findings in survivors of previous coronavirus illnesses compared with findings reported after other types of collective traumatic events,” the authors wrote.

The study, “Posttraumatic Stress Disorder in Patients After Severe COVID-19 Infection,” was published online in JAMA Psychiatry.