ABSTRACT
Background: Since the identification of a cluster of pneumonia cases in China (Wuhan) in December 2019, the COronaVIrus Disease-19 (COVID-19) outbreak rapidly spread across different countries. Italy was the first European Country to face COVID-19 Emergency and one of the most affected. The COVID-19 Emergency has forced people to change everyday life habits in response to restrictions, stimulating people's feelings of fear and physical health threat, increasing the risk of psychological adverse outcomes, such as anxiety, depression and Post-Traumatic Stress Symptoms (PTSS) [1]. A severe illness in one's child is acknowledged to be a destabilizing event, having a negative impact on parent psychological wellbeing with an increased risk of negative mental health consequences, among which PTSS throughout the development of Post-Traumatic Stress Disorder (PTSD) [2,3]. Consistently with this evidence, parents who interfaced with suspected COVID-19 infection in their children, particularly in the early acute phase of the pandemic, may have resulted a challenging population at risk for negative psychological consequences [4]. However, scant data explored this issue. Objective: The aim of the present study was to investigate psychological outcomes on parents who accessed Pediatric Emergency Departments of three University Hospitals in Italy (Azienda Ospedaliero-Universitaria Pisana, Pisa;Azienda Ospedaliero-Universitaria Sant'Orsola Malpighi, Bologna;Fondazione IRCSS Policlinico San Matteo, Pavia) for symptoms of suspicious COVID-19 in their children during the acute phase of the COVID-19 outbreak (April, 2020), with particular attention to the onset of PTSS. Methods: 110 parents of children with suspected COVID-19 were recruited within one month from diagnostic assessment for COVID-19 and were assessed through the Impact of Event Scale-Revised (IES-R), to evaluate PTSS. Comparison of socio-demographic and clinical features between subjects with and without PTSS was performed. A logistic regression model was used to identify the factors associated with the development of PTSS. Results: 39 (35.4%) parents reported moderate to severe PTSS (IES-R score≥24). Results showed parents of children tested positive for COVID-19 being more prone to develop PTSS as compared to those whose children were negative (p<0.001). Similarly, PTSS rates were significantly higher among mothers with respect to fathers (p=0.012), among those tested positive themselves for COVID-19 compared to those negative (p=0.026) and among those who received indication to quarantine with respect to ones who had not (p<0.001). Mean age of participants was significantly lower among subjects with PTSS than those without (p=0.025). Finally, having a child tested positive for COVID-19 showed a positive association with the onset of PTSS (p=0.007). Conclusions: These results highlight the traumatic burden of children's illness on parents, particularly on the mothers that, besides representing the most vulnerable gender to post-traumatic stress reactions, often represent the principal caregiver and suggest the need of further studies to address tailored prevention and intervention strategies, also in the framework of the ongoing COVID-19 pandemic. No conflict of interest
ABSTRACT
Background: Patients with Bipolar Disorder (BD) are highly vulnerable to stressful events and can experience a wide range of symptoms and emotions in the immediate aftermath of exposure, leading to a later onset of Post-traumatic stress disorder (PTSD) [1]. Peritraumatic Distress (PD) encompasses several negative physiological, emotional, and cognitive responses that occur immediately after the event, such as: a sense of personal life threat;feelings of fear helplessness and horror;guilt, shame and anger;loss of bowel and bladder control;shaking, trembling, and increased heart rate [2,3]. Increasing studies highlighted that PD may predict the development of PTSD symptoms in subjects exposed to potential traumatic events [4]. However, scant data are still available about the effects of the COVID-19 pandemic on the clinical course of BD [5]. Objective: The aim of this study was to investigate PD symptoms related to the COVID-19 emergency in a sample of patients with BD in euthymic phase at the time of the acute phase of the pandemic and their possible correlation with PTSD symptoms emerged within a 6-month follow-up. Methods: Ninety-two patients with BD were enrolled at the Psychiatric Clinic of the University of Pisa (Italy) during the first wave of the COVID-19 pandemic in Italy and assessed at baseline (T0) by means of the Impact Event Scale – revised (IES-R), to explore PTSD symptoms, and the Peritraumatic Distress Inventory (PDI), to investigate PD;the IER-R was submitted again after a 6-month (T1) follow-up. Comparative analyses were performed using Student's t-test for parametric variables. In the case of comparison of