Stress induced by the COVID-19 health situation in a cohort of 111 subjects present in the Bataclan concert hall during the November 2015 terrorist attacks in Paris.

Background: The management of the psychological consequences of the COVID-19 pandemic is all the more difficult when subjects suffer from a prior psychiatric illness. BV13 is a 54-month prospective longitudinal cohort study of 111 subjects who were present in the Bataclan concert hall during the November 2015 terrorist attack in Paris. Objectives: Our first objective was to investigate the association between stress related to the COVID-19 pandemic and PTSD symptoms, notably with respect to two positive risk factors: trait mindfulness and social support. The second was to explore how PTSD severity mediated the relationship between trait mindfulness and COVID-19-induced stress. Method: The primary endpoint was evaluated using the COVID-19 Peritraumatic Distress Index (CPDI). PTSD symptoms were evaluated using the PTSD Check List Scale (PCL-5) during the sanitary crisis and two years before. Social support was assessed with a Likert scale that measured perceived support from family, friends and the workplace. Trait mindfulness was measured with the 14-item Freiburg Mindfulness Inventory (FMI). Results: 54 months after the attack, a univariate analysis identified a significant positive correlation between COVID-19 stress (CPDI) and PCL-5 (r=0.77, p<0.01) scores, on the one hand, and significant negative correlations with FMI (r=-0.59, p<0.01), and social support (r=-0.28, p<0.01) scores, on the other hand. In the multivariate model, CPDI scores were closely associated with PCL-5 scores (p<0.01) after adjustment for FMI and social support scores. CPDI and FMI scores were significantly associated (p=0.05), but not CPDI and social support scores (p=0.89). The PTSD score was a strong mediator of the relationship between trait mindfulness (FMI) and COVID-19 stress (CPDI) scores. Conclusion: PTSD symptoms diminished the beneficial impact of trait mindfulness on stress related to COVID-19. Our finding highlights that subjects with previous experience of trauma need specific treatment for PTSD symptoms during the COVID-19 crisis.

Antecedentes: El manejo de las consecuencias psicológicas de la pandemia del COVID-19 es aún más difícil cuando los sujetos padecen de una enfermedad psiquiátrica previa. BV13 es un estudio de cohorte longitudinal prospectivo de 54 meses de 111 sujetos que estuvieron presentes en la sala de conciertos Bataclan durante el ataque terrorista de Noviembre del 2015 en Paris.Objetivos: Nuestro primer objetivo fue el de investigar la asociación entre estrés relacionado con la pandemia de COVID-19 y síntomas de TEPT, en particular con respecto a dos factores de riesgo positivos: rasgos de atención plena (Mindfulness) y apoyo social. El segundo fue de explorar cómo la severidad del TEPT mediaba la relación entre los rasgos de atención plena y el estrés inducido por COVID-19.Método: El criterio de evaluación principal se evaluó usando el Índice de Malestar Peri traumático COVID-19 (CPDI en sus siglas en ingles). Los síntomas de TEPT se evaluaron usando la Escala de lista de chequeo para TEPT (PCL-5) durante la crisis sanitaria y dos años antes. El apoyo social fue evaluado con una escala de Lickert que medía el apoyo percibido por la familia, los amigos y el lugar de trabajo. Los rasgos de atención plena se midieron con el Inventario de Mente plena de Friburgo (FMI en sus siglas en ingles).Resultados: 54 meses después del ataque, un análisis univariado identifico una correlación positiva significativa entre los puntajes de estrés por COVID-19 (CPDI) y el PCL-5 (r= 0.77, p<0.01), por una parte, y una correlación negativa significativa con los puntajes de FMI (r= −0.59, p<0.01) y apoyo social (r= −0.28, p<0.01), por otro lado. En el modelo multivariado, los puntajes de CPDI se asociaron estrechamente con los puntajes del PCL-5 (p<0.01) después del ajuste por FMI y puntajes de apoyo social. Los puntajes de CPDI y FMI se asociaron significativamente (p=.05), pero no los puntajes CPDI y apoyo social (p=.89). El puntaje de TEPT fue un fuerte mediador de la relación entre rasgos de atención plena (FMI) y los puntajes de estrés por COVID-19 (CPDI).Conclusión: Los síntomas de TEPT disminuyeron el impacto beneficioso de los rasgos de atención plena en el estrés relacionado con COVID-19. Nuestros hallazgos enfatizan que los sujetos con experiencias previas de trauma necesitan un tratamiento específico para los síntomas de TEPT durante la crisis COVID-19.

Crisis Standards of Care.

Nursing considerations during states of emergency.

Baseline well-being, perceptions of critical incidents, and openness to debriefing in community hospital emergency department clinical staff before COVID-19, a cross-sectional study.

BACKGROUND: Emergency department personnel routinely bear witness to traumatic experiences and critical incidents that can affect their own well-being. Peer support through debriefing has demonstrated positive impacts on clinicians' well-being following critical incidents. This study explored community hospital emergency department staff's perceptions of critical incidents, assessed openness to debriefing and measured baseline well-being. Our analysis provides a baseline of provider well-being immediately prior to the local onset of COVID-19. The potential need for additional resources to support frontline providers during the pandemic can be evaluated. METHOD: We conducted a cross-sectional study for 4-weeks prior to the first COVID-19 case in Connecticut using a survey offered to an interprofessional group of emergency department clinical staff. The main outcome measures were the Hospital Anxiety and Depression Scale (HADS) and the Professional Quality of Life (ProQOL) scale. Pearson's chi-square test was used to identify significant differences in perceptions of critical incidents and debriefings between professional categories. One-way ANOVA and Tukey's test were used to analyze significant differences in well-being between professional categories. RESULTS: Thirty-nine clinical personnel from St. Vincent's Emergency Department responded to the survey. Events frequently selected as critical incidents were caring for critically ill children (89.7%), mass casualty events (84.6%), and death of a patient (69.2%). Critical incidents were commonly reported (81.6%) as occurring once per week. Additionally, 76.2% of participants reported wanting to discuss a critical incident with their team. Across all respondents, 45.7% scored borderline or abnormal for anxiety, 55.9% scored moderate for burnout, and 55.8% scored moderate to high for secondary traumatic stress. CONCLUSIONS: At baseline, providers reported caring for critically ill children, mass casualty events, and death of a patient as critical incidents, which typically occurred once per week. Death of a patient occurs at increased frequency during the protracted mass casualty experience of COVID-19 and threatens provider well-being. Receptiveness to post-event debriefing is high but the method is still underutilized. With nearly half of staff scoring borderline or abnormal for anxiety, burnout, and secondary traumatic stress at baseline, peer support measures should be implemented to protect frontline providers' well-being during and after the pandemic.