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Advances in Social Sciences Research Journal – Vol. 9, No. 10
Publication Date: October 25, 2022
DOI:10.14738/assrj.910.13213. Mazzotti, E., & Costantini, A. (2022). Emotional Scars from COVID-19: The Wave of Post-Traumatic Stress Disorder. Advances in
Social Sciences Research Journal, 9(10). 71-83.
Services for Science and Education – United Kingdom
Emotional Scars from COVID-19: The Wave of Post-Traumatic
Stress Disorder
Eva Mazzotti
Department of Clinical and Molecular Medicine
Sant’Andrea Hospital, Sapienza University of Rome, Rome, Italy
Anna Costantini
Psycho-Oncology Departmental Unit, Sant’ Andrea Hospital, Rome, Italy.
ABSTRACT
This study examined the prevalence and the characteristics of post-traumatic stress
disorder (PTSD), as measured by IES-R, in a sample of 1464 online respondents 4 or
more months after the first pandemic wave in Italy. Results. 375 (25.61%) of
respondents were probable case of PTSD. In multivariate logistic regression
analysis, the variables independently associated with PTSD were peritraumatic
distress (Adjusted Odds Ratio, AOR 25.69; 95% Confidence Interval, CI 17.96-
36.74), have been in quarantine (AOR 3.16; 95%CI 1.94-5.15), have been worried
about dying (AOR 2.58; 95%CI 1.74-3.83), female gender (AOR 2.49; 95%CI 1.64-
3.78), having used sleep remedies (AOR 2.25; 95%CI 1.549-3.29), feeling shunned
by others as a possible source of contagion (AOR 1.92; 95%CI 1.33-2.78), and having
tested positive for a COVID-19 (as protection factor) (AOR 0.25; 95%CI 0.08-0.80),
after adjusting for age. Conclusions. One in four of people could be a case of PTSD
and could have important long-term physical and psychological consequences. The
COVID-19 pandemic is connoted as a "trauma" that can favor the development of a
PTSD, which if not treated in addition to psychological, social and occupational
distress, could cause in the long term, biological damage. It is therefore important
to recognize the symptoms of PTSD for early diagnosis and timely treatment chosen
from those that have also been shown to be effective in promoting neurogenesis.
Keywords: COVID-19, PTSD, distress, psychological trauma, perceived isolation, sleep
difficulties.
- This study examined the prevalence and the characteristics of post-traumatic stress disorder
(PTSD), as measured by IES-R, in a sample of online population 4 or more months after the first
pandemic wave in Italy
- A battery of anonymous questionnaires was proposed online. - The prevalence of probable
post-traumatic stress disorder (PTSD) was found to be close to 26%, as that of peritraumatic
distress.
- These results showed that: (1) high levels of peritraumatic distress, (2) having been in
quarantine, (3) being concerned about dying from COVID-19, (4) being female, (5) having sleep
difficulties, (6) feeling shunned by others as a possible source of contagion, are variables
independently associated with being a probable case of post-traumatic stress disorder, unlike
(7) having tested positive for COVID-19 is associated with absence of symptoms of PTSD.
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Advances in Social Sciences Research Journal (ASSRJ) Vol. 9, Issue 10, October-2022
Services for Science and Education – United Kingdom
- To be exposed to the COVID-19 represents a risk factor, and one in 4 people developed
pathological symptoms
- In the long run, if left untreated (symptoms), can lead to neurobiological, structural and
functional changes in different brain regions (eg: reduction of the hippocampus), and therefore
can cause biological damage.
- It has been shown that drug treatment and environmental factors, as well as some
psychotherapies, favor neurogenesis, and in particular the increase in the volume of the
hippocampus.
-These data must guide us, at this historical moment, towards a mass screening for the
diagnosis and intervention in the case of PTSD.
INTRODUCTION
The COVID-19 has been a powerful direct and indirect stressor (Rossi et al, 2020; Costantini et
al, 2020). The pandemic caught everyone unprepared as it was a new and unexpected event
that put people's safety at risk. Many behaviors have changed since February 2020, especially
those in defense of health. Attention to health information came first of all at least in the first
phase of the pandemic. Common feelings have been feeling insecure and worried about one's
safety. People have been afraid of getting sick, dying, getting sick again, but also of infecting
others, of not being able to see their loved ones, of not being able to give them a last farewell.
More generally, in addition to the mentioned sources of fear, people have experienced social
isolation at individual, family, social and work levels. This has also been maintained and
reinforced by repeated media exposure to news about the epidemic (Thompson RR, Jonsen NM
et al. 2019).
