The Impact of COVID-19 on Mental Health: PTSD and Post-Traumatic Growth Among Survivors

doi:10.21203/rs.3.rs-4946343/v1

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The Impact of COVID-19 on Mental Health: PTSD and Post-Traumatic Growth Among Survivors

https://doi.org/10.21203/rs.3.rs-4946343/v1

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The COVID-19 pandemic has had a profound impact on mental health, with many survivors experiencing psychological challenges, including Post-Traumatic Stress Disorder (PTSD). This study assessed PTSD symptoms and Post-Traumatic Growth (PTG) among 62 individuals who recovered from COVID-19 and were under the care of the Department of Pneumonology, Oncology, and Allergology at the Medical University of Lublin. The results revealed that 40.32% of participants exhibited PTSD symptoms. Cognitive symptoms and post-COVID self-rated health were significant predictors of PTSD severity, with cognitive symptoms positively associated and self-rated health negatively associated with PTSD severity. Additionally, a positive correlation was found between PTSD severity and PTG, suggesting that while many individuals endure significant distress, they may also experience positive psychological changes, such as improved self-perception and resilience. These findings highlight the dual impact of COVID-19 on mental health and underscore the importance of integrated mental health care that addresses both mitigating PTSD symptoms and promoting resilience and growth in COVID-19 survivors.

Biological sciences/Psychology

Health sciences/Diseases

Health sciences/Health care

Health sciences/Medical research

COVID-19 Survivors

Post-Traumatic Stress Disorder (PTSD)

Post-Traumatic Growth (PTG)

Mental Health

The coronavirus pandemic has profoundly impacted the mental health of society, with individuals who contracted COVID-19 particularly affected by its physical and psychological effects. Research has consistently shown that many patients who have recovered from COVID-19 continue to grapple with mental health issues such as depression, anxiety, and post-traumatic stress disorder (PTSD). Estimates suggest that 12.4–30% of COVID-19 survivors exhibit symptoms of PTSD [1, 2, 3].

According to the current edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5; American Psychiatric Association, 2013), PTSD emerges following exposure to actual or threatened death, serious injury, or sexual violence. It is characterized by distinct symptom clusters: re-experiencing, avoidance, numbing, and heightened arousal, which persist for more than one month after the traumatic event [4]. Patients exhibiting these symptoms often struggle to manage without intervention; untreated PTSD can lead to ongoing psychological distress and adversely impact various aspects of life.

Previous studies have highlighted the high prevalence of PTSD among COVID-19 survivors. For example, a study by Bo et al. (2021) found that approximately 96.2% of patients hospitalized with COVID-19 reported significant PTSD symptoms one month after discharge [5].

Interestingly, some individuals not only endure negative consequences from traumatic experiences but also undergo positive changes, a phenomenon known as post-traumatic growth (PTG). Tedeschi and Calhoun (1996) define PTG as the "positive change that the individual experiences as a result of the struggle with a traumatic event." PTG encompasses improved self-perception, enhanced interpersonal relationships, and a transformed life philosophy. These positive changes can manifest as increased resilience to stress, a heightened appreciation for life and loved ones, and shifts in religious or spiritual beliefs.[6]

This study aims to investigate the prevalence and intensity of PTSD symptoms in post-COVID-19 patients and explore their association with various factors. Additionally, the study seeks to assess the occurrence of PTG and its relationship with other variables. This study is particularly timely given the ongoing consequences of the pandemic and the increasing number of Covid-19 survivors experiencing long-term effects.

Study Design and Participants

This cross-sectional study was conducted among patients under the care of the Department of Pneumonology, Oncology, and Allergology in Lublin, as well as the Tuberculosis and Lung Diseases Clinic. A total of 90 individuals who had recovered from COVID-19 were initially recruited. Ultimately, 62 patients, aged 25–80, who fully and correctly completed all research instruments were included in the analysis. Inclusion criteria were a history of COVID-19, the ability to provide informed consent, and the completion of the specified questionnaires. All methods were conducted in accordance with relevant guidelines and regulations. The Bioethics Committee of the Medical University of Lublin, in Resolution No. KE-0254/97/2021, after reviewing the complete documentation and in accordance with its principles (Good Clinical Practice, GCP), issued a positive opinion on the presented research project. Informed consent was obtained from all patients.

