1
|
Ouyang H, Wu L, Yan W, Si K, Lv H, Zhan J, Wang J, Jia Y, Shang Z, Chen W, Liu W. Network analysis of the comorbidity between post-traumatic stress, depression and anxiety symptoms among frontline healthcare workers during the COVID-19 pandemic. Ther Adv Psychopharmacol 2024; 14:20451253241243292. [PMID: 38644941 PMCID: PMC11032008 DOI: 10.1177/20451253241243292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 02/28/2024] [Indexed: 04/23/2024] Open
Abstract
Background Coronavirus disease 2019 pandemic pointed out significant mental symptoms of frontline healthcare workers (HCWs). Objective We aimed to estimate the prevalence and comorbidity of post-traumatic stress symptoms (PTSS), depression and anxiety symptoms in HCWs from Fangcang shelter hospitals during the pandemic. Design Demographic information, post-traumatic stress disorder checklist for DSM-5 (PCL-5), Patient Health Questionnaire (PHQ-9) and Generalized Anxiety Disorder Questionnaire (GAD-7) were obtained online based on stratified random sampling design during April 2022, with 284 eligible responses. Method Hierarchical regression analyses were applied to investigate independent variables associated with psychological status outcomes (PHQ-9, GAD-7 and PCL-5), and the network analyses were applied to explore the comorbidity using all items of PCL-5, PHQ-9 and GAD-7. Results (1) 10.56%, 13.03% and 8.10% of HCWs reported PTSS, depression and anxiety symptoms. Fifty-three (18.66%) HCWs experienced at least one mental health disorder, among which 26.42-37.74% HCWs had comorbidity of two or three mental disorders; (2) several influence factors of mental health were identified, including medical professions, working hours, contacted patients (p < 0.05); (3) prominent bridge symptoms between PTSS and depression were sleep problems, suicide ideation, concentration difficulties and recklessness. Comorbidity between PTSS and anxiety was thought to mainly stem from negative affect, such as afraid, anxious, annoyed and worrying. Depressed mood and worry might be good targets during treatment of comorbidity of depression and anxiety. Conclusion Our data suggest mild level of PTSS, depression and anxiety symptoms among HCWs during the pandemic and might give novel insights into assessment and intervention of comorbidity.
Collapse
Affiliation(s)
- Hui Ouyang
- Lab for Post-traumatic Stress Disorder, Faculty of Psychology and Mental Health, Naval Medical University, Shanghai, China
- The Emotion and Cognition Lab, Faculty of Psychology and Mental Health, Naval Medical University, Shanghai, China
| | - Lili Wu
- Lab for Post-traumatic Stress Disorder, Faculty of Psychology and Mental Health, Naval Medical University, Shanghai, China
- The Emotion and Cognition Lab, Faculty of Psychology and Mental Health, Naval Medical University, Shanghai, China
| | - Wenjie Yan
- Lab for Post-traumatic Stress Disorder, Faculty of Psychology and Mental Health, Naval Medical University, Shanghai, China
- The Emotion and Cognition Lab, Faculty of Psychology and Mental Health, Naval Medical University, Shanghai, China
| | - Keyi Si
- Department of Military Health Statistics, Naval Medical University, Shanghai, China
| | - Hongli Lv
- Department of Gastroenterology and Hepatology, Jinling Hospital, Clinical School of Medical College, Nanjing University, Nanjing, China
| | - Jingye Zhan
- Lab for Post-traumatic Stress Disorder, Faculty of Psychology and Mental Health, Naval Medical University, Shanghai, China
- The Emotion and Cognition Lab, Faculty of Psychology and Mental Health, Naval Medical University, Shanghai, China
| | - Jing Wang
- Lab for Post-traumatic Stress Disorder, Faculty of Psychology and Mental Health, Naval Medical University, Shanghai, China
- The Emotion and Cognition Lab, Faculty of Psychology and Mental Health, Naval Medical University, Shanghai, China
| | - Yanpu Jia
- Lab for Post-traumatic Stress Disorder, Faculty of Psychology and Mental Health, Naval Medical University, Shanghai, China
- The Emotion and Cognition Lab, Faculty of Psychology and Mental Health, Naval Medical University, Shanghai, China
| | - Zhilei Shang
- Lab for Post-traumatic Stress Disorder, Faculty of Psychology and Mental Health, Naval Medical University, Shanghai, China
- The Emotion and Cognition Lab, Faculty of Psychology and Mental Health, Naval Medical University, Shanghai, China
| | - Wenfang Chen
- Department of Urology, Jinling Hospital, Clinical School of Medical College, Nanjing University, 305 East Zhongshan Road, Nanjing 210000, China
| | - Weizhi Liu
- Lab for Post-traumatic Stress Disorder, Faculty of Psychology and Mental Health, Naval Medical University, 800 Xiangyin Road, Shanghai 200433, China
- The Emotion and Cognition Lab, Faculty of Psychology and Mental Health, Naval Medical University, Shanghai, China
| |
Collapse
|
