Factors Associated With Posttraumatic Stress Symptoms 3 and 6 Months After Hospitalization for COVID-19: A Longitudinal Multicenter Study

Victor Pitron, MD, PhD^a,b,‡ ; Willys Cantenys, MD^c,‡ ; Anne Herbelin, MSc^c ; Hugo Bottemanne, MD^c,d ; Nathalie Dzierzynski, MD^e ; Eric Caumes, MD, PhD^f ; Alexis Mathian, MD, PhD^g ; Zahir Amoura, MD, PhD^g ; Yves Allenbach, MD, PhD^h,i,j ; Patrice Cacoub, MD, PhD^h,i,j ; Antoine Parrot, MD^k ; Jean-Yves Rotgé, MD, PhD^c,d ; Philippe Fossati, MD, PhD^c,d

J Clin Psychiatry. 2023;84(1):21m14277

ABSTRACT

Objective: To identify factors associated with posttraumatic stress symptoms (PTSS) 3 and 6 months after the discharge of patients hospitalized for COVID-19.

Methods: Patients hospitalized for COVID-19 between March 1 and July 31, 2020, were included in a longitudinal study. Clinical assessments were conducted with online auto-questionnaires. PTSS were assessed with the Posttraumatic Stress Disorder Checklist Scale (PCLS). We screened for several putative factors associated with PTSS, including socio-demographic status, hospitalization in an intensive care unit, history of psychiatric disorder, the Hospital Anxiety and Depression Scale, the Peritraumatic Dissociative Experiences Questionnaire, and the home-to-hospital distance. Bivariate and multilinear regression analyses were performed to evaluate their association with PTSS.

Results: 119 patients were evaluated 3 months after hospital discharge, and a subset of 94 were evaluated 6 months after discharge. The prevalence of PTSS was 31.9% after 3 months and 30.9% after 6 months. Symptoms of anxiety and depression and history of psychiatric disorder were independently associated with PTSS. Additionally, dissociative experiences during hospitalization (β = 0.35; P < .001) and a longer home-to-hospital distance (β = 0.07; P = .017) were specifically associated with PTSS 3 and 6 months after discharge, respectively.

Conclusions: Patients with COVID-19 showed persistent high scores of PTSS up to 6 months after discharge from the hospital. In this specific pandemic setting, PTSS were associated with high rates of dissociative experiences during hospitalization and a longer home-to-hospital distance due to the saturation of health care facilities. These results can foster early identification and better prevention of PTSS after hospitalization for COVID-19.

Trial Registration: ClinicalTrials.gov identifier: NCT04362930

Continue Reading...

Did you know members enjoy unlimited free PDF downloads as part of their subscription? Subscribe today for instant access to this article and our entire library in your preferred format. Alternatively, you can purchase the PDF of this article individually.

Subscribe Now

Already a member? Login

Buy PDF for $40

Please sign in or purchase this PDF for $40.

References (59)