Instruments

Author's Questionnaire: This instrument collected demographic data and additional information regarding circumstances related to the COVID-19 illness. It also included the pre- and post-morbid Self-Rated Health index.
Revised Impact of Event Scale (IES-R): Developed by Weiss and Marmar, this self-assessment tool consists of 22 items designed to measure subjective stress caused by a traumatic event.
Posttraumatic Growth Inventory (PTGI): Constructed by Tedeschi and Calhoun, this scale assesses positive personality changes following a traumatic event.

Procedure

Participants were asked to complete the above instruments, ensuring that they provided a comprehensive view of their mental health status and coping mechanisms post-COVID-19. The condition for conducting the study was also to obtain the patient's informed consent. Data collection focused on identifying the presence and severity of PTSD symptoms, as well as the occurrence and extent of PTG.

Statistical Analysis

Data analysis involved calculating descriptive statistics for demographic variables and scores on the IES-R and PTGI. Correlation analyses were conducted to explore relationships between PTSD symptoms, PTG, and other variables, such as age, gender, and pre- and post-morbid health status.

Demographic Characteristics

A total of 62 patients who had recovered from COVID-19 participated in this study, including 38 women (61.29%) and 24 men (38.71%). The ages ranged from 25 to 80 years, with a median age of 59 years. Detailed descriptive statistics of quantitative variables are presented in Table 1.

Table 1

Descriptive Statistics of Quantitative Variables (n = 62)
Variable	Me	Min	Max	SD
Age	58,92	25,00	80,00	13,24
SRH after COVID	3,32	2,00	5,00	0,70
SRH before COVOD	4,08	3,00	5,00	0,52
Anxiety	8,73	5,00	15,00	2,34
Depession	11,42	6,00	16,00	1,93
Irratibility	2,53	0,00	6,00	1,78
Agitation	1,89	0,00	3,86	1,19
Avoidance	1,51	0,00	3,57	1,08
Intrusion	1,66	0,00	3,88	1,17
Severity of PTSD symptoms	37,10	0,00	80,00	23,69
Severity of PTGI	38,50	0,00	90,00	27,93

SRH: Self-Rated Health, PTSD: Post-Traumatic Stress Disorder, PTGI: Post-Traumatic Growth Inventory, Me: Mean, Min: Minimum, Max: Maximum, SD: Standard Deviation

Nearly one-third of respondents resided in cities with populations between 100,000 and 500,000 (n = 19, 30.65%). About one-quarter lived in rural areas (n = 16, 25.81%) or cities with populations between 10,000 and 100,000 (n = 16, 25.81%). More detailed data on the respondents' place of residence are presented in Table 2.

Table 2

Place of Residence of Respondents
Category	Frequency table
Category	Count	Cumulative Count	Percent	Cumulative Percent
Rural areas	16	16	25,81	25,81
Town with up to 10,000 inhabitants	7	23	11,29	37,10
Town with 10,000 to 100,000 inhabitants	16	39	25,81	62,90
City with 100,000 to 500,000 inhabitants	19	58	30,65	93,55
City with more than 500,000 inhabitants	4	62	6,45	100,00

Educational attainment varied, with the largest group having higher education (n = 24, 38.71%), followed by secondary education (n = 14, 22.58%), vocational education (n = 13, 20.97%), and primary education (n = 3, 4.84%). Data regarding the respondents' education are presented in Table 3.

Table 3

Education Level of Respondents
Category	Frequency table
Category	Count	Cumulative Count	Percent	Cumulative Percent
Primery Education	3	3	4,84	4,84
Vocational Edutacation	13	16	21,00	25,81
Secondary Education	22	38	35,48	61,29
Higher Education	24	62	38,71	100,00

More than half of the patients were married (n = 35, 56.45%), with fewer widowed (n = 10, 16.12%), single (n = 9, 14.52%), divorced (n = 4, 6.45%), or in relationships (n = 4, 6.45%). The majority were retirees or pensioners (n = 28, 45.16%), followed by employed individuals (n = 26, 41.94%), farm workers (n = 5, 8.07%), unemployed, and students (n = 3, 4.84%).

