Comment on Dutheil, Mondillon, and Navel (2020): the importance of adjustment disorders and resilience

Post-what stress? A review of methods of research on posttraumatic stress during COVID-19

BACKGROUND

Post-traumatic stress (PTS) was extensively investigated during the COVID-19 pandemic. However, numerous researchers have raised concerns regarding the adherence of many of these studies to the diagnostic criteria for PTSD as outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM) or the International Classification of Diseases (ICD). This review aimed to provide insight into the methodology of research on PTS during the COVID-19 pandemic.

METHODS

Two independent reviewers examined a total of 1129 studies published between 1/01/2020 and 1/07/2023. The investigation focused on the scales employed to assess PTS, the diagnostic framework used (DSM or ICD), whether there was referral to an index-event in the PTS measurement and country where data collection took place.

RESULTS

Among the 1129 studies, 70.0% did not provide any indication of an index-event to which PTS symptoms were attributed. Only 11.3% of the studies explicitly indicated an index-event associated with the PTS symptoms. Furthermore, 54.1% of the studies utilized scales based on DSM-IV criteria. Finally, the majority of PTS-studies had data collections in China, United States and Italy.

CONCLUSION

A limited number of studies conducted during the COVID-19 pandemic reported use of an index-event in their PTS measurement. Furthermore, most studies used scales based on a previous iteration of the most used diagnostical system, namely the DSM. This delay in the implementation of new diagnostic criteria, may impair the clinical relevance of scientific studies.

Incidence, Risk Factors, and Consequences of Post-Traumatic Stress Disorder Symptoms in Survivors of COVID-19-Related ARDS

Purpose: To assess the prevalence of symptoms of Post-Traumatic Stress Disorder (PTSD) in survivors of COVID-19 Acute Respiratory Distress Syndrome that needed ICU care; to investigate risk factors and their impact on the Health-Related Quality of life (HR-QoL). Materials and Methods: This multicenter, prospective, observational study included all patients who were discharged from the ICU. Patients were administered the European Quality of Life 5 Dimensions 5 Level Version (EQ-5D-5L) questionnaire, the Short-Form Health Survey 36Version 2 (SF-36v2), a socioeconomic question set and the Impact of Event Scale-Revised (IES-R) to assess PTSD. Results: The multivariate logistic regression model found that an International Standard Classification of Education Score (ISCED) higher than 2 (OR 3.42 (95% CI 1.28-9.85)), monthly income less than EUR 1500 (OR 0.36 (95% CI 0.13-0.97)), and more than two comorbidities (OR 4.62 (95% CI 1.33-16.88)) are risk factors for developing PTSD symptoms. Patients with PTSD symptoms are more likely to present a worsening in their quality of life as assessed by EQ-5D-5L and SF-36 scales. Conclusion: The main factors associated with the development of PTSD-related symptoms were a higher education level, a lower monthly income, and more than two comorbidities. Patients who developed symptoms of PTSD reported a significantly lower Health-Related Quality of life as compared to patients without PTSD. Future research areas should be oriented toward recognizing potential psychosocial and psychopathological variables capable of influencing the quality of life of patients discharged from the intensive care unit to better recognize the prognosis and longtime effects of diseases.

Love and Infidelity: Causes and Consequences

This is a narrative review addressing the topic of romantic infidelity, its causes and its consequences. Love is commonly a source of much pleasure and fulfillment. However, as this review points out, it can also cause stress, heartache and may even be traumatic in some circumstances. Infidelity, which is relatively common in Western culture, can damage a loving, romantic relationship to the point of its demise. However, by highlighting this phenomenon, its causes and its consequences, we hope to provide useful insight for both researchers and clinicians who may be assisting couples facing these issues. We begin by defining infidelity and illustrating the various ways in which one may become unfaithful to their partner. We explore the personal and relational factors that enhance an individual's tendency to betray their partner, the various reactions related to a discovered affair and the challenges related to the nosological categorization of infidelity-based trauma, and conclude by reviewing the effects of COVID-19 on unfaithful behavior, as well as clinical implications related to infidelity-based treatment. Ultimately, we hope to provide a road map, for academicians and clinicians alike, of what some couples may experience in their relationships and how can they be helped.

COVID-19-Related Stressors and Clinical Mental Health Symptoms in a Northeast US Sample

Research has linked specific COVID-19-related stressors to the mental health burden, yet most previous studies have examined only a limited number of stressors and have paid little attention to their clinical significance. This study tested the hypothesis that individuals who reported greater COVID-19-related stressors would be more likely to have elevated levels of anxiety, posttraumatic stress symptoms, and serious psychological distress.

METHODS

An online survey was administered to a convenience sample from 18 June to 19 July 2020, in US states that were most affected by COVID-19 infections and deaths at the time. Individuals who were 18 or older and residents of five Northeast US states were eligible to participate (N = 1079). In preregistered analyses, we used logistic regression models to test the associations of COVID-19 stressors with symptoms on the Generalized Anxiety Disorder-7 (GAD-7), Impact of Event Scale-Revised, and K6, adjusting for sociodemographic covariates.

RESULTS

COVID-19-related stressors (i.e., essential worker status, worry about COVID-19 infection, knowing someone hospitalized by COVID-19, having children under 14 at home, loneliness, barriers to environmental rewards, food insecurity, loss of employment) were associated with meeting thresholds (i.e., positive screening) for anxiety, posttraumatic stress, and/or serious psychological distress. Loneliness and barriers to environmental rewards were associated with all mental health outcomes.

LIMITATIONS

We used a non-probability sample and cannot assume temporal precedence of stressors with regard to development of mental health symptoms.

CONCLUSIONS

These findings link specific stressors to the mental health burden of the COVID-19 pandemic.

Post-Traumatic Stress Disorder among Funeral Directors after the First Wave of COVID-19 in Belgium

(1) Background: Studies have shown that healthcare workers have an increased chance of developing post-traumatic stress symptoms (PTSS) during the COVID-19 pandemic. However, funeral directors have not yet been studied, despite facing many of the same possible causes of PTSS as healthcare workers. (2) Methods: An online survey was spread to directors of funeral home organization DELA in Belgium (n = 287). The validated scale PCL-5 was used to assess PTSS. Additionally, fear of being infected, fear of infecting family or friends and demographic factors (age, gender, living situations, work experience) were asked. Respondents were asked to indicate if they thought of the COVID-19 period when completing the PCL-5. In addition, with a self-made question, respondents were also asked to compare their current stress-levels with those before COVID-19. (3) Results: 107 respondents were included in the study. Thirteen respondents were above the threshold for possible PTSD-diagnosis, but only four fulfilled the criteria of completing the PCL-5 with COVID-19 in mind. PTSS-scores were significantly associated with a fear of being infected (p = 0.006). Almost a majority (49.5%) of the respondents felt more stress during the period of completing the survey than the period before COVID-19, though 33.6% felt no change. (4) Conclusions: Though the PTSS-symptom rates were lower than for healthcare workers, this study does show that there should be attention for the mental health of funeral directors in the aftermath of COVID-19.