Nalbandian A, Sehgal K, Gupta A, et al. Post-acute COVID-19 syndrome. Nat Med. 2021;27(4):601–615. PubMed CrossRef
Taquet M, Luciano S, Geddes JR, et al. Bidirectional associations between COVID-19 and psychiatric disorder: retrospective cohort studies of 62 354 COVID-19 cases in the USA. Lancet Psychiatry. 2021;8(2):130–140. PubMed CrossRef
Mazza MG, De Lorenzo R, Conte C, et al; COVID-19 BioB Outpatient Clinic Study group. Anxiety and depression in COVID-19 survivors: role of inflammatory and clinical predictors. Brain Behav Immun. 2020;89:594–600. PubMed CrossRef
Liu D, Baumeister RF, Veilleux JC, et al. Risk factors associated with mental illness in hospital discharged patients infected with COVID-19 in Wuhan, China. Psychiatry Res. 2020;292:113297. PubMed CrossRef
Qi R, Chen W, Liu S, et al. Psychological morbidities and fatigue in patients with confirmed COVID-19 during disease outbreak: prevalence and associated biopsychosocial risk factors. medRxiv. 2020;2020.05.08.20031666. PubMed CrossRef
Beck K, Vincent A, Becker C, et al. Prevalence and factors associated with psychological burden in COVID-19 patients and their relatives: a prospective observational cohort study. PLoS One. 2021;16(5):e0250590–e0250590. PubMed CrossRef
Méndez R, Balanzá-Martínez V, Luperdi SC, et al. Short-term neuropsychiatric outcomes and quality of life in COVID-19 survivors. J Intern Med. 2021;290(3):621–631. PubMed CrossRef
Chang MC, Park D. Incidence of post-traumatic stress disorder after coronavirus disease. Healthcare (Basel). 2020;8(4):373–380. PubMed CrossRef
Bellan M, Soddu D, Balbo PE, et al. Respiratory and psychophysical sequelae among patients with covid-19 four months after hospital discharge. JAMA Netw Open. 2021;4(1):e2036142. PubMed CrossRef
de Graaf MA, Antoni ML, Ter Kuile MM, et al. Short-term outpatient follow-up of COVID-19 patients: a multidisciplinary approach. EClinicalMedicine. 2021;32(100731):100731. PubMed CrossRef
Janiri D, Carfì A, Kotzalidis GD, et al; Gemelli Against COVID-19 Post-Acute Care Study Group. Posttraumatic stress disorder in patients after severe COVID-19 infection. JAMA Psychiatry. 2021;78(5):567–569. PubMed CrossRef
Tarsitani L, Vassalini P, Koukopoulos A, et al. Post-traumatic stress disorder among COVID-19 survivors at 3-month follow-up after hospital discharge. J Gen Intern Med. 2021;36(6):1702–1707. PubMed CrossRef
Bonazza F, Borghi L, di San Marco EC, et al. Psychological outcomes after hospitalization for COVID-19: data from a multidisciplinary follow-up screening program for recovered patients. Res Psychother. 2021;23(3):491. PubMed CrossRef
Einvik G, Dammen T, Ghanima W, et al. Prevalence and risk factors for post-traumatic stress in hospitalized and non-hospitalized COVID-19 patients. Int J Environ Res Public Health. 2021;18(4):2079. PubMed CrossRef
Xiong L-J, Zhong B-L, Cao X-J, et al. Possible posttraumatic stress disorder in Chinese frontline healthcare workers who survived COVID-19 6 months after the COVID-19 outbreak: prevalence, correlates, and symptoms. Transl Psychiatry. 2021;11(1):374. PubMed CrossRef
Vanderlind WM, Rabinovitz BB, Miao IY, et al. A systematic review of neuropsychological and psychiatric sequalae of COVID-19: implications for treatment. Curr Opin Psychiatry. 2021;34(4):420–433. PubMed CrossRef
Shanbehzadeh S, Tavahomi M, Zanjari N, et al. Physical and mental health complications post-COVID-19: scoping review. J Psychosom Res. 2021;147:110525. PubMed CrossRef
Qiu D, Li Y, Li L, et al. Infectious disease outbreak and post-traumatic stress symptoms: a systematic review and meta-analysis. Front Psychol. 2021;12:668784. PubMed CrossRef
Schou TM, Joca S, Wegener G, et al. Psychiatric and neuropsychiatric sequelae of COVID-19: a systematic review. Brain Behav Immun. 2021;97:328–348. PubMed CrossRef
Cai X, Hu X, Ekumi IO, et al. Psychological distress and its correlates among COVID-19 survivors during early convalescence across age groups. Am J Geriatr Psychiatry. 2020;28(10):1030–1039. PubMed CrossRef
