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Post-traumatic stress disorder may be induced by severe COVID-19

Rod Tucker
23 February, 2021  

The experience of a traumatic event can result in the development of post-traumatic stress disorder. Whether this can arise after infection with COVID-19 has not been fully determined.

The presence of any form of trauma can lead to the development of post-traumatic stress disorder (PTSD). For instance, the condition was found to be present in patients after hurricane Katrina and in a meta-analysis of studies, PTSD was observed in just over 30% of patients in the post-illness period after infection with two other coronaviruses, SARS and MERS. Whether PTSD would develop after infection with COVID-19 is unclear and was the subject of an analysis by a group of Italian doctors in Rome. The group examined patients admitted to hospital with severe COVID-19 infection and who were subsequently referred to a post-acute care service for a multidisciplinary assessment. This detailed assessment included interviews with psychiatrists trained in the diagnosis of PTSD as well as the collection of clinical, demographic and psychopathological and COVID-19 characteristics. The diagnosis of PTSD was made based on the DSM-5 criteria which includes seven different criteria (labelled as A to G) and requires the presence of at least one or more symptoms from the various criteria. For example, criterion B includes intrusion symptoms such as unwanted, upsetting memories, nightmares, flashbacks, emotional distress after exposure to traumatic reminders and physical reactivity after exposure to traumatic reminders. For the present study, data obtained from COVID-19 sufferers were compared with those without PTSD and the post-care assessments occurred approximately 96 days after symptom onset. In further analysis, factors associated with PTSD were subjected to binary logistic regression.

Findings
In total, 381 patients were included with a mean age of 55 years (43% female), of whom 81% were hospitalised because of COVID-19 for an average of 18 days and the presence of 3 or more persistent COVID-19 symptoms were found in 62.6% of those diagnosed with PTSD. diagnosis of PTSD was made in 115 (30%) of this cohort and more frequently among women (55.7%). Furthermore, among the groups diagnosed with PTSD, a previous diagnosis of a psychiatric disorder was also present in 34.8% of patients compared to 20.7% in those without PTSD and this difference was statistically significant (p = 0.003). Additionally, among the whole cohort, depressive episodes and generalised anxiety disorder was present in 17.3% and 7% respectively. Logistic regression analysis revealed that female gender, delirium or agitation and persistent medical symptoms were significantly associated with PTSD. While this was only a single centre study and lacked a control group, it did suggest that PTSD may arise after severe infection, especially among those for whom symptoms persisted.

Citation
Janiri D et al. Posttraumatic stress disorder in patients after severe COVID-19 infection. JAMA Psychiatry 2021