Post-Traumatic Stress Disorder in Patients with Rheumatic Diseases During the COVID-19 Outbreak​ (preprint)

Background: The COVID-19 pandemic is not only a traumatic event, but a collective stressor unfolding over time, causing alarming implications for the mental health. This study aims to shed light on the mental health status of patients with rheumatic disease (RD) during the massive outbreak of COVID-19 in China, especially the prevalence and severity of post-traumatic stress disorder (PTSD) compared with the levels in healthy people. Methods: A questionnaire survey was conducted in a cross-sectional study of 486 RD patients and 486 healthy control subjects. We collected participants’ demographic and clinical characteristics and surveyed the prevalence and severity of PTSD and sleep quality in the samples using the PTSD Checklist for DSM-5 (PCL-5) and 4 items from the Pittsburgh Sleep Quality Index (PSQI). Findings: Compared with healthy control subjects (n=486), RD patients (n=486) had a higher prevalence of PTSD (12·1% vs. 4·1%; p<0·001). They also had higher total scores on the PCL-5 and on all four items from the PSQI (p≤ 0·001). Female gender, old age, poor sleep quality, long duration of RD, poor subjective evaluation of the disease and pessimistic subjective perception of the epidemic were identified as risk factors for PTSD in RD patients during the COVID-19 epidemic. Interpretation: During the COVID-19 outbreak, RD patients presented a higher prevalence and severity of PTSD and more sleep disturbances. Our findings confirm the importance of psychological assessment and mental health care in addition to regular clinical care for RD patients during the pandemic. Funding: National Natural Science Foundation of China, China Ministry of Science and Technology, Shanghai Municipal Key Clinical Specialty Fund.Declaration of Interests: The authors declare no competing interests.Ethics Approval Statement: This study was approved by the Human Research Ethics Committee of Changzheng Hospital, and informed consent was obtained from all participants.

Time Course of Psychological Impact for Male: Discovered in COVID-19 Cases (preprint)

The outbreak of Coronavirus Disease 2019 (COVID-19) pandemic is leading to widespread emotional distress such as post-traumatic stress disorder (PTSD). Our objective was to investigate the gender differences in PTSD symptoms (PTSS) among COVID-19 symptomatic patients over time caused by delayed medical visit. We investigated 258 confirmed cases of COVID-19 from two designated hospitals in Wuhan from 26 February to 16 March. PTSS was measured by PTSD Checklist for DSM-5 (PCL-5). Demographics and time interval from symptom onset to the first medical visit were also collected. The results show that 48 of 258 participants (18.6 %) met the criteria of PTSD symptoms. Males had significantly higher PCL-5 scores when time interval was 7 days or more compared with less than 7 days (22.18 vs. 15.11, t=-2.280, P<0.05), whereas no such significant time effect was found in females, regardless of the severity of the disease. The present study emphasizes the significant effect of time course on PTSS only in male. It is suggested that policy makers and health services should pay more attention to PTSD in male, and call on male to seek medical treatment as soon as developing symptoms of coronavirus disease if local medical conditions permitted.

High risk of infection caused posttraumatic stress symptoms in individuals with poor sleep quality: A study on influence of coronavirus disease (COVID-19) in China (preprint)

The influence of the outbreak of coronavirus disease (COVID-19) on mental health was poorly understood. The present study aimed to exam sleep problems and posttraumatic stress symptoms (PTSS) in Chinese immediately after the massive outbreak of COVID-19. A total of 2027 Chinese participated in the present study. Wuhan-expose history, sleep quality and PTSS were measured with self-rating scales. Results showed that there were significant differences of PCL-5 and of sleep quality scores in different data-collection dates (ps<0.05). There were significant differences of PCL-5 scores (p<0.05) and latency onset of sleep (p<0.05) between participants with and without Wuhan-expose history. The interaction effect of Wuhan exposure history x sleep quality significantly influenced PCL-5 (ps<0.05). These results indicate that keeping good sleep quality in individuals with high infectious risk is a way to prevent PTSS.

Prevalence and Risk Factors of Acute Posttraumatic Stress Symptoms during the COVID-19 Outbreak in Wuhan, China (preprint)

BackgroundTo exam the prevalence of and risk factors for acute posttraumatic stress disorder (PTSD) in Chinese people shortly after the COVID-19 outbreak. MethodsAn online questionnaire survey was conducted between 30 January and 3 February, 2020. The survey included two self-administered questionnaires: one was designed to require participants personal information (gender, age, education background), current location, recent epidemic area contact history, the classification of population, and subjective sleep quality; the other was the PTSD Checklist for DSM-5 (PCL-5). ResultsA total of 2091 Chinese participated in this study. The prevalence of PTSD among the Chinese public one month after the COVID-19 outbreak was 4.6%. Multiple linear regression analysis revealed that gender (p < 0.001), epidemic area contact history (p = 0.047), classification of population (p < 0.001), and subjective sleep quality (p < 0.001) could be regarded as predictor factors for PTSD. LimitationsFirst, the majority of participants in this study were the general public, and confirmed or suspected patients being a small part. Second, the measurement of PTSD might be vulnerable to selection bias because of an online self-report study, such as participants recruitment. Third, the prevalence of PTSD in this study was estimated by an online questionnaire rather than a clinical interview. ConclusionsThe results revealed that some Chinese showed acute PTSD during the COVID-19 outbreak. Therefore, comprehensive psychological intervention needs further implementation. Furthermore, females, people who having recent epidemic area contact history, those at high risk of infection or with poor sleep quality deserve special attention.