How Severe Does COVID-19 Need to Be to Cause Post-Traumatic Stress?

What you need to know

• Post-traumatic stress symptoms are common in COVID-19 patients, even those with mild to moderate illness.
• The severity of COVID-19 may not be the only factor determining the risk of developing post-traumatic stress.
• Various factors, including the hospital environment and delirium, may contribute to psychological trauma in COVID-19 patients.

Understanding Post-Traumatic Stress in COVID-19 Patients

The COVID-19 pandemic has brought unprecedented challenges to global health, not only in terms of physical symptoms but also mental health consequences. One area of growing concern is the development of post-traumatic stress (PTS) symptoms in individuals who have had COVID-19. This article explores the relationship between COVID-19 severity and PTS, challenging some common assumptions and highlighting the complexity of this issue.

The Prevalence of Post-Traumatic Stress in COVID-19 Patients

Recent studies have reported a high prevalence of post-traumatic stress disorder (PTSD) and PTS symptoms in patients who have had COVID-19. This is not entirely surprising, as previous coronavirus outbreaks, such as SARS, have been associated with a significant risk of PTSD. However, the factors contributing to this increased vulnerability in COVID-19 patients are still not fully understood.

The Role of Disease Severity

Traditionally, it has been assumed that severe illness, particularly those requiring intensive care unit (ICU) admission, is a primary factor in the development of PTSD. This is based on the well-established link between critical illness and lasting psychological trauma. However, recent research on COVID-19 patients has challenged this assumption.

Studies have found that even patients with mild to moderate COVID-19 can experience significant PTS symptoms. For example, one study reported that 12.4% of patients with predominantly mild-moderate COVID-19 had clinically meaningful PTS one month after hospital discharge. Another study found an astonishingly high prevalence of 96.2% in patients with mild-moderate COVID-19 who were assessed prior to discharge from a quarantine facility.

These findings suggest that the severity of COVID-19 may not be the only, or even the primary, factor determining the risk of developing PTS symptoms.

Factors Contributing to Post-Traumatic Stress in COVID-19 Patients

Several factors may contribute to the development of PTS symptoms in COVID-19 patients, regardless of disease severity:

1. Hospital Environment: COVID-19 wards are often characterized by patient isolation, extensive use of personal protective equipment by staff, and lack of access to visitors. This unfamiliar and potentially frightening environment may contribute to psychological distress.

2. Delirium: There is a high prevalence of delirium in COVID-19 patients, not only in those in ICU but also in general hospital wards. Delirium has been linked to an increased risk of PTSD, suggesting it could be a contributing factor to PTS symptoms in COVID-19 patients.

3. Timing of Assessment: The point at which patients are assessed for PTS symptoms can significantly affect the results. Assessments done during hospitalization may capture acute psychological distress, while those done after discharge may reflect more persistent symptoms.

4. Measurement Tools: Different studies have used various tools to measure PTS symptoms, which can lead to discrepancies in reported prevalence rates.

5. Treatment Setting: The environment in which patients are treated (e.g., hospital ward, quarantine facility) may influence their psychological experiences and subsequent development of PTS symptoms.

Implications for Patient Care and Research

Understanding the complex relationship between COVID-19 severity and PTS symptoms has important implications for patient care and future research:

1. Early Identification and Support: Recognizing that even patients with mild-moderate COVID-19 may be at risk for PTS symptoms allows for early identification and support.

2. Service Planning: Given that the number of mild-moderate COVID-19 cases far exceeds severe cases, this group may represent a larger demand on healthcare and social resources for mental health support.

3. Research Priorities: Further research is needed to understand the biological and environmental factors that contribute to PTS in COVID-19 patients, including the potential mediating role of disease severity.

4. Holistic Care: The findings highlight the importance of providing holistic care to COVID-19 patients, addressing both physical and psychological needs, regardless of disease severity.

Conclusions

• Post-traumatic stress symptoms in COVID-19 patients are not solely determined by disease severity or ICU admission.
• Patients with mild to moderate COVID-19 may also be at risk for developing significant PTS symptoms.
• Multiple factors, including the hospital environment, delirium, and the timing of assessment, may contribute to the development of PTS symptoms in COVID-19 patients.
• Further research is needed to fully understand the complex interplay of factors contributing to PTS in COVID-19 patients and to develop effective prevention and treatment strategies.

This evolving understanding of PTS in COVID-19 patients underscores the need for comprehensive mental health support as part of COVID-19 treatment and recovery, regardless of the severity of the initial illness. By recognizing and addressing the psychological impact of COVID-19, we can work towards more complete and effective patient care.