Association between Structural Determinants of Health and Posttraumatic Stress Symptoms during the COVID-19 Pandemic

Background:

Psychological problems, such as post-traumatic stress symptoms (PTSS), are among the most important complications associated with the COVID-19 pandemic in people. Studying the social determinants of health (SDH) and its impact on the populations during the crisis will help governments deal better with health emergencies so that every person can have an equal opportunity to stay healthy.

Objective:

To determine what factors affect PTSS, we conducted a study to investigate the association between structural determinants of health and PTSS during the COVID-19 pandemic.

Methods:

We conducted a cross-sectional study on 370 people referred to a selected laboratory between June and July 2020 in Karaj province, Iran. Post-traumatic stress disorder (PTSD) 8-item inventory was used to evaluate the PTSS and its subscales, including intrusion, avoidance, and hypervigilance in the participants.

Results:

Overall, 51.2% of participants were male, and 17.3% were positive for the IgM or IgG COVID-19 test. The most common symptoms in these patients were weakness, myalgia, cough, anosmia, and fever. The prevalence of total PTSS, intrusion, avoidance, and hypervigilance symptoms were 7.1%, 25.7%, 41.6%, and 16.2%, respectively. In univariable regression analysis, female gender (p-value=0.01, 95%CI (2.25-0.31)), un-employment (p-value=0.011, 95%CI (0.37-2.81)), having symptoms of COVID-19 disease (p-value=0.000, 95%CI (.82-2.75)), underlying chronic disease, were directly associated with PTSS.

Conclusion:

Results showed that sex and occupation as structural determinants of health could affect PTSS in the COVID-19 pandemic. However, in the multivariable model, having symptoms of the COVID-19 disease and underlying disease affected PTSS.

An overview of the CERC ARTEMIS project

The basic premise of this effort is that health care can be made more effective and affordable by applying modern computer technology to improve collaboration among diverse and distributed health care providers. Information sharing, communication, and coordination are basic elements of any collaborative endeavor. In the health care domain, collaboration is characterized by cooperative activities by health care providers to deliver total and real-time care for their patients. Communication between providers and managed access to distributed patient records should enable health care providers to make informed decisions about their patients in a timely manner. With an effective medical information infrastructure in place, a patient will be able to visit any health care provider with access to the network, and the provider will be able to use relevant information from even the last episode of care in the patient record. Such a patient-centered perspective is in keeping with the real mission of health care providers. Today, an easy-to-use, integrated health care network is not in place in any community, even though current technology makes such a network possible. Large health care systems have deployed partial and disparate systems that address different elements of collaboration. But these islands of automation have not been integrated to facilitate cooperation among health care providers in large communities or nationally. CERC and its team members at Valley Health Systems, Inc., St. Marys Hospital and Cabell Huntington Hospital form a consortium committed to improving collaboration among the diverse and distributed providers in the health care arena. As the first contract recipient of the multi-agency High Performance Computing and Communications (HPCC) Initiative, this team of computer system developers, practicing rural physicians, community care groups, health care researchers, and tertiary care providers are using research prototypes and commercial off-the-shelf technologies to develop an open collaboration environment for the health care domain. This environment is called ARTEMIS--Advanced Research TEstbed for Medical InformaticS.