2
|
Schilz L, Kemna S, Karnouk C, Böge K, Lindheimer N, Walther L, Mohamad S, Suboh A, Hasan A, Höhne E, Banaschewski T, Plener P, Strupf M, Hahn E, Bajbouj M. A house is not a home: a network model perspective on the dynamics between subjective quality of living conditions, social support, and mental health of refugees and asylum seekers. Soc Psychiatry Psychiatr Epidemiol 2023; 58:757-768. [PMID: 36633630 PMCID: PMC10097787 DOI: 10.1007/s00127-022-02419-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 12/21/2022] [Indexed: 01/13/2023]
Abstract
BACKGROUND Providing adequate living conditions for forcibly displaced people represents a significant challenge for host countries such as Germany. This study explores refugee mental health's reciprocal, dynamic relationship with post-migration living conditions and social support. METHODS The study sample included 325 Arabic- or Farsi-speaking asylum seekers and refugees residing in Germany since 2014 and seeking mental health treatment. Associations between reported symptoms of post-traumatic stress and depression and the subjective quality of living conditions and perceived social support were analyzed using a two-level approach including multiple linear regression and network analyses. RESULTS Post-migration quality of living conditions and perceived social support were significantly associated with negative mental health outcomes on both levels. In the network, both post-migration factors were negatively connected with overlapping symptoms of psychiatric disorders, representing potential target symptoms for psychological treatment. CONCLUSION Post-migration quality of living conditions and social support are important factors for refugee mental health and should be targeted by various actors fostering mental well-being and integration.
Collapse
Affiliation(s)
- Laura Schilz
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - Solveig Kemna
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - Carine Karnouk
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - Kerem Böge
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - Nico Lindheimer
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - Lena Walther
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - Sara Mohamad
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - Amani Suboh
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - Alkomiet Hasan
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical Faculty, University of Augsburg, BKH Ausgburg, Augsburg, Germany
| | - Edgar Höhne
- Department of Child and Adolescent Psychiatry, Philipps-University Marburg, Marburg, Germany
| | - Tobias Banaschewski
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Paul Plener
- Department of Child and Adolescent Psychiatry, Medical University Vienna, Vienna, Austria.,Department of Child and Adolescent Psychiatry and Psychotherapy, University of Ulm, Ulm, Germany
| | - Michael Strupf
- Department of Psychiatry and Psychotherapy, University Hospital LMU, Munich, Germany
| | - Erik Hahn
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - Malek Bajbouj
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany.
| |
Collapse
|
3
|
Brier ZMF, Burt KB, Legrand AC, Price M. An examination of the heterogeneity of the relationships between posttraumatic stress disorder, self-compassion and gratitude. Clin Psychol Psychother 2022. [PMID: 36508309 DOI: 10.1002/cpp.2815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 11/02/2022] [Accepted: 12/04/2022] [Indexed: 12/14/2022]
Abstract
Previous research has found both self-compassion and gratitude to be protective against overall posttraumatic stress disorder (PTSD) symptom severity. PTSD is a highly heterogeneous disorder; however, it is unclear if these protective constructs are differentially associated with each cluster of PTSD. The present study examined differences in the association of self-compassion and gratitude with the four clusters of PTSD as indicated by the DSM-5. Participants were 1424 trauma-exposed individuals recruited via Amazon's Mechanical Turk. The mean age of participants was 31.49 (SD = 11.25) years old, and 55.3% of the sample identified as female. A structural equation model (SEM) approach was used to examine relationships between factors of gratitude, self-compassion and the four PTSD symptom clusters. A two-factor model of self-compassion best fits the data. Both the self-compassion and gratitude factors were significantly associated with all symptom clusters of PTSD. Wald chi-square tests indicated self-compassion and gratitude to have the strongest association with negative alterations in cognitions and mood (NACM) PTSD symptoms. These findings may have important implications for treatment targets to reduce specific symptoms of PTSD, particularly in PTSD symptoms related to negative affect.
