Post-traumatic Stress Disorder Symptoms in COVID-19 Survivors 6 Months After Hospital Discharge: An Application of the Conservation of Resource Theory

Bingyi Wang; Xue Yang; Leiwen Fu; Yuqing Hu; Dan Luo; Xin Xiao; Niu Ju; Weiran Zheng; Hui Xu; Yuan Fang; Paul Shing Fong Chan; Zhijie Xu; Ping Chen; Jiaoling He; Hongqiong Zhu; Huiwen Tang; Dixi Huang; Zhongsi Hong; Xiaojun Ma; Yanrong Hao; Lianying Cai; Jianrong Yang; Shupei Ye; Jianhui Yuan; Yao-Qing Chen; Fei Xiao; Zixin Wang; Huachun Zou

doi:10.3389/fpsyt.2021.773106

Post-traumatic Stress Disorder Symptoms in COVID-19 Survivors 6 Months After Hospital Discharge: An Application of the Conservation of Resource Theory

Front Psychiatry. 2022 Jan 4:12:773106. doi: 10.3389/fpsyt.2021.773106. eCollection 2021.

Authors

Bingyi Wang¹, Xue Yang², Leiwen Fu¹, Yuqing Hu¹, Dan Luo¹, Xin Xiao^{1

3}, Niu Ju¹, Weiran Zheng¹, Hui Xu¹, Yuan Fang⁴, Paul Shing Fong Chan², Zhijie Xu⁵, Ping Chen⁵, Jiaoling He⁵, Hongqiong Zhu⁵, Huiwen Tang⁵, Dixi Huang⁵, Zhongsi Hong⁵, Xiaojun Ma⁶, Yanrong Hao⁷, Lianying Cai⁸, Jianrong Yang⁹, Shupei Ye¹⁰, Jianhui Yuan¹¹, Yao-Qing Chen¹, Fei Xiao⁵, Zixin Wang², Huachun Zou^{1

12

13

14}

Affiliations

¹ School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China.
² The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China.
³ Center for Optometry and Visual Science, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China.
⁴ Department of Early Childhood Education, The Education University of Hong Kong, Hong Kong, Hong Kong SAR, China.
⁵ The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China.
⁶ Guangdong Provincial People's Hospital, Guangzhou, China.
⁷ Department of Scientific Research, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China.
⁸ Department of Education, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China.
⁹ Department of Hepatobiliary, Pancreas and Spleen Surgery, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China.
¹⁰ Department of Emergency, SSL Central Hospital of Dongguan City, Dongguan, China.
¹¹ Shenzhen Nanshan District Center for Disease Control and Prevention, Shenzhen, China.
¹² School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
¹³ Shenzhen Center for Disease Control and Prevention, Shenzhen, China.
¹⁴ Kirby Institute, University of New South Wales, Sydney, NSW, Australia.

Abstract

COVID-19 survivors who had acute respiratory symptoms might experience prolonged post-traumatic stress disorder (PTSD) due to further rehabilitation, somatic symptoms and related distress. The conservation of resource (COR) theory is a well-developed theory to understand how people develop PTSD symptoms in traumatic events. The current study aimed to examine the potential factors of PTSD symptoms and interrelationships among this factors among COVID-19 survivors based on the COR theory. This cross-sectional telephone survey enrolled 199 COVID-19 patients (Mean age = 42.7; 53.3% females) 6 months after their hospital discharge in five Chinese cities (i.e., Wuhan, Shenzhen, Zhuhai, Dongguan, and Nanning). The results showed that 7% of participants were classified as having probable PTSD. The significant potential factors relating to PTSD symptoms included socio-demographic status, hospitalization experiences, post-hospitalization experiences, and psychological status. Besides, the proposed statistical mediation model based on the COR framework showed good model fit, χ²(df) = 17.286 (5), p = 0.004, CFI = 0.962, NNFI = 0.951, RMSEA = 0.077. Perceived resource loss/gain fully mediated the association between exposure to other patients' suffering during hospitalization and PTSD symptoms, and partially mediated the relationships from somatic symptoms/perceived impact of being infected with COVID-19 after discharge to PTSD symptoms. On the other hand, resilience was a full mediator in the relationship from ICU experience to PTSD symptoms and a partial mediator in the relationship from perceived impact to PTSD symptoms. The results provide preliminary support on applying the COR theory to understand the factors of PTSD symptoms among COVID-19 survivors. Interventions to reduce PTSD symptoms in this population can be developed based on the modifiable psychosocial mediators.

Keywords: conservation of resource theory (COR); hospitalization-related factors; post-traumatic stress disorder (PTSD); resilience; resource loss and gain.