ABSTRACT
Purpose The stressful global situation due to the COVID-19 pandemic has had a tremendous impact on mental health in hospitalized patients with schizophrenia. The mediating roles of psychological impacts related to COVID-19 sleep quality and emotional distress were investigated in the association between childhood trauma and suicide risk in inpatients with schizophrenia. Methods A total of 270 participants, including 125 in-patients with schizophrenia and 145 healthy controls (HCs) were enrolled. Childhood trauma, psychological impact related to COVID-19, global sleep quality, and psychological distress were measured using the Childhood Trauma Questionnaires (CTQ), Impact of Event Scale-Revised (IES-R), Pittsburgh Sleep Quality Index (PSQI), and Depression, Anxiety and Stress Scale (DASS-21), respectively. Results The total score and subtype scores of CTQ and the mean scores of the IES-R, PSQI, and DASS-21 in patients with schizophrenia were higher than those in HCs (all p < 0.001). Hierarchical linear regression analyses showed that a history of childhood trauma or schizophrenia was a good predictor of psychological impact, global sleep quality, and emotional distress (all p < 0.01). Moreover, the chain mediation model showed that the effect of childhood trauma on suicide risk in hospitalized patients with schizophrenia was totally sequentially mediated by thepsychological impact of COVID-19, sleep quality, and emotional distress. Conclusions It is important for clinicians to recognize the increased suicide risk associated with COVID-19-related psychological distress in patients with schizophrenia with a history of childhood trauma.
Subject(s)
COVID-19ABSTRACT
Background: Coronavirus-2019 (COVID-19) has been coexisting with humans for almost 2 years, consistently impacting people's daily life, medical environment, and mental health. This study aimed to test the series mediation model triggered by childhood trauma, in which perceived psychological impact of COVID-19 pandemic and sleep quality mediated the path sequentially and led to adverse mental health outcomes. Methods: A cross-sectional design involving 817 participants were enrolled via WeChat online survey. Participants completed questionnaires, including demographic features, the Childhood Trauma Questionnaire, Impact of Event Scale-Revised (IES-R) questionnaire, Pittsburgh Sleep Quality Index (PSQI) questionnaire, and Depression, Anxiety, and Stress Scale (DASS-21). Pearson correlations and hierarchical multiple linear regression were employed to examine the association of childhood trauma and psychological stress of COVID-19, sleep quality, and mental health status. In addition, a series mediate analysis was carried out to examine sequence mediating effects of psychological impact of COVID-19 and sleep quality between childhood trauma and mental health status. Results: The results showed that childhood trauma is positively and significantly related to psychological distress of COVID-19 pandemic, sleep quality, and mental health status (p < 0.05). Hierarchical multiple linear regression analysis shown that demographic features explained 4.4, 2.1, and 4.0% of the total variance in DASS-21, IES-R, and PSQI total scale scores, respectively. Adding childhood trauma significantly increased the model variance of DASS-21 (ΔR 2 = 0.129, F = 126.092, p = 0.000), IES-R (ΔR 2 = 0.062, F = 54.771, p = 0.000), and PSQI total scale scores (ΔR 2 = 0.055, F = 48.733, p = 0.000), respectively. Moreover, the series mediation model showed that the perceived impact of the COVID-19 pandemic and sleep quality were sequential mediators between childhood trauma and mental health status (proportion explained: 49.17%, p < 0.05). Conclusion: Amid the ravages of COVID-19, childhood trauma predicts poor mental health status, in part because of greater psychological impact related to COVID-19 and poorer global sleep quality. In order to improve mental health, future researchers should pay more attention to individuals with childhood trauma, for its association with greater stress related to life events and poorer sleep quality.