Health Status Pre- and Post-COVID-19

Retrospective self-assessment of health before contracting COVID-19 showed most respondents rated their health as 4 out of 5 (n = 45, 72.58%), with others rating it as 5 (n = 11, 17.74%) or 3 (n = 6, 9.68%). Post-COVID-19 self-assessments dropped, with most rating their health as 3 (n = 29, 46.77%) or 4 (n = 25, 40.32%), with fewer rating it as 2 (n = 7, 11.29%) or 5 (n = 1, 1.62%) (Table 4).

Table 4

Self-Rated Health Before and After COVID-19 Illness
Category	Frequency table: PRE_SRH		Frequency table: POST_SRH
Category	Count	Percent	Count	Percent
2	0	0,00	7	11,29
3	6	9,68	29	46,77
4	45	72,58	25	40,32
5	11	17,74	1	1,61
PRE_SRH: Self-Rated Health before COVID-19, POST_SRH: Self-Rated Health after COVID-19

Chronic Conditions and COVID-19 Complications

The largest group of respondents had one chronic condition (n = 26, 41.94%), with others having multiple conditions: two (n = 17, 27.42%), three (n = 2, 3.23%), four (n = 4, 6.45%), and five (n = 2, 3.23%). Hospitalization due to COVID-19 was reported by 20 respondents (32.26%). Post-COVID symptoms were reported by 43 respondents (69.35%), including somatic complaints (n = 40, 64.52%) and cognitive problems (n = 19, 30.65%). Psychological help was utilized by 10 respondents (16.13%) before COVID-19 and by 5 (8.06%) post-COVID-19. Psychiatric help was sought by 9 respondents (14.52%) pre-COVID-19 and by 4 (6.45%) post-COVID-19. Positive PTSD screening was found in 25 respondents (40.32%).

Correlation Analysis

The severity of PTSD symptoms was negatively correlated with the number of diseases (r=-0.27, p < 0.05), post-COVID self-assessment of health (r=-0.33, p < 0.05), and the intensity of positive emotions (r=-0.50, p < 0.05). PTSD severity was positively correlated with anxiety (r = 0.41, p < 0.05), irritability (r = 0.47, p < 0.05), the severity of negative emotions (r = 0.39, p < 0.05), and post-traumatic growth (r = 0.28, p < 0.05) (Table 5).

Table 5

Spearman Correlation Matrix of Sociodemographic and Medical Variables
	AGE	NUM_D	POST_SRH	PRE_SRH	ANX	DEPR	IRR	PTSD SUM	PTGI SUM	P_EMOT
AGE	-
NUM_D	0,46*	-
POST_SRH	0,00	0,10	-
PRE_SRH	-0,40*	-0,46*	0,22	-
ANX	-0,16	-0,07	-0,36*	-0,1	-
DEPR	-0,19	-0,06	-0,23	-0,05	0,04	-
IRR	-0,16	-0,06	-0,42*	0,02	0,67*	-0,05	-
PTSD_SUM	-0,05	-0,27*	-0,33*	-0,04	0,41*	0,05	0,47*	-
PTGI_SUM	-0,13	-0,19	-0,14	-0,07	0,16	0,11	0,28*	0,53*	-
P_EMOT	-0,05	0,14	0,42*	0,07	-0,38*	0,01	-0,42*	-0,50*	-0,12	-
N_EMOT	0,00	-0,09	-0,34*	-0,16	0,52*	-0,03	0,59*	0,39*	0,19	-0,53*
NUM_D: Number of Diseases, POST_SRH: Self-Rated Health after COVID-19, PRE_SRH: Self-Rated Health before COVID-19, ANX: Anxiety, DEPR: Depression, IRR: Irritability, PTSD_SUM: Total PTSD Symptoms, PTGI_SUM: Total PTGI Score, P_EMOT: Positive Emotions, N_EMOT: Negative Emotions

Regression Analysis

The model analyzing PTSD severity included four post-COVID health status variables: number of diseases, post-COVID self-assessment of health, presence of somatic symptoms, and cognitive symptoms. This model was statistically significant (F(4,55) = 4.61, p < 0.01) and explained 20% of the variance in PTSD severity (R^2 = 0.25, Adjusted R^2 = 0.20). Significant predictors were cognitive symptoms (b*=0.35, p < 0.01) and post-COVID self-rated health (b*=-0.36, p < 0.01) (Table 6).

