Comparing the COVID-19-related PTSD symptoms between psychiatric patients and healthy subjects: an observational retrospective study from Northern Italy.

COVID-19 pandemic had a great impact on mental health, both in the general population and psychiatric patients. Little is known about the difference between these two populations in perceiving the pandemic as a traumatic event. The aim of the study was to compare psychiatric patients and healthy controls (HC) in terms of change over time of post-traumatic (PTSD) symptoms. Demographic and clinical variables were collected. Impact of Event Scale Revised (IES-R) scores were registered at T1 as lockdown period (March-April 2020) and T2 as restarting (May-June 2020). Descriptive analyses and linear regression models were performed. A total of 166 outpatients and 57 HC were recruited. Time (F = 15.76; p < 0.001) and diagnosis (F = 4.94; p < 0.001) had a significant effect on the change of IES-R scores, which resulted T1 > T2 (p < 0.001), except for subjects affected by Obsessive-Compulsive Disorder (OCD). Overall, IES-R scores were < in patients than in HC (p = 0.02), particularly in the schizophrenia (SKZ) subgroup (p < 0.001). IES-R scores of subjects with personality disorders (PDs) resulted to be > HC, although not statistically significant. The lockdown period was perceived as more traumatic than the reopening phase by both groups, with the exception of OCD patients, probably because of the clinical worsening associated with the urge of control against risks of contamination. Overall, HC reported more PTSD symptoms than psychiatric patients did, particularly SKZ ones. PD patients, in contrast, may be more vulnerable to PTSD symptoms probably as a result of poor coping skills. Together with OCD patients, subjects with PDs may need closer monitoring during the different phases of the pandemic. Trial Registration: ClinicalTrials.gov Identifier: NCT04694482.

Psychological Impact Among Newly Diagnosed Covid-19 Positive Cases

Background: India was one of the worst affected countries during the second wave of COVID-19 infection. The pandemic brought in a multitude of psychological problems leading to a negative impact on the mental health of affected individuals. Several studies across the globe have assessed the psychological impact of this pandemic in general and vulnerable populations with a scanty data in the assessment of those found positive for this condition. Material(s) and Method(s): This was a cross-sectional, descriptive and observational study conducted at a tertiary health care centre involved in the management of COVID-19 cases. Cases were assessed using a semi structured proforma for socio demographic and clinical details, Impact of Events Scale Revised (IES-R) and Patient Health Questionnaire- 9 S6(PHQ-9) to assess psychological impact. Descriptive and inferential statistics were used for data analysis. Result(s): A total of 60 individuals participated in the study. The mean age of the participants was 50.8 +/- 14.10 years, with a majority of males (65%). More than half (53%) of the individuals had minimal severity on IES-R while about 9% showed moderate to severe levels. About 32% had minimal depression while 25% had moderately severe or severe depression on PHQ-9 score. A significant positive correlation was observed between number of deaths due to COVID-19 infection in the family and IES-R scores. Conclusion(s): Higher levels of stress and depression were found among those found positive for COVID-19. This highlights the need for early assessment of psychological problems and timely intervention to avoid long term psychiatric sequelae to those affected by COVID-19 infection.

COVID-19 pandemic impact on mental health and quality of life among general population in Pakistan

Purpose: The purpose of this study was to evaluate the psychosocial impact during the current epidemic situation of COVID-19 in Pakistan. Design/methodology/approach: A total of 1,149 respondents were recruited in the study. Mental health status and psychological impact of COVID-19 outbreak were measured by impact of events scale-revised (IES-R) instrument and depression, anxiety and stress scales (DASS-21), respectively. Findings: Results of IES-R revealed moderate or severe psychological impact in 13.05% respondents (score > 33). DAAS score revealed that severe and extremely severe depression (score: 21-42), anxiety (score: 15-42) and stress (score: 27-42) were reported in 6.35%, 6.87% and 2.78% respondents, respectively. Higher levels of stress, anxiety and depression were recorded in female gender, student, medical professionals, farmer and daily wages employed, exhibiting significant (p < 0.05) association with psychological impact of the COVID-19 outbreak. Majority of respondents received increased support, shared feeling and family care. Originality/value: Mild to moderate psychological impact on mental health status was recorded in this study, which enables further planning and opportunities for health authorities to design psychological interventions for the improvement of negative psychological impact of COVID-19 epidemic in vulnerable groups. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

The Impact of Event Scale-Revised: Examining Its Cutoff Scores among Arab Psychiatric Patients and Healthy Adults within the Context of COVID-19 as a Collective Traumatic Event.

