Coronavirus disease 2019 aftermath: psychological trauma in ICU healthcare workers.

PURPOSE OF REVIEW: We aim to describe the extent of psychological trauma and moral distress in healthcare workers (HCW) working in the intensive care unit (ICU) during the coronavirus disease 2019 (COVID-19) pandemic. Specifically, we review reports on prevalence of mental health symptoms, highlight vulnerable populations and summarize modifiable risk factors associated with mental health symptoms in ICU HCW. RECENT FINDINGS: The pandemic has resulted in a multitude of closely intertwined professional and personal challenges for ICU HCW. High rates of posttraumatic stress disorder (14-47%), burnout (45-85%), anxiety (31-60%), and depression (16-65%) have been reported, and these mental health symptoms are often interrelated. Most studies suggest that nurses and female HCW are at highest risk for developing mental health symptoms. The main personal concerns associated with reporting mental health symptoms among ICU HCW were worries about transmitting COVID-19 to their families, worries about their own health, witnessing colleagues contract the disease, and experiencing stigma from their communities. Major modifiable work-related risk factors were experiencing poor communication from supervisors, perceived lack of support from administrative leadership, and concerns about insufficient access to personal protective equipment, inability to rest, witnessing hasty end-of-life decisions, and restriction of family visitation policies. SUMMARY: The COVID-19 pandemic has severely impacted ICU HCW worldwide. The psychological trauma, manifesting as posttraumatic stress disorder, burnout, anxiety, and depression, is substantial and concerning. Urgent action by lawmakers and healthcare administrators is required to protect ICU HCW and sustain a healthy workforce.

COVID-19-related institutional betrayal associated with trauma symptoms among undergraduate students.

Individuals are dependent on institutions (e.g., universities, governments, healthcare systems) to protect their safety and advocate for their needs. When institutions harm the individuals who depend on them, they commit institutional betrayal, which has been associated with numerous negative outcomes in prior research. Throughout the COVID-19 pandemic, students have entrusted universities to protect both their health and their educational opportunities. However, many universities have failed to meet these expectations, and it is likely that many students experience COVID-19-related institutional betrayal. In two similar studies, we examined the prevalence and correlates of institutional betrayal among undergraduate students at a large, public university in the Northwest United States during the fall 2020 and winter 2021quarters. In both studies, more than half of students endorsed at least one type of COVID-19-related institutional betrayal, and higher institutional betrayal ratings were significantly correlated with both current trauma symptoms and COVID-19-related avoidance and intrusion cognitions. In Study 2, the relationship between COVID-19-related institutional betrayal and current trauma symptoms remained significant, even when controlling for gender, personal and familial COVID-19 infection, and past trauma history. These results indicate that COVID-19 institutional betrayal is common and may be uniquely associated with distress among undergraduate students. We suggest it would behoove university institutions to reduce COVID-19-related institutional betrayal.

Risk and protective factors, stressors, and symptoms of adjustment disorder during the COVID-19 pandemic - First results of the ESTSS COVID-19 pan-European ADJUST study.

Background: The COVID-19 pandemic exposes individuals to multiple stressors, such as quarantine, physical distancing, job loss, risk of infection, and loss of loved ones. Such a complex array of stressors potentially lead to symptoms of adjustment disorder. Objective: This cross-sectional exploratory study examined relationships between risk and protective factors, stressors, and symptoms of adjustment disorder during the first year of the COVID-19 pandemic. Methods: Data from the first wave of the European Society of Traumatic Stress Studies (ESTSS) longitudinal ADJUST Study were used. N = 15,563 participants aged 18 years and above were recruited in eleven countries (Austria, Croatia, Georgia, Germany, Greece, Italy, Lithuania, the Netherlands, Poland, Portugal, and Sweden) from June to November 2020. Associations between risk and protective factors (e.g. gender, diagnosis of a mental health disorder), stressors (e.g. fear of infection, restricted face-to-face contact), and symptoms of adjustment disorder (ADNM-8) were examined using multivariate linear regression. Results: The prevalence of self-reported probable adjustment disorder was 18.2%. Risk factors associated with higher levels of symptoms of adjustment disorder were female gender, older age, being at risk for severe COVID-19 illness, poorer general health status, current or previous trauma exposure, a current or previous mental health disorder, and longer exposure to COVID-19 news. Protective factors related to lower levels of symptoms of adjustment disorder were higher income, being retired, and having more face-to-face contact with loved ones or friends. Pandemic-related stressors associated with higher levels of symptoms of adjustment disorder included fear of infection, governmental crisis management, restricted social contact, work-related problems, restricted activity, and difficult housing conditions. Conclusions: We identified stressors, risk, and protective factors that may help identify individuals at higher risk for adjustment disorder.