Collapse
Affiliation(s)
- Zoe M F Brier
- Department of Psychological Science, University of Vermont, Burlington, Vermont, USA
| | - Keith B Burt
- Department of Psychological Science, University of Vermont, Burlington, Vermont, USA
| | | | - Matthew Price
- Department of Psychological Science, University of Vermont, Burlington, Vermont, USA
| |
Collapse
|
4
|
Cao S, Zhu Y, Li P, Zhang W, Ding C, Yang D. Age Difference in Roles of Perceived Social Support and Psychological Capital on Mental Health During COVID-19. Front Psychol 2022; 13:801241. [PMID: 35282222 PMCID: PMC8905441 DOI: 10.3389/fpsyg.2022.801241] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 01/06/2022] [Indexed: 11/13/2022] Open
Abstract
Due to the outbreak of the Coronavirus Disease-2019 (COVID-19) pandemic and consequent confinement measures, young people are vulnerable to mental health problems. The current study compared a group of 440 young adolescents (10-12 years) and a group of 330 emerging adults (18-25 years) to investigate the extent to which perceived social support and psychological capital (PsyCap) were differentially associated with mental health problems. Participants were asked to report their current psychosocial adaptation status during the COVID-19 pandemic, and data were collected via online questionnaires during a relatively severe period of COVID-19 in China. Results of the multi-group path analysis indicated that the effect of perceived social support on mental health problems was mediated by PsyCap for young adolescents, but not for emerging adults. These results were discussed with respect to the mechanism of how social support and PsyCap serve as protective mental health factors for youth in the context of the COVID-19 pandemic.
Collapse
Affiliation(s)
- Shiyue Cao
- Faculty of Psychology, Southwest University, Chongqing, China
| | - Yue Zhu
- Faculty of Psychology, Southwest University, Chongqing, China
| | - Pei Li
- Faculty of Psychology, Southwest University, Chongqing, China
| | - Wei Zhang
- Faculty of Psychology, Southwest University, Chongqing, China
| | - Cody Ding
- Faculty of Psychology, Southwest University, Chongqing, China.,Department of Educational Psychology, University of Missouri-St. Louis, St. Louis, MO, United States
| | - Dong Yang
- Faculty of Psychology, Southwest University, Chongqing, China
| |
Collapse
|
5
|
Short-term psychological consequences of the COVID-19 pandemic: Results of the first wave of an ecological daily study in the Italian population. Psychiatry Res 2021; 305:114206. [PMID: 34537539 PMCID: PMC8420137 DOI: 10.1016/j.psychres.2021.114206] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 09/01/2021] [Accepted: 09/04/2021] [Indexed: 12/23/2022]
Abstract
COVID-19 pandemic involved several psychosocial consequences. We aimed at monitoring the mental health of Italian adults during the lockdown imposed by the government. We present here results from the baseline assessment of the "EmotionalThermometer [TermometroEmotivo] project on a sample of 1548 Italian adults. We assessed the socio-demographic conditions of participants, individuals' perception of the COVID-19-situation, psychological distress, emotion regulation strategies, and perceived social support. Having a worse representation of COVID-19 and consulting news more frequently, with higher anxiety and less credibility of different sources of information, were positively associated with psychological distress and post-traumatic responses. Being female, younger age, living in high-risk regions, having symptoms of COVID-19, and having relatives/friends with such symptoms represented risk factors for a worse perception of COVID-19 and distress. Social support and cognitive reappraisal represented protective factors for mental health.
Collapse
|
6
|
Brienza A, Suffoletto BP, Kuhn E, Germain A, Jaramillo S, Repine M, Callaway CW, Pacella-LaBarbara ML. The role of specific sources of social support on postinjury psychological symptoms. Rehabil Psychol 2021; 66:600-610. [PMID: 34398631 PMCID: PMC8648976 DOI: 10.1037/rep0000388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
PURPOSE/OBJECTIVE The role of perceived social support from specific sources (e.g., families, friends, and significant others) on the development of postinjury posttraumatic stress disorder (PTSD) and associated psychological symptoms (e.g., depression and anxiety) remains relatively unexplored. We examined the predictive role of social support from specific sources on psychological symptoms among emergency department (ED) patients following motor vehicle crash (MVC). Research Methods/Design: Sixty-three injured patients (63.5% female; 37 years old on average) with moderately painful complaints were recruited in the EDs of two Level-1 trauma centers within 24 hr post-MVC. In the ED, participants completed surveys of baseline psychological symptoms and perceived social support; follow-up surveys were completed at 90 days postinjury. RESULTS Most of the sample (84.1%) was discharged home from the ED with predominantly mild injuries and did not require hospitalization. After adjusting for race, sex, age, and baseline symptoms, hierarchical regression analyses demonstrated that lower perceived social support in the ED predicted higher PTSD symptoms and depressive symptoms (but not anxiety) at 90 days. This effect seemed to be specific to significant others and friends but not family. CONCLUSIONS/IMPLICATIONS MVC-related injuries are robust contributors to psychological sequelae. These findings extend prior work by highlighting that perceived social support, particularly from significant others and friends, provides unique information regarding the development of psychological symptoms following predominantly mild MVC-related injuries. This data may serve to inform recovery expectations. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