The Impact of Event Scale-Revised (IES-R) is the most popular measure of post-traumatic stress disorder (PTSD). It has been recently validated in Arabic. This instrumental study aimed to determine optimal cutoff scores of the IES-R and its determined six subscales in Arab samples of psychiatric patients (N = 168, 70.8% females) and healthy adults (N = 992, 62.7% females) from Saudi Arabia during the COVID-19 pandemic as a probable ongoing collective traumatic event. Based on a cutoff score of 14 of the Depression Anxiety Stress Scale 8-items (DASS-8), receiver operator curve (ROC) analysis revealed two optimal points of 39.5 and 30.5 for the IES-R in the samples (area under the curve (AUC) = 0.86 & 0.91, p values = 0.001, 95% CI: 0.80-0.92 & 0.87-0.94, sensitivity = 0.85 & 0.87, specificity = 0.73 & 0.83, Youden index = 0.58 & 0.70, respectively). Different cutoffs were detected for the six subscales of the IES-R, with numbing and avoidance expressing the lowest predictivity for distress. Meanwhile, hyperarousal followed by pandemic-related irritability expressed a stronger predictive capacity for distress than all subscales in both samples. In path analysis, pandemic-related irritability/dysphoric mood evolved as a direct and indirect effect of key PTSD symptoms (intrusion, hyperarousal, and numbing). The irritability dimension of the IES-R directly predicted the traumatic symptoms of sleep disturbance in both samples while sleep disturbance did not predict irritability. The findings suggest the usefulness of the IES-R at a score of 30.5 for detecting adults prone to trauma related distress, with higher scores needed for screening in psychiatric patients. Various PTSD symptoms may induce dysphoric mood, which represents a considerable burden that may induce circadian misalignment and more noxious psychiatric problems/co-morbidities (e.g., sleep disturbance) in both healthy and diseased groups.

A study to evaluate the effect of the COVID-19 pandemic on the mental health of junior doctors of a Government Medical College in West Bengal

Background: The COVID-19 pandemic had posed huge challenges to junior doctors as they had to work as frontline health workers during this emergency. Objectives: To evaluate the mental health status of junior doctors during the present pandemic using Depression, Anxiety, Stress Scale-21 (DASS-21) and impact of even scale-revised (IES-R) scale scores. Methods and Participants: This longitudinal study was conducted over a time period of 8 months after taking Institutional Ethical Clearance and informed consent of 220 participants. This online survey was conducted using Google Forms and DASS-21 and IES-R scores were evaluated twice in an interval of 6 months. Results: Depression scores, anxiety scores, and stress scores were significantly increased on the second assessment. Gradation of depression, anxiety, and stress in month 1 among participants were as follows: Depression scores (normal;mild;moderate;severe;extremely severe): 82;40;52;33;13. Anxiety scores (normal;mild;moderate;severe;extremely severe): 113;21;55;16;15. Stress scores (normal;mild;moderate;severe;extremely severe): 137;33;41;8;1. ISE-R scores: <24 = 98;24-32 = 39;33-36 = 15;≥37 = 68. Gradation of depression, anxiety, and stress in month 6 were the following: Depression scores (normal;mild;moderate;severe;extremely severe): 50;19;63;26;62. Anxiety scores (normal;mild;moderate;severe;extremely severe): 34;5;67;25;89. Stress scores (normal;mild;moderate;severe;extremely severe): 61;12;42;38;67. ISE-R Scores: <24 = 73;24-32 = 34;33-36 = 11;≥37 = 102. Conclusions: Junior doctors working during the COVID-19 pandemic developed increased levels of stress, anxiety, and depression with the progression of the pandemic. They were the major frontline health workers to combat COVID-19 which may be the cause of their decreased psychological resilience resulting in mental health issues. Psychological counseling sessions can be used among these young doctors to build up their mental resilience. © 2022 by the Author(s).