Horn M, Wathelet M, Fovet T, et al. Is COVID-19 associated with posttraumatic stress disorder? J Clin Psychiatry. 2020;82(1):20m13641. PubMed CrossRef
Vlake JH, Wesselius S, van Genderen ME, et al. Psychological distress and health-related quality of life in patients after hospitalization during the COVID-19 pandemic: a single-center, observational study. PLoS One. 2021;16(8):e0255774. PubMed CrossRef
Hawkins M, Sockalingam S, Bonato S, et al. A rapid review of the pathoetiology, presentation, and management of delirium in adults with COVID-19. J Psychosom Res. 2021;141:110350. PubMed CrossRef
Chaudhury SS, Sinha K, Majumder R, et al. COVID-19 and central nervous system interplay: a big picture beyond clinical manifestation. J Biosci. 2021;46(2):47. PubMed CrossRef
Delorme C, Houot M, Rosso C, et al; CoCo-Neurosciences Study Group. The wide spectrum of COVID-19 neuropsychiatric complications within a multidisciplinary centre. Brain Commun. 2021;3(3):b135. PubMed CrossRef
Karamchandani K, Dalal R, Patel J, et al. Challenges in sedation management in critically ill patients with COVID-19: a brief review. Curr Anesthesiol Rep. 2021;11(2):107–115. PubMed CrossRef
Lyssenko L, Schmahl C, Bockhacker L, et al. Dissociation in psychiatric disorders: a meta-analysis of studies using the dissociative experiences scale. Am J Psychiatry. 2018;175(1):37–46. PubMed CrossRef
Ozer EJ, Best SR, Lipsey TL, et al. Predictors of posttraumatic stress disorder and symptoms in adults: a meta-analysis. Psychol Bull. 2003;129(1):52–73. PubMed CrossRef
Breh DC, Seidler GH. Is peritraumatic dissociation a risk factor for PTSD? J Trauma Dissociation. 2007;8(1):53–69. PubMed CrossRef
Murray H, Grey N, Wild J, et al. Cognitive therapy for post-traumatic stress disorder following critical illness and intensive care unit admission. Cogn Behav Therap. 2020;13:e13. PubMed CrossRef
Grosse-Holz VM, Nikendei C, Andermann M, et al. Predictors of posttraumatic stress following transient ischemic attack: an observational cohort study. J Psychosom Res. 2020;137:110205. PubMed CrossRef
Schäfer SK, Becker N, King L, et al. The relationship between sense of coherence and post-traumatic stress: a meta-analysis. Eur J Psychotraumatol. 2019;10(1):1562839. PubMed CrossRef
Valsø Å, Rustøen T, Skogstad L, et al. Post-traumatic stress symptoms and sense of coherence in proximity to intensive care unit discharge. Nurs Crit Care. 2020;25(2):117–125. PubMed CrossRef
Benzakour L, Braillard O, Mazzola V, et al. Impact of peritraumatic dissociation in hospitalized patients with COVID-19 pneumonia: a longitudinal study. J Psychiatr Res. 2021;140:53–59. PubMed CrossRef
Fan Y, Shi Y, Zhang J, et al. The effects of narrative exposure therapy on COVID-19 patients with post-traumatic stress symptoms: a randomized controlled trial. J Affect Disord. 2021;293:141–147. PubMed CrossRef
Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983;67(6):361–370. PubMed CrossRef
Marmar CR, Metzler TJ, Otte C, et al. The peritraumatic dissociative experiences questionnaire an international perspective. In: Cross-Cultural Assessment of Psychological Trauma and PTSD. Springer US; 2007:197–217. doi.org/10.1007/978-0-387-70990-1_9
Birmes P, Brunet A, Benoit M, et al. Validation of the Peritraumatic Dissociative Experiences Questionnaire self-report version in two samples of French-speaking individuals exposed to trauma. Eur Psychiatry. 2005;20(2):145–151. PubMed CrossRef
Weathers FW, Litz BT, Herman DS, et al. The PTSD Checklist (PCL): reliability, validity, and diagnostic utility. Presented at the Annual Convention of the International Society for Trauma Stress Studies. January 1, 1993; San Antonio, TX.
Yao SN, Cottraux J, Note I, et al Évaluation des états de stress post-traumatique: validation d’une échelle, la PCLS (Evaluation of post-traumatic stress disorder: validation of a measure, the PCLS). L’Encéphale. 2003;29(3 I).