Table 6

Regression Analysis: Dependent Variable – Severity of PTSD Symptoms
	Regression Summary for Dependent Variable: PTSD R = 0,50; R2 = 0,25; Adjusted R2 = 0,20; F(4,55) = 4,62; p0<,01
	b*	Std.Err. of b*	b	Std.Err. Of b	t(55)	p-value
Intercept			84,67	17,56	4,82	0,00
Number of diseases	-0,19	0,12	-3,72	2,26	-1,64	0,11
Somatic symptoms	-0,26	0,14	-12,63	6,89	-1,83	0,07
Cognitive symptoms	0,35	0,13	17,63	6,39	2,76	0,01
Post – COVID SRH	-0,36	0,13	-11,90	4,36	-2,73	0,01
SRH: Self-Rated Health

Regression analysis was also used to analyze the relationship between the severity of post-traumatic development and variables describing the respondents' mental state at the time of the study. The model analyzing post-traumatic growth included irritability, PTSD severity, intensity of positive emotions, and intensity of negative emotions. This model was statistically significant (F(4,57) = 5.97, p < 0.001) and explained 25% of the variance in post-traumatic growth (R^2 = 0.30, Adjusted R^2 = 0.25). PTSD severity (b*=0.58, p < 0.001) was the significant predictor (Table 7).

Table 7

Regression Analysis: Dependent Variable – Severity of Post-Traumatic Growth
	Regression Summary for Dependent Variable: PTG; R = 0,54; R2 = 0,30; Adjusted R2 = 0,25; F(4,57) = 5,97; p < 0,001
	b*	Std.Err. of b*	b	Std.Err. Of b	t(55)	p-value
Intercept			-16,51	24,70	-0,67	0,51
Irratibility	0,06	0,15	0,89	2,29	0,39	0,70
Severity of PTSD	0,58	0,13	0,68	0,16	4,31	0,00
Positive emotions	0,03	0,14	1,19	5,72	0,21	0,84
Negative emotions	0,21	0,13	8,11	5,20	1,56	0,12
PTG: Post-Traumatic Growth, PTSD: Post-Traumatic Stress Disorder

The findings of this study highlight the considerable psychological burden experienced by individuals who have recovered from COVID-19. A significant proportion of participants reported symptoms consistent with PTSD, aligning with previous research indicating a high prevalence of PTSD among COVID-19 survivors. For example, Mazza et al. (2020) found a 30.2% prevalence of PTSD among COVID-19 survivors, while Liu et al. (2021) reported a 23.6% prevalence, identifying pre-existing health conditions and severity of infection as significant predictors of PTSD [3, 7]. Our study's finding of a 40.32% prevalence of PTSD is slightly higher, possibly due to differences in sample demographics or methodologies.

The cognitive symptoms identified in our study as predictors of PTSD severity are consistent with findings from other research. Qi et al. (2020) reported significant psychological morbidities and cognitive deficits among COVID-19 patients, suggesting that these cognitive symptoms play a crucial role in the development and persistence of PTSD [8]. Similarly, Bonazza et al. (2022) found that cognitive issues, along with anxiety and depression, were prevalent among COVID-19 survivors and contributed to PTSD symptoms six months after discharge [9]. Taquet et al. (2021) identified that COVID-19 survivors had a higher incidence of psychiatric disorders, including PTSD, compared to control groups. They highlighted that cognitive deficits were common in those with severe PTSD symptoms. The link between cognitive symptoms and PTSD severity in our study is supported by Taquet et al.'s findings [10]. Their study emphasizes the need for mental health interventions similar to our recommendations.

The Zhou et al. (2021) research found a prevalence of 28% for PTSD among COVID-19 survivors and noted a significant positive correlation between PTSD symptoms and irritability. The prevalence of PTSD in our study is higher, and our findings of irritability correlating with PTSD symptoms align with Zhou et al.'s results [11].

