ABSTRACT
Background: The COVID-19 pandemic, with its uncertainties, fears of contagion, mass lockdowns and containment measures, has dramatically impacted on people's everyday lives leading to an increased risk of mental disorders, particularly Post-Traumatic Stress Disorder (PTSD). Despite evidence in general population and healthcare workers1,2, scant data emerged on vulnerable populations, such as of patients with chronic illness, particularly rheumatic and musculoskeletal diseases (RMDs)3,4, who also underwent difficulties in the management and treatment of their disorders. Objectives: To assess PTSD and post-traumatic stress symptoms in a sample of patients with RMDs, during the COVID-19 pandemic in Italy. Methods: PERMAS is a monocentric prospective observational study led by the Rheumatology Unit, the Psychiatric Clinic and the Institute of Management of the School of Advanced Studies. Patients with a RMD diagnosis, were consecutively enrolled from May 2021 to January 2022. During the visit, sociodemographic characteristics and psychopathological data were collected through online survey, whereas clinical data were collected by physician. The survey included the Trauma and Loss Spectrum-Self Report (TALS-SR) and the Impact of Event Scale-Revised (IES-R), aimed to assess symptomato-logical PTSD and post-traumatic stress symptoms related to the impact of the COVID-19 pandemic. Results: A total of 194 eligible patients, with a mean age of 50.3±12.17 years, was included: 142 (73.19%) were females;112 (57.74%) patients reported connective tissue diseases (CTD), 63 (32.47%) arthritis and 19 (9.8%) vasculitis. A total of 33 (17%) subjects reported a symptomatological PTSD by means of the TALS-SR. The prevalence of Partial PTSD (defned by at least 2 out of the 4 criteria for DSM-5 diagnosis of the disorder) was 56.7%, with signifcant higher rates among females (90, 81.8%) with respect to males (20, 18.2%) (p=.013). Accordingly, a IES-R mean total score of 21.90 ±15.98 was found in the total sample and a gender difference emerged, with higher mean scores among females rather than males (23.42 ±16.26 vs 21.90 ±15.98, p=.031). Conclusion: The present fndings point out high prevalence rates of symptoma-tological PTSD among patients suffering from RMDs, highlighting the potentially traumatic burden of the COVID-19 pandemic in this particular population, especially among females, suggesting the need of further investigations to address tailored prevention and intervention strategies.
ABSTRACT
Background: Management of the health emergency caused by COVID-19 pandemic majorly disrupted the delivery of healthcare services to patients with chronic conditions like Systemic Autoimmune Diseases (SAD), both because resources were mainly channeled towards the care of infected patients, but also because patients tended to avoid seeking medical care for fear of becoming infected. PER-MAS is a 2-year project aimed at assessing the clinical, psychopathological, and socio-economic impact of COVID-19 in a cohort of patients with SAD. Objectives: To assess the impact of COVID-19 pandemic on drug withdrawal, disease fares and hospitalizations for disease exacerbation in a cohort of patients with SAD through an interim analysis of data from the PER-MAS project. Methods: A sample of 214 consecutive patients was recruited in a reference center for rare and complex autoimmune diseases from April 2021 to January 2022. Inclusion criteria were definite diagnosis of SAD (Connective Tissue Disease (CTD), Inflammatory Arthritis (IA) or Vasculitis), regular follow-up and at least 2 years of disease. Patients were asked to fill out an extensive self-administered questionnaire on disease activity and healthcare resource use during the pandemic (March 2020-moment of assessment). Pre-pandemic (March 2019-February 2020) and early pandemic (March 2020-February 2021) clinical data were recorded through retrospective chart review and patient interview. Results: At enrolment, 119 patients were affected by CTDs (55.6%), 71 by IA (33.18%), 24 by vasculitis (11.21%), with mean age 50.44± 12.97, and mean disease duration 11.17 ± 8.94. 