What symptoms best predict severe distress in an online survey of UK health and social care staff facing COVID-19: development of the two-item Tipping Point Index

ObjectivesCOVID-19 has altered standard thresholds for identifying anxiety and depression. A brief questionnaire to determine when individuals are at a tipping point for severe anxiety or depression would greatly help decisions about when to seek assessment or treatment.DesignData were collected as part of the Frontline-COVID Study, a cross-sectional national online survey with good coverage of health and social care settings. New questionnaire items reflecting when coping was actually breaking down were compared with standard measures of severe anxiety and depression. Data were collected between 27 May and 23 July 2020.SettingThe majority of participants worked in hospitals (53%), in nursing or care homes (15%), or in other community settings (30%).ParticipantsOf 1194 qualifying respondents, 1038 completed the six tipping point items. Respondents included nurses, midwives, doctors, care workers, healthcare assistants, allied healthcare professionals and other non-medical staff. Over 90% were white and female.Main outcome measuresThreshold for severe anxiety according to the Generalised Anxiety Disorder Scale-7 or moderately severe depression according to the Patient Health Questionnaire-9.ResultsAnswering yes to one of two simple questions (‘Over the last week have you been often feeling panicky or on the point of losing control of your emotions?’, ‘Over the last week have you felt complete hopelessness about the future?’) demonstrated very high sensitivity (0.95, 95% CI 0.92 to 0.97) and negative predictive value (0.97, 95% CI 0.95 to 0.98). Answering yes to both questions yielded high specificity (0.90, 95% CI 0.87 to 0.92) and positive predictive value (0.72, 95% CI 0.67 to 0.77). Results were replicated in two random subsamples and were consistent across different genders, ethnic backgrounds, and health or social care settings.ConclusionsAnswering two simple yes/no questions can provide simple and immediate guidance to assist with decisions about whether to seek further assessment or treatment.

Anticipating PTSD in severe COVID survivors: the case for screen-and-treat Anticipando el TEPT en los sobrevivientes de COVID severo: El caso para detección y tratamiento 预测重症 COVID 幸存者的 PTSD: 筛查和治疗的案例

Based on research from previous pandemics, studies of critical care survivors, and emerging COVID-19 data, we estimate that up to 30% of survivors of severe COVID will develop PTSD. PTSD is frequently undetected across primary and secondary care settings and the psychological needs of survivors may be overshadowed by a focus on physical recovery. Delayed PTSD diagnosis is associated with poor outcomes. There is a clear case for survivors of severe COVID to be systematically screened for PTSD, and those that develop PTSD should receive timely access to evidence-based treatment for PTSD and other mental health problems by multidisciplinary teams. HIGHLIGHTS We anticipate that up to 30% of survivors of severe COVID will develop PTSD, yet PTSD is frequently undetected in primary and secondary care settings. There is, therefore, a clear case for establishing systematic screening and ensuring timely access to treatment.

Anticipating PTSD in severe COVID survivors: the case for screen-and-treat.

Based on research from previous pandemics, studies of critical care survivors, and emerging COVID-19 data, we estimate that up to 30% of survivors of severe COVID will develop PTSD. PTSD is frequently undetected across primary and secondary care settings and the psychological needs of survivors may be overshadowed by a focus on physical recovery. Delayed PTSD diagnosis is associated with poor outcomes. There is a clear case for survivors of severe COVID to be systematically screened for PTSD, and those that develop PTSD should receive timely access to evidence-based treatment for PTSD and other mental health problems by multidisciplinary teams.

Basados en la investigación de pandemias previas, los estudios de los sobrevivientes a cuidados críticos, y los datos emergentes de COVID-19, estimamos que hasta un 30% de los sobrevivientes del COVID grave desarrollarán TEPT. El TEPT es frecuentemente subdetectado en los servicios de salud primarios y secundarios y las necesidades psicológicas de los sobrevivientes puede verse eclipsadas por un enfoque en la recuperación física. El diagnóstico tardío de TEPT se asocia con pobres resultados. Existe un caso claro para que los sobrevivientes del COVID grave sean evaluados sistemáticamente para detectar el TEPT, y aquellos que desarrollan un TEPT deben tener acceso oportuno a tratamientos basados en la evidencia para el TEPT y para otros problemas de salud mental por equipos multidisciplinarios.

Cost-effectiveness of 'screen-and-treat' interventions for post-traumatic stress disorder following major incidents.