Antecedentes: La pandemia de COVID-19 expone a las personas a múltiples factores estresantes, como la cuarentena, el distanciamiento físico, la pérdida del trabajo, el riesgo de infección, y la pérdida de seres queridos. Esta compleja serie de factores estresantes puede potencialmente conducir a síntomas del trastorno de adaptación.Objetivo: Este estudio exploratorio transversal examinó las relaciones entre los factores de riesgo y de protección, los factores estresantes, y los síntomas del trastorno de adaptación durante el primer año de la pandemia de COVID-19.Métodos: Se utilizaron datos de la primera ola del estudio longitudinal ADJUST de la Sociedad Europea de Estudios de Estrés Traumático (ESTSS en su sigla en inglés). N = 15.563 participantes de 18 años o más fueron reclutados en once países (Austria, Croacia, Georgia, Alemania, Grecia, Italia, Lituania, Países Bajos, Polonia, Portugal, y Suecia) de junio a noviembre de 2020. Se examinaron mediante regresión lineal multivariante las asociaciones entre los factores de riesgo y de protección (p. ej., género, diagnóstico de un trastorno de salud mental), factores estresantes (p. ej., miedo a la infección, contacto restringido cara a cara), y síntomas del trastorno de adaptación (ADNM-8 en su sigla en inglés).Resultados: La prevalencia del trastorno de adaptación probable autoinformado fue del 18,2%. Los factores de riesgo asociados con niveles más altos de síntomas del trastorno de adaptación fueron género femenino, edad avanzada, riesgo de enfermedad grave por COVID-19, peor estado de salud general, exposición a un trauma actual o anterior, un trastorno de salud mental actual o anterior, y una exposición más prolongada a las noticias de COVID-19. Los factores de protección relacionados con niveles más bajos de síntomas del trastorno de adaptación fueron mayores ingresos, estar jubilado, y tener más contacto cara a cara con sus seres queridos o amigos. Los factores estresantes relacionados con la pandemia que se asociaron con niveles más altos de síntomas del trastorno de adaptación incluyeron miedo a la infección, manejo gubernamental de crisis, contacto social restringido, problemas relacionados con el trabajo, actividad restringida, y condiciones de vivienda difíciles.Conclusiones: Identificamos factores estresantes, de riesgo, y protectores que pueden ayudar a identificar a las personas con mayor riesgo de trastorno de adaptación.

Vicarious traumatization in healthcare providers in response to COVID-19 pandemic in Kelantan, Malaysia.

BACKGROUND: In the fight against the COVID-19 pandemic, frontline healthcare providers who are engaged in the direct diagnosis, treatment, and care of patients face a high risk of infection yet receive inadequate protection from contamination and minimal support to cope with overwork, frustration, and exhaustion. These problems have created significant psychological and mental health concerns for frontline healthcare providers. This study aimed to compare the levels of vicarious traumatization between frontline and non-frontline healthcare providers in response to the COVID-19 pandemic. METHODOLOGY: All the subjects who met the inclusion criteria were recruited for this comparative cross-sectional study, which was conducted from May to July 2020 in two hospitals in Kelantan, Malaysia. A self-administered questionnaire, namely, the Malay-version Vicarious Traumatization Questionnaire and the Medical Outcome Study Social Support Survey were utilized. A descriptive analysis, independent t-test, and analysis of covariance were performed using SPSS Statistics version 26. RESULTS: A total of 160 frontline and 146 non-frontline healthcare providers were recruited. Vicarious traumatization was significantly higher among the non-frontline healthcare providers (estimated marginal mean [95% CI]: 79.7 [75.12, 84.30]) compared to the frontline healthcare providers (estimated marginal mean [95% CI]: 74.3 [68.26, 80.37]) after adjusting for sex, duration of employment, and social support. CONCLUSION: The level of vicarious traumatization was higher among non-frontline compared to frontline healthcare providers. However, the level of severity may differ from person to person, depending on how they handle their physical, psychological, and mental health. Hence, support from various resources, such as colleagues, family, the general public, and the government, may play an essential role in the mental health of healthcare providers.