Rogers JP, Chesney E, Oliver D, et al. Psychiatric and neuropsychiatric presentations associated with severe coronavirus infections: a systematic review and meta-analysis with comparison to the COVID-19 pandemic. Lancet Psychiatry. 2020;7(7):611–627. PubMed CrossRef
Ahmed H, Patel K, Greenwood DC, et al. Long-term clinical outcomes in survivors of severe acute respiratory syndrome and Middle East respiratory syndrome coronavirus outbreaks after hospitalisation or ICU admission: a systematic review and meta-analysis. J Rehabil Med. 2020;52(5):jrm00063. PubMed CrossRef
Nikayin S, Rabiee A, Hashem MD, et al. Anxiety symptoms in survivors of critical illness: a systematic review and meta-analysis. Gen Hosp Psychiatry. 2016;43:23–29. PubMed CrossRef
Rabiee A, Nikayin S, Hashem MD, et al. Depressive symptoms after critical illness: a systematic review and meta-analysis. Crit Care Med. 2016;44(9):1744–1753. PubMed CrossRef
Parker AM, Sricharoenchai T, Raparla S, et al. Posttraumatic stress disorder in critical illness survivors: a meta-analysis. Crit Care Med. 2015;43(5):1121–1129. PubMed CrossRef
Kessler RC, Chiu WT, Demler O, et al. Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry. 2005;62(6):617–627. PubMed CrossRef
Guina J, Baker M, Stinson K, et al. Should posttraumatic stress be a disorder or a specifier? towards improved nosology within the DSM categorical classification system. Curr Psychiatry Rep. 2017;19(10):66. PubMed CrossRef
Serra-Blasco M, Radua J, Soriano-Mas C, et al. Structural brain correlates in major depression, anxiety disorders and post-traumatic stress disorder: a voxel-based morphometry meta-analysis. Neurosci Biobehav Rev. 2021;129:269–281. PubMed CrossRef
Pyszczynski T, Lockett M, Greenberg J, et al. Terror management theory and the COVID-19 pandemic. J Humanist Psychol. 2021;61(2):173–189. CrossRef
Pyszczynski T, Greenberg J, Solomon S. A dual-process model of defense against conscious and unconscious death-related thoughts: an extension of terror management theory. Psychol Rev. 1999;106(4):835–845. PubMed CrossRef
Rosa RG, Tonietto TF, da Silva DB, et al; ICU Visits Study Group Investigators. Effectiveness and safety of an extended ICU visitation model for delirium prevention: a before and after study. Crit Care Med. 2017;45(10):1660–1667. PubMed CrossRef
Pabón-Martínez BA, Rodríguez-Pulido LI, Henao-Castaño AM. The family in preventing delirium in the intensive care unit: scoping review. Enferm Intensiva (Engl Ed). 2021;S1130-2399(21)00033-X. PubMed CrossRef
Matalon N, Dorman-Ilan S, Hasson-Ohayon I, et al. Trajectories of post-traumatic stress symptoms, anxiety, and depression in hospitalized COVID-19 patients: a one-month follow-up. J Psychosom Res. 2021;143:110399. PubMed CrossRef
Nadig NR, Sterba KR, Simpson AN, et al. Psychological outcomes in family members of patients with acute respiratory failure: does inter-ICU transfer play a role? Chest. 2021;160(3):890–898. PubMed CrossRef
Henneman PL, Garb JL, Capraro GA, et al. Geography and travel distance impact emergency department visits. J Emerg Med. 2011;40(3):333–339. PubMed CrossRef
Nicholl J, West J, Goodacre S, et al. The relationship between distance to hospital and patient mortality in emergencies: an observational study. Emerg Med J. 2007;24(9):665–668. PubMed CrossRef
Kelly C, Hulme C, Farragher T, et al. Are differences in travel time or distance to healthcare for adults in global north countries associated with an impact on health outcomes? a systematic review. BMJ Open. 2016;6(11):e013059. PubMed CrossRef
Jensen JF, Thomsen T, Overgaard D, et al. Impact of follow-up consultations for ICU survivors on post-ICU syndrome: a systematic review and meta-analysis. Intensive Care Med. 2015;41(5):763–775. PubMed CrossRef
Nakayama A, Nagayama M, Morita H, et al. The use of geographical analysis in assessing the impact of patients’ home addresses on their participation in outpatient cardiac rehabilitation: a prospective cohort study. Environ Health Prev Med. 2020;25(1):76. PubMed CrossRef