OBJECTIVES: Post-traumatic stress disorder (PTSD) is commonly experienced in the aftermath of major incidents such as terrorism and pandemics. Well-established principles of response include effective and scalable treatment for individuals affected by PTSD. In England, such responses have combined proactive outreach, screening and evidence-based interventions (a 'screen-and-treat' approach), but little is known about its cost-effectiveness. The objective of this paper is to report the first systematic attempt to assess the cost-effectiveness of this approach. METHODS: A decision modelling analysis was undertaken to estimate the costs per quality-adjusted life-year (QALY) gained from a screen-and-treat approach compared with treatment-as-usual, the latter involving identification of PTSD by general practitioners and referral to psychological therapy services. Model input variables were drawn from relevant empirical studies in the context of terrorism and the unit costs of health and social care in England. The model was run over a 5-year time horizon for a hypothetical cohort of 1000 exposed adults from the perspective of the National Health Service and Personal Social Services in England. RESULTS: The incremental cost per QALY gained was £7931. This would be considered cost-effective 88% of the time at a willingness-to-pay threshold of £20 000 per QALY gained, the threshold associated with the National Institute for Health and Care Excellence in England. Sensitivity analysis confirmed this result was robust. CONCLUSIONS: A screen-and-treat approach for identifying and treating PTSD in adults following terrorist attacks appears cost-effective in England compared with treatment-as-usual through conventional primary care routes. Although this finding was in the context of terrorism, the implications might be translatable into other major incident-related scenarios including the current COVID-19 pandemic.

Predictors and rates of PTSD, depression and anxiety in UK frontline health and social care workers during COVID-19.

Background: Studies have shown that working in frontline healthcare roles during epidemics and pandemics was associated with PTSD, depression, anxiety, and other mental health disorders. Objectives: The objectives of this study were to identify demographic, work-related and other predictors for clinically significant PTSD, depression, and anxiety during the COVID-19 pandemic in UK frontline health and social care workers (HSCWs), and to compare rates of distress across different groups of HCSWs working in different roles and settings. Methods: A convenience sample (n = 1194) of frontline UK HCSWs completed an online survey during the first wave of the pandemic (27 May - 23 July 2020). Participants worked in UK hospitals, nursing or care homes and other community settings. PTSD was assessed using the International Trauma Questionnaire (ITQ); Depression was assessed using the Patient Health Questionnaire-9 (PHQ-9); Anxiety was assessed using the Generalized Anxiety Disorder Scale (GAD-7). Results: Nearly 58% of respondents met the threshold for a clinically significant disorder (PTSD = 22%; anxiety = 47%; depression = 47%), and symptom levels were high across occupational groups and settings. Logistic regression analyses found that participants who were concerned about infecting others, who could not talk with their managers if there were not coping, who reported feeling stigmatized and who had not had reliable access to personal protective equipment (PPE) were more likely to meet criteria for a clinically significant mental disorder. Being redeployed during the pandemic, and having had COVID were associated with higher odds for PTSD. Higher household income was associated with reduced odds for a mental disorder. Conclusions: This study identified predictors of clinically significant distress during COVID-19 and highlights the need for reliable access to PPE and further investigation of barriers to communication between managers and staff.

Antecedentes: Los estudios han mostrado que el trabajo en roles de primera línea de salud durante epidemias y pandemias se asoció a TEPT, depresión, ansiedad y otros trastornos de salud mental.Objetivos: Los objetivos de este estudio fueron identificar predictores demográficos, predictores relacionados al trabajo y otros, para TEPT, depresión y ansiedad clínicamente significativos durante la pandemia por COVID-19 en la primera línea de trabajadores sociales y de la salud (HSCWs), y comparar las tasas de afectación entre los diferentes grupos de HSCWs trabajando en diferentes roles y contextos.Métodos: Una muestra por conveniencia (n=1194) de la primera línea de HSCWs en Reino Unido completó un cuestionario en línea durante la primera ola de la pandemia (27 de mayo ­ 23 de julio de 2020). Los participantes trabajaban en hospitales del Reino Unido, centros asistenciales u otros contextos clínicos comunitarios. Se evaluó TEPT usando el Cuestionario Internacional de Trauma (ITQ); la depresión fue evaluada usando el Cuestionario sobre la salud del paciente 9 (PHQ-9); la ansiedad fue evaluada usando la Escala sobre Trastorno Ansioso (GAD-7).Resultados: Cerca del 58% de los participantes cumplieron el umbral para algún trastorno clínicamente significativo (TEPT = 22%; ansiedad = 47%; depresión = 47%), y los niveles de síntomas fueron altos entre los grupos y contextos ocupacionales. Los análisis de regresión logística encontraron que los participantes que estaban preocupados respecto a contagiar a otros; quienes no pudieron hablar con sus administradores cuando no se estaban adaptando a la situación; quienes reportaron sentirse estigmatizados y quienes no tuvieron acceso a elementos de protección personal (EPP) confiables, tuvieron mayor probabilidad de cumplir los criterios para un trastorno mental clínicamente significativo. Ser redistribuido a otras funciones durante la pandemia, y haber tenido COVID se asociaron a mayores probabilidades de desarrollar TEPT. Un mayor ingreso familiar se asoció con menores probabilidades de desarrollar un trastorno mental.Conclusiones: Este estudio identificó predictores para afectación clínicamente significativa durante la pandemia por COVID-19 y resalta la necesidad de un acceso confiable a EPP y de mayor investigación sobre las barreras de comunicación entre los administradores y los equipos de trabajo.