Post-traumatic stress is a common experience during disease outbreaks. Dr. Weizhi Liu and his team have researched the prevalence of post-traumatic stress among COVID-19 infected populations, providing some suggestions to increase mental health and resilience.
Weizhi Liu, Ph.D., M.D., Professor, Director of Lab for PTSD and Lab for Emotion & Cognition, Faculty of Psychology and Mental Health, Naval Medical University, Shanghai, China. He has published more than 60 professional articles in the field of PTSD and has authored 4 books, most recently Trauma Recovery published by SMMU press. He is the vice-director of Clinical Psychology and Psychological Counseling Committee, Shanghai Psychological Association. He is also the honors fellow at the Lab for Brain Imaging & Behavior, Westman center, University of Wisconsin-Madison and advised by Richard J. Davidson from 2011 to 2012 years.
JA: How did you first get interested in this topic?
WL: The incidence of natural disasters, accidents, and military conflicts has risen obviously in this century, and post-traumatic stress disorder (PTSD) has become one of the greatest public health problems. Our team was devoted to studying PTSD for several years, including among earthquake survivors, Shidu parents (parents who lost their only child), and people who suffered childhood trauma. We started a Psychological Trauma Recover Project as we know very well that public health emergencies will increase the prevalence of PTSD.
So, when China’s CDC reported a novel coronavirus that is genetically the same as SARS virus, we immediately decided to conduct a study to investigate the mental health of the people in the disaster area due to the deleterious impact of the SARS epidemic in 2003 on people’s mental health indicated in several previous studies.
JA: What was the focus of your study?
WL: This study investigated the prevalence and related risk factors of post-traumatic stress symptoms (PTSS) in the hardest-hit areas during the COVID-19 outbreak, especially exploring the gender difference existing in PTSS.
One month after the COVID-19 outbreak, we surveyed PTSS and sleep qualities among 285 common residents in Wuhan, China and surrounding cities using the PTSD Checklist for DSM-5 (PCL-5) and 4 items from the Pittsburgh Sleep Quality Index (PSQI). This study was unique because our research started early and was conducted on the public in hardest-hit areas. It was the first study focusing on PTSD during COVID-19, which reminds us to take precautions against public mental health in the face of the pandemic.
JA: What did you discover in your study?
WL: In this study, we found that nearly one out of every ten people in parts of China hit hardest by COVID-19 reported PTSS. There is a significant gender difference in the occurrence of PTSS, and females showed a higher prevalence. To be specific, females reported significantly higher scores in three aspects of PTSS. The first is re-experiencing (such as "having repeated, disturbing, and unwanted memories"), and then negative alterations in cognition or mood (such as "loss of interest in activities that they used to enjoy"), and lastly, hyper-arousal (such as "irritable behavior, angry outbursts, or acting aggressively"). Also, participants with better subjective sleep quality or faster speed of falling asleep indicated a lower incidence of PTSS.
JA: Is there anything that surprised you in your findings, or that you weren't fully expecting?
WL: Yes, there is. First, our study found that the prevalence of PTSS among the public in hardest-hit areas of China was 7 percent during the COVID-19 outbreak, which was relatively lower than previous studies. For example, Mak et al. (2010) reported that 47.8 percent of the subjects had PTSD at some time point after the SARS outbreak. It may be attributed to China’s rapid but proper actions in the face of COVID-19 and making great efforts to publicize the knowledge related to the novel virus, thus reducing the psychological impact of the epidemic on the public. This is also the reason why the inflection point of the epidemic in China came so quickly.
Second, we found there were significant gender differences in PTSS during the epidemic. This was in line with previous studies that females often developed higher levels of PTSS, while males reported higher rates of severe disease and mortality in this pandemic. We thought the results should be different this time, but it’s not. Therefore, our team further explored the gender differences of PTSS and discovered the effect of time course on PTSS.
JA: How might readers apply what you found to their lives during COVID-19?
WL: According to this study, the general public is at risk of developing PTSS during this pandemic. People must pay attention to their mental health, especially those living in epidemic areas, females, and people with poor sleep quality. Sleep quality is important—maintaining good sleep when possible. Listening to soothing music would be a nice choice if you’re not sleeping well.
This advice is provided based on the whole of our research. Firstly, people should view this novel virus with a scientific eye and take proper precautions to prevent infection, such as wearing masks, going outdoors less, and developing good health habits. More exercise is also recommended. Secondly, seek medical treatment as soon as coronavirus symptoms develop if local medical conditions permit.
JA: How can readers use what you found to help others amidst this pandemic?
WL: Results showed that the prevalence of PTSS was highest among infected patients, followed by health care workers and the general public. The severity of the epidemic was also an important indicator of mental health. There is an important thing we want to tell the readers. Firstly, if you have friends or relatives infected, or they are health care workers or other staff members who have close contact with patients, please don’t hesitate to give them a phone call to show you care. Your concern will help them get through this hard time. Then, pay more heed to your female friends easing their anxiety and mood. Lastly, spend more time with the people around you—your parents, your partner, your children, your friends—and do something meaningful to discover the beauty of life.
JA: What are you currently working on that you might like to share about?
WL: After this study was conducted, our team further explored gender differences in PTSS of COVID-19 symptomatic patients over time. We investigated the time interval from symptom onset to the first medical visit and PTSS in confirmed cases of COVID-19 from designated hospitals before discharge. Interestingly, results showed that the time interval from symptom onset to the first medical visit had a significant effect on PTSS only in males. Males tended to ignore symptoms in the early stages, which led to a sharp rise in PTSS. It is recommended that males should improve their awareness of the disease and seek medical visits promptly when symptoms occur.
So far, the epidemic in China has been largely controlled and people have returned to normal life. Next, we are conducting a longitudinal study of previously recruited subjects, following up at 1, 3, 6, and 12 months after the outbreak, to investigate the incidence and risk factors of PTSS over time.
Liu, N., Zhang, F., Wei, C., Jia, Y., Shang, Z., Sun, L., Wu, L., Sun, Z., Zhou, Y., Wang, Y., & Liu, W. (2020). Prevalence and predictors of PTSS during COVID-19 outbreak in China hardest-hit areas: Gender differences matter. Psychiatry research, 287, 112921.