Post-traumatic Stress Disorder Among COVID-19 Survivors at 3-Month Follow-up After Hospital Discharge

Lorenzo Tarsitani; Paolo Vassalini; Alexia Koukopoulos; Cristian Borrazzo; Federica Alessi; Chiara Di Nicolantonio; Riccardo Serra; Francesco Alessandri; Giancarlo Ceccarelli; Claudio Maria Mastroianni; Gabriella d'Ettorre

doi:10.1007/s11606-021-06731-7

Post-traumatic Stress Disorder Among COVID-19 Survivors at 3-Month Follow-up After Hospital Discharge

J Gen Intern Med. 2021 Jun;36(6):1702-1707. doi: 10.1007/s11606-021-06731-7. Epub 2021 Mar 29.

Affiliations

¹ Department of Human Neurosciences, Policlinico Umberto I, Sapienza University of Rome, Viale dell'Università 30, 00185, Rome, Italy. lorenzo.tarsitani@uniroma1.it.
² Department of Public Health and Infectious Diseases, Policlinico Umberto I, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185, Rome, Italy.
³ Department of Human Neurosciences, Policlinico Umberto I, Sapienza University of Rome, Viale dell'Università 30, 00185, Rome, Italy.
⁴ Intensive Care Unit, Department of General and Specialist Surgery "Paride Stefanini", Policlinico Umberto I, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185, Rome, Italy.

^# Contributed equally.

Abstract

Background: Post-traumatic stress disorder (PTSD) is a severe but treatable mental disorder that develops after a life-threatening traumatic event. Coronavirus disease 19 (COVID-19) hospitalisation is a potentially traumatic experience, especially in severe cases. Furthermore, the unprecedented context of the severe acute respiratory syndrome coronavirus 2 pandemic, with daily media bombardment about COVID-19 mortality, may have amplified life-threatening perception also in patients with moderate infection. The aim of this study was to assess the prevalence and risk factors of PTSD at 3-month follow-up in patients hospitalised for COVID-19 infection.

Design: In this cohort follow-up study conducted in a large Italian academic COVID-19 hospital, 115 recruited survivors were contacted by telephone 3 months after discharge to home care. The Posttraumatic Stress Disorder Checklist for DSM-5 was administered. Multivariate logistic regression models were used to analyse risk factors for the development of PTSD.

Key results: A total of 10.4% of the sample received a PCL-5-based diagnosis of PTSD. Other 8.6% of the sample received a diagnosis of subthreshold PTSD, which leads to significant levels of distress and impairment. Multivariate regression analysis indicated that previous psychiatric diagnosis (odds ratio (OR) = 6.3, 95% confidence interval (CI): 3.7-78.6, p < 0.001) and obesity (OR = 3.51, 95% CI: 1.4-857.9, p = 0.03) were risk factors for developing PTSD. Chronic pulmonary diseases approached significance as a risk factor (OR = 6.03, 95% CI: 1.0-37.1, p = 0.053). Male sex was a protective factor (OR=0.04, 95% CI: 0.0-0.041, p = 0.007).

Conclusions: PTSD and subthreshold PTSD rates in patients hospitalised for COVID-19 are worrying. Female sex and pre-existing mental disorders are established risk factors for PTSD, while the prospective association with obesity needs further investigation. Clinicians treating COVID-19 should consider screening for PTSD at follow-up assessments in patients discharged from the hospital.

Keywords: COVID-19; SARS-CoV-2; hospitalisation; mental health; post-traumatic stress disorder.

MeSH terms

COVID-19*
Female
Follow-Up Studies
Hospitals
Humans
Male
Patient Discharge
Prospective Studies
SARS-CoV-2
Stress Disorders, Post-Traumatic* / diagnosis
Stress Disorders, Post-Traumatic* / epidemiology
Stress Disorders, Post-Traumatic* / etiology
Survivors