30.37% took steroids, 39.7% hydroxy-chloroquine, 61.68% DMARDs, and 9.3% vasoactive drugs. Overall, disease course was similar in pre-pandemic and early pandemic phase: in the first period, rheumatologic condition was stable in 57.35% of patients, persistently active in 27.3% and 35.61% had ≥ 1 episode of disease exacerbation (mean 0.665±1.15, range 0-6);in the second period, 60.56% of patients was stable, 24.88% persistently active, and 39.44% had ≥1 exacerbation (mean 0.49 ±0.77, range 0-4). Mean number of visits (2.56±2.57 and 2.61±2.79), hos-pitalizations (0.168±0.698 and 0.14±0.473, p=0.6), number of patients with outpatient visits=0 (7.47 vs 7%), and number of patients with ≥ 1 hospital admission (10.28 vs 11.6%) were also similar, while the number of patients with hospital admissions for disease exacerbation was significantly higher in the second period (6.1 vs 11.21%, p=0.001). 170 patients completed the survey: from March 2020 to enrolment, 18.2% suspended ≥1 anti-rheumatic drug (6.25% of them for fear of contracting COVID-19 disease, 15.6% for difficulty in obtaining medications), 20% self-managed ≥ 1 disease exacerbation, and 40% had ≥ 1 telemedicine consult. From March to July 2020, 41.76% had their visit rescheduled (35.23% for hospital access restrictions, 5.3% for travel restrictions, 1.17% for fear). Conversely, only 14.7% of patients had their visit rescheduled (8.23% for hospital access restrictions, 4.7% for other reasons) from July 2020 to enrolment. Conclusion: In the early pandemic phase, overall disease course was similar to the pre-pandemic phase, but we observed an increase in the number of patients with ≥ 1 hospitalization for disease. Moreover, despite our efforts, patients reported a non-negligible rate of drug discontinuation for non-medical indication and difficulty to get access to rheumatologic consultation, highlighting the need of alternative organizational models in case of future pandemics.
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: The recent COVID-19 pandemic pointed out new burdens for researchers on mental health and that evidence-based (EB) studies on vulnerable populations are timely needed. The present paper aims at analysing the impact of suspicious of SARS-COV-2 infection in a cohort of parents presented at 3 major hospitals (spread between north and center of Italy) during the Italian COVID-19 pandemic phase 1. METHODS: Participants of the present cross-sectional, multicenter study were parental couples of children suspected to have COVID-19 who underwent testing with nasopharyngeal swabbing. All subjects were assessed by means of the: Impact of Event Scale-Revised (IES-R), Generalized Anxiety Disorder 7-Item (GAD-7) and Patient Health Questionnaire-9 (PHQ-9) in order to evaluate Post-traumatic stress (PTSS), anxiety, and depressive symptoms, respectively. OUTCOMES: Results evidenced that parents whose children tested positive for COVID-19 were more prone to developing PTSS, anxiety and depressive symptoms. The same results emerged for parents who had quarantined as opposed to those who had not. Moreover, patients who suffered economic damage showed a higher prevalence of anxiety and depressive symptoms, whereas PTSS was more common among unemployed subjects and among mothers. INTERPRETATION: This study identified a mental health strain represented by parenting a child who tested positive for SARS-CoV-2 infection. Further EB research is needed to develop evidence-driven strategies to reduce adverse psychological impacts and related psychiatric symptoms in caregivers of COVID-19 infected children during the next phases of the pandemic.
Subject(s)
Anxiety Disorders/psychology , COVID-19/diagnosis , COVID-19/psychology , Parents/psychology , Quarantine/psychology , Stress Disorders, Post-Traumatic/psychology , Anxiety , Anxiety Disorders/etiology , COVID-19 Testing , Cross-Sectional Studies , Depression , Humans , Italy , Sex Factors , Socioeconomic Factors , Stress Disorders, Post-Traumatic/etiologyABSTRACT
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