COVID-19 pandemic impact on mental health and quality of life among general population in Pakistan

Purpose: The purpose of this study was to evaluate the psychosocial impact during the current epidemic situation of COVID-19 in Pakistan. Design/methodology/approach: A total of 1,149 respondents were recruited in the study. Mental health status and psychological impact of COVID-19 outbreak were measured by impact of events scale-revised (IES-R) instrument and depression, anxiety and stress scales (DASS-21), respectively. Findings: Results of IES-R revealed moderate or severe psychological impact in 13.05% respondents (score > 33). DAAS score revealed that severe and extremely severe depression (score: 21-42), anxiety (score: 15-42) and stress (score: 27-42) were reported in 6.35%, 6.87% and 2.78% respondents, respectively. Higher levels of stress, anxiety and depression were recorded in female gender, student, medical professionals, farmer and daily wages employed, exhibiting significant (p < 0.05) association with psychological impact of the COVID-19 outbreak. Majority of respondents received increased support, shared feeling and family care. Originality/value: Mild to moderate psychological impact on mental health status was recorded in this study, which enables further planning and opportunities for health authorities to design psychological interventions for the improvement of negative psychological impact of COVID-19 epidemic in vulnerable groups. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

Rasch Modeling and Multilevel Confirmatory Factor Analysis for the Usability of the Impact of Event Scale-Revised (IES-R) during the COVID-19 Pandemic.

BACKGROUND: Several instruments are currently used to assess Coronavirus Disease 2019 (COVID-19) -induced psychological distress, including the 22-item Impact of Event Scale-Revised (IES-R). The IES-R is a self-administered scale used to assess post-traumatic stress disorder (PTSD). The current study aimed to examine the construct validity of the IES-R, based on the Rasch model, with COVID-19-related data, as well as to test the multilevel construct validity of the IES-R within and among countries during the pandemic crisis. METHODS: A multi-country web-based cross-sectional survey was conducted utilizing the 22-item IES-R. A total of 1020 participants enrolled in our survey, of whom 999 were included in the analyses. Data were analyzed using Rasch modeling and multilevel confirmatory factor analysis (MCFA). RESULTS: The Rasch modeling results of the IES-R demonstrated that the IES-R is a satisfactory instrument with the five-point Likert scale, asserting that its 22 items are significant contributors to assessing PTSD as a unidimensional construct covered by the items of the IES-R. The MCFA confirmed that the 22-item IES-R, with its three factors, including intrusion, avoidance, and hyperarousal, demonstrates adequate construct validity at the within- and among-country levels. However, the results of the Akaike information criterion (AIC) model determined that the 16-item IES-R is better than the 22-item IES-R. CONCLUSION: The results suggested that the 22-item IES-R is a reliable screening instrument for measuring PTSD related to the COVID-19 pandemic, and can be utilized to provide timely psychological health support, when needed, based on the screening results.

Development and Application of Global Health Events-Mental Stress Scale for Assessment of Medical Staff?s Acute Mental Stress Responses

Background: Medical workers have been increasingly involved in emergent public health events, which can lead to severe stress. However, no standardized, officially recognized, unified tool exists for mental distress measurement in medical workers who experienced the public health events. Purpose: In the present study, we propose the Global Health Events-Mental Stress Scale (GHE-MSS), as a revised version of the Impact of Event Scale-Revision (IES-R), for assessment of medical workers' acute mental stress responses within one month and their chronic mental stress responses within six months after major health events. Patients and methods: The IES-R was slightly modified, developed, and its reliability and validity were tested using the Delphi survey, primary survey with 115 participants, formal survey with 300 participants, and clinical evaluation with 566 participants. Results: Exploratory factor analysis and confirmatory factor analysis confirmed a promising validity of the scale. The values of Cronbach's alpha coefficient, the Spearman-Brown coefficient, and the retested Cronbach's alpha coefficient of the scale applied for the clinical evaluation were 0.88, 0.87, and 0.98, respectively, which confirmed a good internal consistency and stability. The results of the goodness-of-fit test indicated a good adaptation of the model. A correlation analysis was conducted to assess the correlation between the GHE-MSS and the PCL-C, which had a correlation coefficient of 0.68 (P < 0.01). Conclusion: GHE-MSS can be applied with a promising reliability and validity for the assessment of the acute mental stress response of medical workers experiencing public health events. This method can also be used for the screening of mental stress-associated disorders.