In the COVID-19 experience there are all the characteristics that connote a trauma: life- threatening event, changes in daily functioning that lasted for months, physical and
psychological symptoms.
Symptoms can be varied, from feeling anxious, insecure and alert, to being less willing to do
things that most people consider safe. The surrounding world becomes dangerous, and you no
longer feel confident that you can effectively manage the situation. Others are to be kept at a
distance as they are possible sources of contagion. This living with circumspection and fear can
reactivate previous trauma and amplify the symptoms of post-traumatic stress disorder
(PTSD), increasing the risk of an “unprecedented wave of PTSD occurring” as stated by Di Cugno
(2020).
The aims of this study were: (a) to measure the prevalence and the characteristics of PTSD in a
sample of general population 4 or more months after the first pandemic wave in Italy, and (b)
to examine what behaviors and fears were associated with PTSD.
Due to the restrictions for COVID-19 pandemic, it was decided to conduct an online survey using
a self-report questionnaire, such as the IES-R, which has proved to be a good screening tool for
PTSD.
MATERIALS AND METHODS
Data collection was conducted between May 2020 and October 2020. Participants completed
an online survey accessible via computers. The study and its procedures complied with the
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Mazzotti, E., & Costantini, A. (2022). Emotional Scars from COVID-19: The Wave of Post-Traumatic Stress Disorder. Advances in Social Sciences
Research Journal, 9(10). 71-83.
URL: http://dx.doi.org/10.14738/assrj.910.13213
ethical standards and with the Helsinki Declaration of 1975, as revised in 2008 and all
respondents provided informed consent.
Instruments
- Impact of Event Scale – Revised (IES-R; Weiss & Marmar, 1997) is a 22-item
questionnaire that assesses subjective distress caused by traumatic events. Items
correspond directly to 14 of the 17 DSM-IV symptoms of Post-Traumatic Stress
Disorder. Items are rated on a 5-point scale ranging from 0 (“not at all”) to 4
(“extremely”). The IES-R yields a total score, ranging from 0 to 88, and three subscale
scores for Avoidance, Intrusions and Hyperarousal. As other questionnaires it is not
used for psychiatric diagnoses but can be a useful screening tool for probable cases of
PTSD in people who have been exposed to situations where they feared for their physical
safety. A score below 33 indicates no PTSD, between 33 and 50 mild to moderate PTSD,
and above 50 severe PTSD. As reported in previous studies (Morina et al, 2013) a cut-off
score of 33 provided good values of sensitivity and specificity. The instructions specified
to respond to the IES-R based on the COVID-19 pandemic, rather than other types of
traumas. In this study internal consistency was excellent-to-good for all scores, with
Cronbach’s alpha coefficients ranging from 0.880 to 0.963.
- COVID-19 Peritraumatic Distress Index (CPDI), (Qiu, 2020; Costantini 6 Mazzotti, 2020)
a 24-item questionnaire referred to anxiety, depression, specific phobias, cognitive
change, avoidance and compulsive behavior, physical symptoms and loss of social
functioning due to the COVID-19 pandemic, in the previous week. The questionnaire was
developed to measure the level of distress that the person experiences when facing a
new traumatic event such as the COVID-19 pandemic. Each item is rated on a 5-point
scale from 0 (“not at all”) to 4 (“extremely”). The total score is generated by the sum of
the individual items, compared to 100, based on the formula:
(raw total score / 96) * 100
A score below 28 indicates no distress, between 28 and 51 mild to moderate peritraumatic
distress, and above 51 severe peritraumatic distress. CPDI scores above 27 identify those
operationally defined as peritraumatic stress “cases”. In this study, internal consistency was
excellent, with Cronbach’s alpha coefficient = 0.933.
- Three questions indirectly measure the severity of symptoms, in the month before:
“Have you received psychological support?”, “Have you used psychotropic drugs?”,
“Have you used sleep remedies (drugs, supplements, herbal teas)?”.
- Two questions measure fear and the perception of isolation: “Were you worried about
dying if you contracted COVID-19?", "Have you ever felt that family and / or friends have
avoided contact with you for fear of a possible infection?".
Socio-demographic data (e.g.: gender, age), lifestyle (e.g.: live alone at home, religiosity) and
COVID-19 exposure history (e.g.: exposure, positivity, quarantine, hospitalization) was also
collected.
Statistical analysis
Binary response data were coded as 1 for yes and 0 for no. Gender was coded as 1 for females
and 0 for males. Workplace as 1 outside the home and 0 as inside. The descriptive statistics