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Post-Traumatic Stress Disorder

Do More People Have PTSD After Covid-19?

Knowledge is power in spotting the symptoms of PTSD and seeking help.

Key points

  • PTSD starts with a highly unpleasant event experienced directly or indirectly; prevalence after pandemics is around 30 percent.
  • The Covid-19 has contributed to a higher prevalence of PTSD, and therefore it is important to be aware of the signs.
  • PTSD is diagnosed if the symptoms persist for over a month, and cause clinically significant distress or impairment in functioning.

Posttraumatic stress disorder, or PTSD, has a lifetime prevalence of 6.8 percent1 although that can vary from country to country, depending on the incidence of national disasters such as war, famine, or other catastrophes affecting large numbers of people. The coronavirus pandemic has been a traumatic event for many people, particularly those infected. A 2021 study found that 30 percent of people who had suffered from severe Covid-19 had PTSD2. The study reported that a similar percentage suffered from PTSD after the 2002 MERS outbreak, and after the 2012 SARS-CoV-1 outbreak, showing that disease outbreaks can be very traumatic. Two years into the SARS-CoV-2 pandemic, it is helpful for people to know the symptoms because knowledge is power in understanding what trauma is, and knowing what symptoms require support from a trained clinician or therapist can help people who have had Covid-19.

Pandemics are traumatic events

The DSM-V criteria for the diagnosis of PTSD tell us that, for an adult to meet the DSM-V diagnostic criteria for PTSD, we must start by considering their exposure to highly unpleasant events. That must be in the sense of them having direct experience at the time that the event happened, being a witness, having a close friend or family member affected by the experience, and or being repeatedly exposed to distressing details about the experience. What counts as a highly unpleasant event that might induce trauma will depend on many factors, and it is important to accept the role of subjectivity and personal history in determining what counts as a source of trauma. Whether someone who had Covid-19 is at risk of trauma might thus depend on their personal circumstances, and the severity of their symptoms or difficulties encountered during hospitalisation or treatment. The evidence2 suggests that about one-third of people tended to develop PTSD after SARS-CoV-1, SARS-CoV-2, and MERS therefore—although the precise prevalence requires validation—there is no doubt that pandemics are sources of trauma for many people.

Flashbacks about Covid-19

Some patients and family members of people with Covid-19 have reported flashbacks about their experiences3. The second set of criteria to consider: for an adult to meet the DSM-V diagnostic criteria for PTSD, they have to have suffered intrusive symptoms connected with the exposure to the highly unpleasant event. The intrusive symptoms are in the sense of someone repeatedly remembering the experience, even if they do not want the memories, or having recurrent unpleasant dreams about it, or flashback incidents where they feel as if they are reliving the experience known as dissociative reactions. The intrusive symptoms might also include someone feeling immensely distressed or reacting in a physiological sense such as shaking or sweating when they see, hear, or read things that remind them of the experience. The intense, repeated news coverage about Covid-19, and the millions of people infected worldwide, might mean that a wider population of people may be at risk of flashbacks and other intrusive symptoms.

Did memory, thinking, or mood change after Covid?

Evidence about post-Covid PTSD is emerging but one of the trends to consider concerns the issue of memory, avoidance, and impaired mood or thinking. For an adult to meet the DSM-V diagnostic criteria for PTSD, they have to persistently avoid memories or external cues that they associate with the traumatic experience; for example; a person avoiding their doctor or visiting a hospital because it reminds them of the trauma. The avoidance can include not going to certain places, not attending certain events, or not meeting with certain people; the coronavirus pandemic can worsen this because of legitimate fears that people have about being infected. Also, a person diagnosable as having PTSD has symptoms of impaired mood or cognition, in the sense of exhibiting two or more symptoms such as impaired memory about the experience, negative self-esteem, prolonged negative emotions, having a distorted idea about what caused the experience or what happened because of it, feeling detached or estranged from others, disinterest in important activities, and persistently feeling unable to feel positive emotions. In considering whether the symptoms are Covid-related, consider the timing of the first onset.

Higher reactivity and longevity of symptoms

For an adult to meet the DSM-V diagnostic criteria for PTSD, they must have experienced two symptoms from among a list of symptoms connected with certain aspects of their behaviour or feelings connected with a sense of physiological or psychological reactivity. For example, they might be more irritable or angry, reckless or self-destructive, hypervigilant, easily startled, find it difficult to concentrate, and find it hard to fall asleep or stay asleep. For an adult to meet the DSM-V diagnostic criteria for PTSD, they must have suffered from the symptoms above for more than a month. It requires clinical training for someone to diagnose these and other symptoms of PTSD, therefore it is best to advise those affected to seek expert support.

Clinically significant distress or impairment

If you notice that the way you function or work has changed after the Covid-19 pandemic, a trained expert can help you identify whether this is part of the symptoms of PTSD. They will consider whether the symptoms cause levels of distress that are clinically significant in the sense of impairing the way that someone functions as a worker, in social relationships, or in any other vital aspect of their functioning. Finally, PTSD can only be diagnosed if the symptoms are not caused by medication, drugs, or another physical or mental disorder—this illustrates where expertise is necessary. For example, Covid-19 can lead to Long Covid in some cases and, as part of that, include symptoms that might be synonymous with those of PTSD but which are in fact caused by the physiological impact of Covid-19 on the body. In some cases, clinicians may notice that someone who meets the criteria for the diagnosis of PTSD has a sense of depersonalisation or derealisation. Examples are someone feeling as though they are outside of their own body or mind, as if they are in a dream, or as if they are living in an unreal or dreamlike world. In that case, a clinician can specify whether the diagnosis of PTSD is accompanied by dissociative symptoms.

Seeking help or sign-posting others to help

People infected with severe Covid-19, those with persistent symptoms, and those who have previously suffered from a mental illness are at risk of PTSD2 The symptoms might get more and more severe over time, meaning that the impact on a person’s functioning might become increasingly severe therefore early diagnosis and treatment can be helpful. If you know someone who might be suffering from PTSD, or if you work in a context where people are exposed to traumatic events (such as healthcare), be aware of the symptoms as a first step towards recommending help-seeking. Only a trained clinician or therapist is qualified to engage in diagnosis, therefore, do not try and diagnose anyone, but be supportive and sign-post them to sources of help.

References

[1] Harvard Medical School (2007). National Comorbidity Survey (NCS), https://www.hcp.med.harvard.edu/ncs/index.php.

[2] https://doi.org/10.1001/jamapsychiatry.2021.0109

[3] Mansoor, T., Mansoor, S., & Bin Zubair, U. (2020). 'Surviving COVID-19': Illness narratives of patients and family members in Pakistan. Annals of King Edward Medical University, 26(Special Issue), 157-164.

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