Measurement of risk and stressors of post-traumatic stress disorder during the first lockdown period of COVID-19 among Industrial workers, Hyderabad, India

Introduction: Post-traumatic stress disorder usually occurs after a traumatic event and the COVID-19 pandemic has affected mental health to a great extent. While there is extensive research being conducted about this aspect among the general population, the most neglected were the industrial workers during the first lockdown period. The aim of the study was to assess the risk of post-traumatic stress disorder symptoms using the impact of event scale-revised (IES-R), their main stressors and coping measurements among the industrial workers of Hyderabad. Methods: A telephonic interview schedule was adopted to fill the online questionnaire among industrial workers of age group 20-55 years during the lockdown period. Hundred and seventy-four participants were included in our study and data was collected using standardized tools IES-R and a brief resilient coping scale. Various stressors and also their coping strategies were elucidated. Results: At the risk of post-traumatic stress disorder, symptoms were found among 20.6% and at risk of suppressed immune system functioning which is presumed to have its effect for the next 10 years was13.8%. The main stressors of Covid -19 with increased IES-R score were staying away from family members, the influence of social media, Any acquaintance with COVID-19 infected person effects daily life and white-collar group. Coping measurements with a brief resilient coping scale found 17.4% as low resilient copers. Conclusion: This identification of high-risk post-traumatic stress disorder symptoms needs to be addressed earlier to bring up preventive strategies such as counseling services in the occupational health care centers of our industries. © 2022 Occupational Health and Safety Society of Nepal. All right reserved.

The Arabic Version of the Impact of Event Scale-Revised: Psychometric Evaluation among Psychiatric Patients and the General Public within the Context of COVID-19 Outbreak and Quarantine as Collective Traumatic Events.

The Coronavirus Disease-19 (COVID-19) pandemic has provoked the development of negative emotions in almost all societies since it first broke out in late 2019. The Impact of Event Scale-Revised (IES-R) is widely used to capture emotions, thoughts, and behaviors evoked by traumatic events, including COVID-19 as a collective and persistent traumatic event. However, there is less agreement on the structure of the IES-R, signifying a need for further investigation. This study aimed to evaluate the psychometric properties of the Arabic version of the IES-R among individuals in Saudi quarantine settings, psychiatric patients, and the general public during the COVID-19 outbreak. Exploratory factor analysis revealed that the items of the IES-R present five factors with eigenvalues > 1. Examination of several competing models through confirmatory factor analysis resulted in a best fit for a six-factor structure, which comprises avoidance, intrusion, numbing, hyperarousal, sleep problems, and irritability/dysphoria. Multigroup analysis supported the configural, metric, and scalar invariance of this model across groups of gender, age, and marital status. The IES-R significantly correlated with the Depression Anxiety Stress Scale-8, perceived health status, and perceived vulnerability to COVID-19, denoting good criterion validity. HTMT ratios of all the subscales were below 0.85, denoting good discriminant validity. The values of coefficient alpha in the three samples ranged between 0.90 and 0.93. In path analysis, correlated intrusion and hyperarousal had direct positive effects on avoidance, numbing, sleep, and irritability. Numbing and irritability mediated the indirect effects of intrusion and hyperarousal on sleep and avoidance. This result signifies that cognitive activation is the main factor driving the dynamics underlying the behavioral, emotional, and sleep symptoms of collective COVID-19 trauma. The findings support the robust validity of the Arabic IES-R, indicating it as a sound measure that can be applied to a wide range of traumatic experiences.