categorical variables, chi-squared test was utilized. A logistic regression model was used to identify the factors associated with the development of PTSD at T1. Results: Thirteen (14.1%) patients with BD reported PTSD symptoms (IES-R score ≥ 24) after a 6-month follow-up. Subjects with PTSD at T1 were more represented by females (92.3% vs. 58.2%, p=0.040) and reported higher IES-R (26.4±14.5 vs. 16.2±12.2, p=0.008) and PDI (18.8±9.4 vs. 11.2±7.0, p=0.001) total scores at T0 than subjects without PTSD. Finally, a logistic regression model showed as PDI total scores at T0 was the only factor positively associated to the PTSD development at T1 [b=0.119 (SE=0.056), p=0.033]. Conclusions: COVID-19 pandemic represents a traumatic experience for individuals exposed to contagion, isolation or social-distancing measures and the dead of a loved one. Our findings suggest that PD related to the acute phase of COVID-19 outbreak could lead patients with a severe psychiatric disorder, such as BD, to be more prone to develop PTSD. Detecting symptomatological post-traumatic stress trajectories by means of clinical longitudinal assessments (including the impact of subjective experience on trauma psychopathology) will be useful for the investigation of possible predictive factors of unfavourable outcome after a traumatic event in BD. No conflict of interest
ABSTRACT
Background: Post-Traumatic Stress Disorder (PTSD) is a severe psychiatric disorder, developed in response to the exposure to one or more traumatic events, and characterized by typical disabling symptoms, chronic course, significant deterioration in the quality of life and a high suicidal risk [1]. Healthcare emergency personnel are a high-risk category for the development of PTSD, due to the repeated exposure to stressful and traumatic experiences during their work activities [2]. In such healthcare professionals can frequently occur also a Burnout Syndrome, that is a condition resulting from a work-related stress-causing process, determining a combination of emotional exhaustion, depersonalization and a reduction of personal abilities [3]. PTSD and Burnout present a complex, and not fully explored, relationship, because of the shared risk factors and overlapping symptomatic manifestations [4]. Objective: The aim of this study is to investigate PTSD, post-traumatic stress spectrum symptoms, Burnout Syndrome, and their relationship, in a sample of emergency operators of a major University Hospital of Italy. Methods: The study sample included 110 emergency operators (Emergency Room, Emergency Medicine, Intensive Care Unit) of the “Azienda Ospedaliero-Universitaria Pisana” (A.O.U.P., Pisa, Italy). Participants were administered the Trauma and Loss Spectrum - Self Report (TALS-SR), to investigate full or partial DSM-5 PTSD and posttraumatic stress spectrum symptoms related to the work activity, and the Professional Quality of Life Scale - Revision IV (ProQOL R-IV), to examine Compassion satisfaction, Burnout and Compassion fatigue related to work. We used the Kruskal-Wallis test for independent samples to evaluate the differences in ProQOL scales between subjects with full PTSD, partial PTSD and without PTSD. Spearman's correlation coefficients were used to verify the possible associations between the TALS-SR symptomatological domains and the three dimensions of ProQOL. Results: Fifteen subjects reported a full (15.05%) and 25 a partial (26.88%) symptomatological DSM-5 PTSD. The ProQOL Compassion Satisfaction subscale mean score did not show statistically significant differences between the three groups. Healthcare operators with PTSD reported higher scores with respect to individuals without PTSD in the ProQOL Burnout and the Compassion Fatigue subscales (18.6±4.9 versus 13.9±4.4, p=0.014;and 14.38±4.073 versus 9.9±3.9, p=0.001 respectively). Pearson's linear correlation between the TALS-SR symptomatological domains, and the ProQOL subscales highlighted significant relationships between Burnout and Reactions to losses or upsetting events (r=0.236, p=0.035), Re-experiencing (r=0.248, p=0.027) or Avoidance and numbing (r=0.319, p=0.004);and between Compassion fatigue and Reactions to losses or upsetting events (r=0.293, p=0.008), Re-experiencing (r=0.359, p=0.001) or Avoidance and numbing (r=0.406, p<0.001). Conclusions: This work underlines a positive correlation between Burnout Syndrome and Post-traumatic stress spectrum symptoms in emergency operators, highlighting the clinical importance of a deeper assessment of work-related trauma and post-traumatic stress manifestations in these subjects to improvethe well-being and to prevent Burnout Syndrome. In this regard, increasing attention is required particularly in healthcare emergency operators due to COVID-19 pandemic, in order to strengthen the training of psychological skills aimed at mitigating the impact of a such stressful and traumatic event [5]. No conflict of interest