Collapse
|
7
|
Zalta AK, Tirone V, Orlowska D, Blais RK, Lofgreen A, Klassen B, Held P, Stevens NR, Adkins E, Dent AL. Examining moderators of the relationship between social support and self-reported PTSD symptoms: A meta-analysis. Psychol Bull 2021; 147:33-54. [PMID: 33271023 PMCID: PMC8101258 DOI: 10.1037/bul0000316] [Citation(s) in RCA: 70] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Social support is one of the most robust predictors of posttraumatic stress disorder (PTSD). Yet, little is known about factors that moderate the relationship between social support and PTSD symptom severity. This meta-analysis estimated the overall effect size of the relationship between self-reported social support and PTSD severity and tested meaningful demographic, social support, and trauma characteristics that may moderate this association using both cross-sectional and longitudinal effect sizes. A comprehensive search identified 139 studies with 145 independent cross-sectional effect sizes representing 62,803 individuals and 37 studies with 38 independent longitudinal effect sizes representing 25,792 individuals. Study samples had to comprise trauma-exposed, nonclinical adult populations to be included in the analysis. Cross-sectional and longitudinal analyses revealed a near medium overall effect size (rcross = -.27; 95% CI [-.30, -.24]; rlong = -.25; 95% CI [-.28, -.21]) with a high degree of heterogeneity (cross-sectional I2 = 91.6, longitudinal I2 = 86.5). Both cross-sectional and longitudinal moderator analyses revealed that study samples exposed to natural disasters had a weaker effect size than samples exposed to other trauma types (e.g., combat, interpersonal violence), studies measuring negative social reactions had a larger effect size than studies assessing other types of social support, and veteran samples revealed larger effect sizes than civilian samples. Several other methodological and substantive moderators emerged that revealed a complex relationship between social support and PTSD severity. These findings have important clinical implications for the types of social support interventions that could mitigate PTSD severity. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
Collapse
Affiliation(s)
- Alyson K. Zalta
- Department of Psychological Science, University of California, Irvine, Irvine, CA
- Department of Psychiatry & Behavioral Sciences, Rush University Medical Center, Chicago, IL
| | - Vanessa Tirone
- Department of Psychiatry & Behavioral Sciences, Rush University Medical Center, Chicago, IL
| | - Daria Orlowska
- University Libraries, Western Michigan University, Kalamazoo, MI
| | | | - Ashton Lofgreen
- Department of Psychiatry & Behavioral Sciences, Rush University Medical Center, Chicago, IL
| | - Brian Klassen
- Department of Psychiatry & Behavioral Sciences, Rush University Medical Center, Chicago, IL
| | - Philip Held
- Department of Psychiatry & Behavioral Sciences, Rush University Medical Center, Chicago, IL
| | - Natalie R. Stevens
- Department of Psychiatry & Behavioral Sciences, Rush University Medical Center, Chicago, IL
| | - Elizabeth Adkins
- Department of Preventive Medicine, Northwestern University, Chicago, IL
| | - Amy L. Dent
- Department of Psychological Science, University of California, Irvine, Irvine, CA
| |
Collapse
|
8
|
Krpalek D, Achondo N, Daher N, Javaherian H. Reducing Veterans’ Symptoms of Depression, Anxiety, Stress, and Posttraumatic Stress, and Enhancing Engagement in Occupations with SCUBA Diving and Occupational Therapy. JOURNAL OF VETERANS STUDIES 2020. [DOI: 10.21061/jvs.v6i1.158] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
|
9
|
The symptoms at the center: Examining the comorbidity of posttraumatic stress disorder, generalized anxiety disorder, and depression with network analysis. J Psychiatr Res 2019; 109:52-58. [PMID: 30502492 PMCID: PMC6420212 DOI: 10.1016/j.jpsychires.2018.11.016] [Citation(s) in RCA: 96] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 11/09/2018] [Accepted: 11/20/2018] [Indexed: 01/05/2023]
Abstract
Comorbid mental health disorders are highly common in trauma-exposed individuals with posttraumatic stress disorder (PTSD), depression, and generalized anxiety disorder (GAD) among the most common co-occurring conditions. Network models of psychopathology offer a novel method to understand how this comorbidity manifests. The present study examined the presence of symptom communities (groups of highly connected symptoms) within a network of these disorders and hub symptoms (symptoms that connect such communities). Cross-sectional data were obtained from a community sample (N = 1184) of trauma exposed adults. Network analyses identified 5 communities: 1 containing all depression and GAD symptoms and 4 for PTSD. The PTSD communities corresponded to symptoms of intrusion and avoidance, hyperarousal, dysphoria, and negative affect. These communities had varying levels of connectivity to the Depression & GAD community. Symptoms of GAD (inability to relax) and PTSD (restricted or diminished positive emotion) were identified as key hub symptoms for the network. The results suggest symptoms of depression and GAD are highly interrelated and that PTSD is heterogeneous. The comorbidity among these diagnoses is thought to stem from their overlap with negative affect.
Collapse
|