Assessment of post-traumatic stress disorder symptoms during COVID-19 pandemic among medical students

Introduction and Aim: Post traumatic stress disorder is known to be a usual response to distressing experiences. Common symptoms include recurrent events of anxiousness, emotional insensibility and escape mechanism. The COVID-19 pandemic is one such recent occasion that is likely to have an enormous psychological impact on medical student based on extreme social restrictions worldwide. This study therefore aims to investigate the post pandemic PTSD symptoms among first year medical students . Materials and Methods: Department of Physiology, Lord Buddha Koshi Medical College, Saharsa, conducted this observational study for a period of four months starting from September 2020 to December 2020. One hundred and forty-six students completed the most advanced Impact Event Scale-Revised (IES-R) questionnaire. Student’s t-test was performed to analyze the strength of association between PTSD symptoms among the participants. Results: The study concurs high level of PTSD between age-matched medical students after the occurrence of COVID-19 pandemic. The IES-R method of PTSD scoring system was used to arrive at this conclusion. However, this area of research requires multi-centric results to verify the outcome measures. Conclusion: Post pandemic PTSD symptoms were high among the first year medical students. © 2022, Indian Association of Biomedical Scientists. All rights reserved.

Risk of PTSD Due to the COVID-19 Pandemic Among Patients in Opioid Substitution Treatment.

Background: The impact of the COVID-19 pandemic on the mental health of patients suffering from addictive disorders is of major concern. This study aimed to explore the presence and potential increase in post-traumatic stress disorder (PTSD) symptoms, depression, and anxiety since the beginning of the pandemic for patients in opioid substitution therapy (OST). Methods: This cross-sectional survey study evaluated a clinical sample of patients in OST (N = 123). Symptoms of post-traumatic stress disorder (PTSD) due to the COVID-19 pandemic were assessed by an adapted version of the impact of event scale (IES-R), resulting in two subgroups of low and high risk for PTSD. The depression, anxiety, and stress scale (DASS-21) was applied to collect data on the respective symptoms, and changes since the onset of the pandemic were reported on separate scales. Sociodemographic and COVID-19 related factors, as well as data on craving, consumption patterns, concomitant use, and the drug market were further assessed. Results: A binary logistic regression analysis confirmed the impact of self-perceived higher burden by psychological and economic factors on the elevated risk for PTSD due to the pandemic. The high-risk PTSD group also showed higher levels of depression, anxiety and stress, as well as a more pronounced deterioration in these symptoms since the pandemic. While reported levels of craving did not differ between the two groups, the high-risk PTSD group indicated a significantly higher increase in craving since the crisis, when compared to the low-risk group. Discussion: Our findings demonstrate elevated levels of clinical symptoms among patients in OST, with more than a quarter of patients found at risk for PTSD due to the COVID-19 pandemic. Furthermore, about 30-50% of our patients reported concerning levels of depression, anxiety, or stress. Special attention should be drawn to these findings, and potential deterioration of the situation should be addressed by health care facilities. Particularly, psychological, and financial burden due to the crisis were identified as factors increasing the risk for PTSD. These factors can easily be evaluated during routine anamneses, and might be a valuable source of information, when special attention is needed.

Dental Students in Germany throughout the COVID-19 Pandemic: A Psychological Assessment and Cross-Sectional Survey.

Multiple investigations have reported high psychological distress among students since the coronavirus (COVID-19) outbreak started. This survey examined the associations between psychological features, and several demographic and social factors among dental students in German universities. Dental students registered in German universities nationwide were asked to join this survey via a self-directed online questionnaire, from July 2020 to January 2021. This study assembled data on demographic statistics, the depression anxiety stress scales (DASS-21), and the impact of events scale-revised (IES-R) instrument. The relationships between demographic-related variables and mental consequences of depression, anxiety, stress, intrusion, avoidance, and hyperarousal were inspected. Two hundred and eleven students contributed to the questionnaire and conveyed overall normal or mild outcomes of depression, anxiety, stress, intrusion, avoidance, and hyperarousal. In addition, female gender, cardiovascular diseases, smoking habits, and seeing the COVID-19 outbreak as a financial risk were stated as significant related factors (p < 0.05), with increased IES-R and DASS-21 scores. These results highlight the features that should be considered to better protect dental students' mental health in German universities during the crisis.

The Psychological Impact of the COVID-19 Pandemic on Dentists in Germany.

