COVID-19 / Mental Health

Post-traumatic stress: psychological consequences of an ongoing pandemic

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Introduction

The pandemic caused by the spread of the SARS-CoV-2 virus is a traumatic event of great proportions that has caused severe effects on people’s mental health[1]. According to the World Health Organization (WHO), before the pandemic, depression levels reached more than 300 million people worldwide, which is equivalent to 4.4% of the world’s population.

 

From a scientific point of view, the researchers agree that it is still too early to know what the real impact of the pandemic was on the cognitive structures of people globally and in the long term because the stressor is still ongoing after more than a year of exposure to the SARS-CoV-2 virus.. Despite this, the latest studies carried out warn about a significant increase in levels of depression and anxiety in general, highlighting acute stress and post-traumatic stress as the mental disorders most frequently experienced by both health workers and citizens in general during this pandemic.

After more than a year of being exposed to the SARS-CoV-2 virus, can we qualify the COVID-19 pandemic as a traumatic event? What does the data say about it?

    According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) prepared by the American Psychiatric Association (APA), post-traumatic stress is diagnosed if the person has been directly exposed to a traumatic event or if you are aware of a close third party who has experienced it. What are the symptoms of PTSD? How do they manifest in the body and in the mind?  Symptoms include: overwhelming, involuntary, and intrusive memories of the traumatic event; Recurrent distressing dreams, intense and prolonged psychological and / or physiological discomfort when exposed to internal or external factors that resemble one or more aspects of the traumatic event, among others. There are also reactive alterations in behavior, among which are observed: irritable behavior or outbursts of anger that are typically expressed as verbal or physical aggression against people or objects, reckless or self-destructive behavior, hypervigilance, exaggerated startle response, concentration problems and sleep disturbance.

     It is important to note that PTSD differs from acute stress by the duration of the symptoms. Acute stress refers to the initial symptoms that a patient presents after having suffered a traumatic event for up to a month, while post-traumatic stress is related to the symptoms that persist in the patient that has passed a period of time greater than one month, as indicated by the DSM-5.

After more than a year since the beginning of the Covid-19 global pandemic, post-traumatic stress is one of the most alarming and common clinical pictures in the world population today. The objective of this article is to describe the symptoms of post-traumatic stress in relation to the current ongoing pandemic and to offer a conclusion in this regard.

The team of psychology professionals at the University of Ottawa in Canada conducted a meta-analysis of 55 international studies. From this study it was concluded that post-traumatic stress, after the COVID-19 outbreak, reached 22%, being five times more frequent compared to what the World Health Organization (WHO) usually reports. The results of this study also show that insomnia was more prevalent in health workers than in other citizens.

So far, there are three types of stressors linked to the pandemic. First, there is the stressor related to the direct impact that the person experiences when they are diagnosed positive for COVID-19. Then there is the stressor to which health workers are exposed, particularly, those who live experience the direct impact suffered by patients. Finally, there is the stressor linked to the socioeconomic consequences of the pandemic, such as the loss of employment, the lack of face-to-face classes in schools and universities, and the closure of numerous businesses, among others.

A study published in the Italian Journal of Psychiatry revealed that the most frequent psychological reactions during the COVID-19 pandemic were: maladaptive behavior[2], emotional distress, defensive responses, anxiety, fear, frustration, loneliness, anger, boredom, depression, stress and avoidance behaviors.

In this sense, health workers are especially susceptible to developing post-traumatic stress symptoms due to stressors to which patients are exposed when facing the disease. To illustrate the above, we can bring up the testimony of a health professional dedicated to the care of COVID-19 patients in a public hospital. “It was difficult for me to assimilate so much pain and suffering, I was filled with fears and fears and I went into an emotional crisis,” he confesses.

    Unfortunately, the psychological effects of the pandemic do not end there. For example, other studies on the psychological effects of the COVID-19 pandemic on mental health emphasize the negative impact of sanitary restriction measures, such as quarantines, lockdowns and social distancing, due to the absence of natural protective mechanisms associated with the lack of social support, factors that are affected by other mental and somatic disorders, as well as re-exposure to previous traumatic experiences. While it is true that the measures have been necessary to reduce the spread of the SARS-Cov-2 virus. For example, if the SARS-CoV epidemics of 2002 in the Asian region and Ebola in the African region are taken as a reference, the presence of post-traumatic stress symptoms is significantly high both in health workers as well as in citizens in general. For example, a study conducted in China, three years after the SARS-CoV outbreak in 2002, revealed that health care workers who had been in quarantine even developed symptoms of alcoholism.[3]

    To diagnose post-traumatic stress, the scientific community uses a questionnaire of 22 questions called IES-R (Impact of Event Scale-Revised) or Revised Scale of Impact of the Event, in which the patient responds according to a scale of values from 0 to 4. This method aims to quantitatively measure the impact of a traumatic event in the adult population taking as a reference the PTSD criteria present in the DSM-5. The three factors that the IES-R analyzes are: 1) intrusive thoughts, 2) cancellation and 3) hyperactivity, regarding the traumatic event experienced.

    Below is a comparative table that summarizes three quantitative studies carried out in Italy,[4] China,[5] and Mexico[6] that show the prevalence of post-traumatic stress symptoms in a number of cases determined during the COVID-19 pandemic.

Nº of cases Period of
time covered
by the study		Symptomatology
and predictors of PTSD 		Prevalence
Italy2286March 18,
2020 – March 31,
2020.		Mood alterations,
intrusions,
dysphoria,
anxiety associated
with memories of the
COVID-19 outbreak
or its restrictive measures.		29,5%
China2091
January 30,
2020 – February 3,
2020.		Poor sleep
conditions prior
to the COVID-19 outbreak.
4,6%
Mexico3932March 24, 2020.Intrusive thoughts,
hyperactivity,
and avoidance of the
traumatic event		27,7%

Conclusion

After more than a year of exposure to the SARS-CoV-2 virus, the psychological consequences in the world are still unknown. In addition, from the studies reviewed, it is estimated that post-traumatic stress will be recorded in a greater number of people over time. As noted above, post-traumatic stress has the characteristic of being a chronic disorder that can lead to depressive states, maladaptive behaviors, anger, frustration and anxiety in people who suffer from it. After having experienced an unprecedented event in recent history such as the COVID-19 pandemic, investigating the prevalence of post-traumatic stress symptoms in the world population is essential. Likewise, it is important to seek professional help if one or more symptoms are observed either in personal mental health, or in that of a loved one.

  1. According to a study by the Department of Psychology of the La Sapienza University of Rome, the pandemic constitutes a traumatic event to the extent that health workers and other population groups have presented symptoms of acute stress and post-traumatic stress. (https://www.mdpi.com/1660-4601/17/11/4151). 
  2.  It refers to the behavior that generates restlessness and disharmony. It occurs when the person does not adapt to the environment.
  3. 28. Wu P, Liu X, Fang Y, et al.Alcohol abuse/dependence symptoms among hospital employees exposed to a SARS outbreak. Alcohol Alcohol 2008; 43: 706-12. 
  4. https://www.mdpi.com/1660-4601/17/11/4151/htm
  5.  https://www.medrxiv.org/content/10.1101/2020.03.06.20032425v1
  6. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7398879/

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