A trauma-informed approach to the pediatric COVID-19 response.

To effectively care for children during COVID-19, pediatricians need to appreciate the stress and potential traumatic effect of the pandemic. By employing the "CARES" framework, pediatric providers can openly discuss the pandemic with patients and families, collaborate to build resiliency, and encourage engagement in activities and resources that are protective. This approach could potentially prevent both the short and long term health consequences resulting from the toxic stress and traumatic exposure of COVID-19. Pediatricians are uniquely positioned to mitigate the extent to which the pandemic affects the nation's children and we believe it is our responsibility to do so, to uphold the health and wellness of pediatric patients across their lifespan.

Adjustment disorder, traumatic stress, depression and anxiety in Poland during an early phase of the COVID-19 pandemic.

Background: The current COVID-19 pandemic is associated with a variety of stressors. Preliminary research has demonstrated that general public are experiencing a range of psychological problems, including stress-related disturbances. However, to date, there is not much research on the prevalence of adjustment disorder during the current pandemic. Objectives: This study aimed to assess the prevalence and severity of symptoms of adjustment disorder compared to posttraumatic symptoms, depression and generalized anxiety in a large sample of adult Poles, in the first phase of the current pandemic. Method: Self-report data from a web-based sample (N = 1,742) was collected between March 25 and April 27, just after the introduction of nationwide quarantine measures in Poland. Results: The current COVID-19 pandemic was a highly stressful event for 75% of participants and the strongest predictor of adjustment disorder. Increased symptoms of adjustment disorder were reported by 49%, and they were associated with female gender and not having a full-time job. However, after exclusion of co-occurring symptomatology, 14% of the sample were finally qualified as meeting diagnostic criteria of adjustment disorder. A substantial proportion of the sample screened also positive for generalized anxiety (44%) and depression (26%); the rate for presumptive PTSD diagnosis was 2.4%. Conclusions: High rates of negative mental health outcomes were found in the Polish population in the first weeks into the COVID-19 pandemic and lockdown measures. They indicate the intense current stress-related symptoms in the early phase of the pandemic and warrant further monitoring on population's mental health.

Antecedentes: La actual pandemia de COVID-19 está asociada con una variedad de estresores. Investigaciones preliminares han demostrado que la población general está experimentando una variedad de problemas psicológicos, incluyendo trastornos relacionados con el estrés. Sin embargo, hasta la fecha no hay mucha investigación acerca de la prevalencia de trastornos de adaptación durante la actual pandemia.Objetivos: Este estudio tuvo como objetivo evaluar la prevalencia y severidad de los síntomas del trastorno adaptativo comparado con los síntomas postraumáticos, depresión y ansiedad generalizada en una gran muestra de adultos polacos, en la primera fase de la actual pandemia.Método: Se recolectó información auto-reportada de una muestra basada en la web (N=1.742) entre el 25 de marzo y el 27 de Abril, justo después de la introducción de medidas de cuarentena a nivel nacional en Polonia.Resultados: La pandemia actual de COVID-19 fue un evento altamente estresante para el 75% de los participantes y el predictor más poderoso de trastorno de adaptación. 49% informó un aumento de síntomas de trastorno de adaptación, y se asociaron con género femenino y no tener trabajo de tiempo completo. Sin embargo, después de la exclusión de la sintomatología concurrente, 14% de la muestra cumplía los criterios para diagnóstico de trastorno de adaptación. Una proporción importante de la muestra tambien resultó positiva para ansiedad generalizada (44%) y depresión (26%): la tasa de diagnóstico presuntivo de TEPT fue de 2,4%.Conclusiones: Se encontraron altas tasas de consecuencias negativas de salud mental en la población Polaca en las primeras semanas de pandemia y medidas de confinamiento por COVID-19. Indican los intensos síntomas actuales relacionados con el estrés en la fase inicial de la pandemia y justifican un mayor seguimiento de la salud mental de la población.