Janiri et al. (2021) reported that 37% of their sample exhibited PTSD symptoms post-COVID-19. They found that both psychological and somatic symptoms were significant predictors of PTSD. Our study's results showing somatic complaints as a significant factor in PTSD severity are consistent with Janiri et al.'s findings [12].

Interestingly, the study also identified a positive relationship between PTSD severity and post-traumatic growth (PTG), suggesting that while individuals may experience significant distress, they can also undergo positive personal changes. This dual outcome underscores the complexity of post-traumatic responses and highlights the potential for resilience and growth even amidst significant psychological challenges. Research conducted by various studies indicates a dual outcome where PTSD symptoms coexist with PTG. For instance, a study published in the Journal of Happiness Studies by Vazquez et al. highlighted that COVID-19 survivors often exhibit significant PTG alongside PTSD symptoms. This study revealed that individuals with higher PTSD severity also reported substantial PTG, demonstrating that the struggle with traumatic stress can lead to meaningful personal development and resilience [13].

Further supporting this notion, Adjorlolo et al. found that resilience and PTG were positively correlated among hospitalized COVID-19 survivors. This research underscored that experiencing severe PTSD symptoms could enhance PTG as survivors reflect on their experiences and develop new strengths and perspectives [14].

These findings underscore the complexity of post-traumatic responses and highlight the potential for resilience and growth amidst significant psychological challenges. They suggest that while PTSD can be distressing and debilitating, it may also act as a catalyst for profound personal development and positive change. This dual outcome is crucial for healthcare providers to consider when developing treatment plans, as it highlights the importance of supporting both the mitigation of PTSD symptoms and the facilitation of PTG [15].

The demographic characteristics of the sample, including a higher proportion of women and older individuals, are consistent with broader trends observed in COVID-19 research, where these groups often report higher levels of psychological distress [16]. The high prevalence of chronic conditions and post-COVID symptoms among participants further underscores the need for comprehensive post-recovery care that addresses both physical and mental health.

This study underscores the significant psychological toll of COVID-19 on survivors, with a notable prevalence of PTSD symptoms. Our findings highlight the critical importance of ongoing mental health monitoring and support for individuals recovering from COVID-19, particularly those experiencing cognitive impairments and poorer health perceptions. Additionally, the positive association between PTSD severity and post-traumatic growth (PTG) suggests that interventions aimed at fostering resilience and promoting positive psychological changes could be highly beneficial. These interventions should be tailored to address both the distress caused by PTSD and the potential for PTG, providing a comprehensive approach to recovery.

Future research should continue to investigate the dynamic interplay between PTSD and PTG, utilizing longitudinal designs to better understand the evolving nature of these conditions over time. The high prevalence of chronic conditions and post-COVID symptoms among participants further emphasizes the need for an integrated approach to post-recovery care, addressing both physical and mental health needs. This study contributes to the growing body of evidence on the mental health impacts of COVID-19 and provides valuable insights for developing targeted mental health interventions for COVID-19 survivors.

Author Contribution

J.M. wrote the main manuscript text, created the research project and coordinated its execution. B.M. participated in the creation of the research concept and also collected all the data. A.F. conducted the statistical analysis along with the description. P.M. entered and adjusted all the data for the calculations. M.S. participated in the creation of the research project concept, reviewed the conducted studies and the main text, making substantive corrections. All authors reviewed the manuscript.

Data Availability

Data is provided within the manuscript or supplementary information files.

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No competing interests reported.

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You are reading this latest preprint version

The Impact of COVID-19 on Mental Health: PTSD and Post-Traumatic Growth Among Survivors

Status:

Version 1

Abstract

Introduction

Materials and Methods

Study Design and Participants

Instruments

Procedure

Statistical Analysis

Results

Demographic Characteristics

Health Status Pre- and Post-COVID-19

Chronic Conditions and COVID-19 Complications

Correlation Analysis

Regression Analysis

Discussion

Conclusions

Declarations

Author Contribution

Data Availability

References

Additional Declarations

Supplementary Files

Status:

Version 1