In China, COVID-19 Outbreak Leads to Posttraumatic Stress Symptoms

Chinese citizens showed acute posttraumatic stress symptoms (PTSS) during the outbreak of the novel coronavirus COVID-19, according to study results published in medRxiv. Posttraumatic stress disorder (PTSD) was the most common psychiatric disorder to arise after the SARS outbreak, with medical staff being significantly affected.

COVID-19, first reported in Wuhan, China, in December 2019 has become a global health emergency within just a few weeks due to its rapidity of transmission. Besides raising public health concerns, COVID-19 also causes tremendous psychological distress, especially the development of PTSD.

Weizhi Liu, PhD, MD, from the faculty of psychology and mental health, Naval Medical University, Shanghai, China, and colleagues investigated the prevalence of and risk factors for acute PTSS via an online survey conducted in mainland China after the COVID-19 outbreak (between January 30 and February 3). The survey consisted of 2 self-administered questionnaires: the first consisted of sociodemographic information, recent exposure history to Wuhan, current location, and subjective sleep quality, and the second consisted of a 20-item PTSD Checklist from the Statistical Manual of Mental Disorders, Fifth Edition, (PCL-5).

A total of 2091 Chinese respondents participated in the study (60.8% female).  The participants were divided into 6 different age groups in intervals of 10 years: 1.4% were age <18 years, 31.5% were between age 18 and 29 years, 29.4% were between age 30 and 39 years, 26.5% were between age 40 and 49 years, 8.6% were between age 50 and 59 years, and 2.5% were age ≥60 years.

The prevalence of PTSS in the study population was 4.6%; specifically, 5.2% in the low-risk general population, 18.4% in the high-risk general population, and 4.4% in healthcare workers. In the multiple linear regression analysis, there were statistically significant differences between genders (t, −5.227; P <.001), with females exhibiting more PTSS. People with poor subjective sleep quality scored higher on the PCL-5 (F, 185.707; P <.001), as well as patients exposed to Wuhan (P =.047). The part of the sample classified as public high-risk was most likely to experience PTSS (P <.001). Age and level of education were not related to PTSS.

Study limitations included the small sample size overall, and only a small sample of the study population was confirmed or suspected of having COVID-19. As a result, PTSD symptoms might be far more severe in the entire population as a result of the pandemic. Furthermore, there may be inherent bias in the measures of PTSS due to the nature of online self-report.

The researchers concluded that the risk factors identified for PTSS in the COVID-19 outbreak will be useful in defining high-risk groups, thus providing recommendations for people to cope with similar epidemics. They also noted that the prevalence of PTSS may be reduced in the study sample because the Chinese population has already experienced other outbreaks in recent decades. However, in countries without prior exposure to serious epidemics, PTSS may affect a larger percentage of the population.

“When making psychological adjustment for the public during this outbreak, special attention should be put on females and those who are at high risk of infection, such as people residing in high disease-prevalent regions and having had close contact with patients,” the researchers recommended.

Reference

Sun L, Sun Z, Wu L, et al. Prevalence and risk factors of acute posttraumatic stress symptoms during the COVID-19 outbreak in Wuhan, China [published online March 10, 2020]. medRxiv. doi:org/10.1101/2020.03.06.20032425