Since the announcement of the coronavirus 2019 (COVID-19) outbreak as a pandemic, several studies reported increased psychological distress among healthcare workers. In this investigation, we examined the association between psychological outcomes and various factors among German dentists. Dentists from all German federal states were invited to participate in this study through a self-administered online questionnaire between July and November 2020. This questionnaire collected information on demographics, Depression Anxiety Stress Scales (DASS-21), and the Impact of Events Scale-Revised (IES-R) instrument. The associations displayed between demographic and psychological outcomes of depression, anxiety, stress, intrusion, avoidance, and hyperarousal were evaluated. Seven-hundred-and-thirty-two dentists participated in the survey and reported overall scores of (4.88 ± 4.85), (2.88 ± 3.57), (7.08 ± 5.04), (9.12 ± 8.44), (10.68 ± 8.88) and (10.35 ± 8.68) for depression, anxiety, stress, intrusion, avoidance, and hyperarousal, respectively. For females, being between 50-59 years of age, being immune deficient or chronically ill, working at a dental practice, and considering the COVID-19 pandemic a financial hazard were reported as significant associated factors (p < 0.05) with higher DASS-21 and IES-R scores. These findings underline the aspects which need to be taken into attention to protect the mental wellbeing of dentists in Germany during the crisis.

Psychological Distress and Post-Traumatic Symptomatology Among Dental Healthcare Workers in Russia: Results of a Pilot Study.

The spread of SARS-CoV-2 infection has increased the risk of mental health problems, including post-traumatic stress disorders (PTSD), and healthcare workers (HCWs) are at greater risk than other occupational groups. This observational cross-sectional study aimed to explore the symptoms of depression, anxiety, and PTSD among dental HCWs in Russia during the coronavirus disease 2019 (COVID-19) pandemic. The survey was carried out among 128 dental HCWs from three dental clinics of Ekaterinburg, Russia. The mean age of the sample was 38.6 years. Depression, anxiety, and stress were assessed using the Depression Anxiety and Stress Scale-21 (DASS-21); PTSD was assessed using the PTSD Symptom Scale-Self-Report (PSS-SR); subjective distress was assessed using the Impact of Event Scale-Revised (IES-R). The results indicated that 20.3-24.2% HCWs had mild to extremely severe symptoms of psychological distress, and 7.1-29.7% had clinical symptoms of PTSD. No differences between females and males were revealed. HCWs working directly with patients had significantly higher levels of PTSD symptoms and the risk of PTSD development compared to those working indirectly, whereas older HCWs had significantly higher levels of both psychological distress and PTSD symptoms compared to younger HCWs. Thus, dental HCWs are at high risk for psychological distress and PTSD symptoms during the COVID-19 pandemic.

Individual Differences, Economic Stability, and Fear of Contagion as Risk Factors for PTSD Symptoms in the COVID-19 Emergency.

On January 30th 2020, the World Health Organization (WHO) declared the COVID-19 pandemic a Public Health Emergency of International Concern (PHEIC). Italy has been one of the most affected countries in the world. To contain further spread of the virus, the Italian government has imposed an unprecedented long-period lockdown for the entire country. This dramatic scenario may have caused a strong psychological distress, with potential negative long-term mental health consequences. The aim of the present study is to report the prevalence of high psychological distress due to the COVID-19 pandemic on the general population, especially considering that this aspect is consistently associated with PTSD symptoms. Furthermore, the present study aims to identify the risk factors for high PTSD symptoms, including individual differences and subjective perception of both economic and psychological aspects. We administered an online survey to 1253 participants during the peak period of the contagion in Italy. A logistic regression on the Impact of Event Scale - Revised (IES-R) scores was used to test the risk factors that predict the possibility to develop PTSD symptoms due to the COVID-19 pandemic. Gender (female), lower perceived economic stability, higher neuroticism, and fear and consequences of contagion were predictors of high PTSD symptomatology. The results, highlighted in the present study, extend our understanding of the COVID-19 pandemic's impact on the population's mental health, by identifying individuals at high-risk of developing PTSD. This may help with the implementation of specific protocols to prevent the possibility of developing symptoms of PTSD in target populations.