[COVID-19: risks of psychological trauma for patients in intensive care or for their families]. / Covid-19 : risques de traumatismes psychologiques pour les malades en réanimation et leurs proches.

For serious cases of COVID-19, with severe respiratory failure due to damage to the lungs by SARS-CoV-2, hospitalisation in intensive care with intubation is often essential. What psychotraumatic risks does this episode present for these patients? Are these sudden, complex treatments, sometimes with fatal outcomes and frequently reported in the media, also a factor in the appearance of psychological trauma for families? These questions are the subject of this clinical reflection.

Pandemic-related mental health risk among front line personnel.

The mental health of frontline workers is critical to a community's ability to manage crises and disasters. This study assessed risks for mental health problems (traumatic stress, depression, anxiety, alcohol use, insomnia) in association with pandemic-related stressors in a sample of emergency and hospital personnel (N = 571). Respondents completed self-report surveys online from April 1st to May 7th, 2020 in the Rocky Mountain region of the United States. Results showed that roughly fifteen to thirty percent of respondents screened positive for each disorder. Odds of screening positive were similar between groups for probable acute traumatic stress, depressive disorder, anxiety disorder, and alcohol use disorder; emergency personnel reported significantly higher rates of insufficient sleep than healthcare workers. Logistic regressions showed that respondents who reported having an immunocompromised condition had higher odds of acute traumatic stress, anxiety, and depression. Having an immunocompromised household member was associated with higher odds of insufficient sleep and anxiety. Being in a direct care provision role was associated with higher odds of screening positive for risky alcohol use. Being in a management role over direct care providers was associated with higher odds of screening positive for anxiety, risky alcohol use, and insufficient sleep. There was an inverse relationship between number of positive COVID-19 cases and anxiety, such that as positive cases went up, anxiety decreased. Overall, the mental health risks that we observed early in the COVID-19 pandemic are elevated above previous viral outbreaks (SARS) and comparable to rates shown in disasters (9/11 attacks; Hurricane Katrina).

COVID-19 and traumatic stress: The role of perceived vulnerability, COVID-19-related worries, and social isolation.

The purpose of the present study was to propose and test two models to understand the relationship between perceived vulnerability to COVID-19 (PVC) and COVID-19-related traumatic stress (TS), as well as the variables that may mediate and moderate this relationship among individuals who have not yet been infected with COVID-19. Using an online survey, data were collected between late March and early April 2020. Participants were recruited through Amazon Mechanical Turk and included 747 adults living in the United States. Supporting our hypotheses, results indicated that both COVID-19-related worries and social isolation were significant mediators of the relationship between PVC and TS (Model 1). In addition, the results of a moderated mediation analysis indicated that the indirect effect of PVC on TS through COVID-19-related worries was stronger for participants who reported greater social isolation (Model 2). Although future research is needed, these findings suggest that both social isolation and disease-related worries may be important variables that can be targeted in interventions to reduce pandemic-related TS.

Developing thinking around mental health science: the example of intrusive, emotional mental imagery after psychological trauma.

INTRODUCTION: One route to advancing psychological treatments is to harness mental health science, a multidisciplinary approach including individuals with lived experience and end users (e.g., Holmes, E. A., Craske, M. G., & Graybiel, A. M. (2014). Psychological treatments: A call for mental-health science. Nature, 511(7509), 287-289. doi:10.1038/511287a). While early days, we here illustrate a line of research explored by our group-intrusive imagery-based memories after trauma. METHOD/RESULTS: We illustrate three possible approaches through which mental health science may stimulate thinking around psychological treatment innovation. First, focusing on single/specific target symptoms rather than full, multifaceted psychiatric diagnoses (e.g., intrusive trauma memories rather than all of posttraumatic stress disorder). Second, investigating mechanisms that can be modified in treatment (treatment mechanisms), rather than those which cannot (e.g., processes only linked to aetiology). Finally, exploring novel ways of delivering psychological treatment (peer-/self-administration), given the prevalence of mental health problems globally, and the corresponding need for effective interventions that can be delivered at scale and remotely for example at times of crisis (e.g., current COVID-19 pandemic). CONCLUSIONS: These three approaches suggest options for potential innovative avenues through which mental health science may be harnessed to recouple basic and applied research and transform treatment development.

From Individual To Social Trauma: Sources Of Everyday Trauma In Italy, The US And UK During The Covid-19 Pandemic.

The heterogeneity of COVID-19 experience and response for each individual is irrefutable; nevertheless, similarities can be observed between countries with respect to people's psychological responses. The main aim of this Commentary is to provide a cultural perspective of the sources of trauma, at the individual and social level, in three different countries: Italy, US and UK. The evidence from previous outbreaks, such as SARS, H1N1 flu, Ebola, and the ongoing Italian, the US, and the UK experience of COVID-19 shows that COVID-19 has introduced not only an individual trauma but also a collective trauma, that researchers should attend to now and in future global emergencies. Future clinical interventions should aim to reconnect dissociated parts both in the individual and in society. This commentary discusses four potential sources of trauma: high-stakes decision fatigue in healthcare professionals, traumatic grief, and bereavement in people who have lost loved ones, loss of roles and identity, and social divisions related to economic shutdown.

Media Exposure and Anxiety during COVID-19: The Mediation Effect of Media Vicarious Traumatization.

The rapid spread and high death rates of the COVID-19 pandemic resulted in massive panic and anxiety all over the world. People rely heavily on media for information-seeking during the period of social isolation. This study aimed to explore the relationship between media exposure and anxiety, and highlighted the underlying mechanisms mediated by the media vicarious traumatization effect. A total of 1118 Chinese citizens participated in the online survey, who were from 30 provinces in mainland China. Results showed that all four types of media (official media, commercial media, social media, and overseas media) cause vicarious traumatization to their audiences to different degrees. It was also found that the impact of media exposure on anxiety was mediated by media vicarious traumatization: there were full mediation effects for commercial media exposure and overseas media exposure, while there were indirect-only mediation effects for official media exposure and social media exposure. Audiences staying in cities with a relatively severe pandemic were more susceptible to the vicarious traumatization caused by commercial media compared to those staying in Hubei. This study expanded the concept and application of vicarious traumatization to the mediated context, and the findings provided insightful advice to media practitioners in the face of major crisis.

Vulnerable Children in a Dual Epidemic.

Two epidemics-Covid-19 and opioid use disorder (OUD) -are creating short- and long-term mental and physical health risks for vulnerable children and adolescents. Information about the risks to children from exposure to the coronavirus is still fragmentary, but even many healthy children are not getting appropriate health care, such as vaccinations or monitoring of developmental milestones during the Covid-19 pandemic. Children living in poverty are at heightened risk. Youngsters who are already dealing with OUD in their families-2.2 million as of 2017-face serious consequences stemming from trauma and stress. Although not officially designated by the Centers for Disease Control and Prevention as "adverse childhood experiences" ("ACEs"), these situations meet the CDC's criteria for inclusion, such as death or separation from a parent. It is important to recognize and meet the needs of all these children now and not just when the long-term consequences become apparent.

Duties toward Patients with Psychiatric Illness.

Patients with psychiatric illness feel the brunt of the intersection of many of our society's and our health care system's disparities, and the vulnerability of this population during the Covid-19 pandemic cannot be overstated. Patients with psychiatric illness often suffer from the stigma of mental illness and receive poor medical care. Many patients with severe and persistent mental illness face additional barriers, including poverty, marginal housing, and food insecurity. Patients who require psychiatric hospitalization now face the risk of transmission of Covid-19 due to the inherent difficulties of social distancing within a psychiatric hospital. Patients whose freedom and self-determination have been temporarily overruled as they receive involuntary psychiatric treatment deserve a setting that maintains their health and safety. While tele-mental health has been rapidly expanded to provide new ways to access psychiatric treatment, some patients may have limitations in technological literacy or access to devices. The social isolation, economic fallout, and potential traumatization related to the current pandemic will disproportionately affect this vulnerable population, and society's duties to them must be considered.