19.05.2020

Posttraumatic Stress Symptoms of Health Care Workers during the Corona Virus Disease 2019 (COVID-19)

Epidemiological Psychiatry
Yin Q et al
Clin Psychol Psychotherapy

Main result

Cohorte characteristics : 

- 377 Chinese caregivers from different provinces that had completed the questionnaire, 6 were excluded, therefore 371 participants for analysis. 38.5% men and 61.5% women. Average age 35.3 years, average education level : baccalaureate. 96.8% outside Wuhan. 18.1% doctors, 71.2% nurses, 10.2% others (medical technicians for example). 66% confined to home and no longer exposed, 34% on the front line. COVID-19 exposure level : low for 77.6%, moderate for 19.1% and high for 3.2% (12 participants).

- Prevalence of Posttraumatic Stress Symptoms (PTSS): 3.8% compatible with a PTSS table (PCL-5 score greater than or equal to 33). Invasive symptoms were prominent (positivity rate of 44.5%). Women seemed more exposed with a significantly higher rate of invasive symptoms than men (HR = 2.136 p = 0.01). Caregivers located in Wuhan were 4 times more at risk of showing symptoms of hypervigilance (HR = 4.026 p = 0.021). 

- Quality of sleep: 2.7% reported very poor satisfaction, 11.3% reported frequent sleep disturbances, 6.7% complained of difficulty falling asleep, 6.2% slept less 6 hours a night. Caregivers with high exposure had significantly more sleep disturbance and difficulty falling asleep. Significant difference in the total sleep quality score between those with a PTSS and those without one (Z value = 6.014, p < 0.001), and between groups with different contact frequencies (Chi2 = 7.307, p = 0.026).

Corrélations : 

- Level of exposure correlated with satisfaction with sleep (p = 0.018), sleep disturbance (p = 0.002) and difficulty falling asleep (p = 0.001); correlated only to symptoms of hypervigilance in the PTSS (p = 0.003). 

- Only the female gender seemed to predict a higher PCL-5 score.

- Correlation between sleep quality and presence of PTSS (coefficient = 1.700, p < 0.001), leading to an indirect correlation between level of exposure and presence of PTSS (coefficient = 1.750, 95% CI of Boostroop test = 0.543-2.998). 

Takeaways

One month before the start of the epidemic (set for January 5 according to the authors), among 371 Chinese caregivers of which 66% were no longer exposed :
 - Prevalence of PTSS: 3.8%, women seeming more at risk (HR = 2.136).
- The most exposed caregivers had significantly more symptoms of hypervigilance (HR = 4,026). 
- It seems to be an indirect link between PTSS and level of exposure (coefficient = 1.750, 95% CI of Boostroop test = 0.543-2.998), being exclusively mediated by a direct link between sleep quality and PTSS (coefficient = 1.700, p & lt; 0.001).

Strength of evidence Weak

- Descriptive cross sectional observational study
- Low numbers: 371 caregivers, only 34% of whom are directly exposed to COVID-19
- Potential bias in reporting and confusion not taken into account.

Objectives

Assess post traumatic stress disorder symptoms (PTSS) and the quality of sleep in Chinese caregivers on the front line against the COVID-19 epidemic after one month of exposure.

 

Method

- Descriptive cross-sectional observational study
 - Snowball sampling via email, Wechat, sharing and online websites from the investigators to their contacts in different Chinese provinces, from February 1 to 5 2020 (which corresponds to the limit marking the end of the first month of fighting COVID-19 according to the investigators). 

- Self-questionnaire which can be completed anonymously including: 

  • Personal characteristics (location, profession, gender, education level, age), exposure to COVID-19 (whether or not in contact with patients suspected of COVID-19 or with confirmed COVID-19 and the frequency contacts), status with regard to confinement (at their home or elsewhere). According to these data, they classifiied traumatic exposure into 3 levels: low (caregivers without contact with potentially COVID-19 patients), moderate (contacts with potentially COVID-19 patients but intermittent exposure) and high (caregivers located in Wuhan).
  • DSM-5 PTSD Checklist (PCL-5) with 20 items on: invasive symptoms (questions 1 to 5), avoidance symptoms (questions 6 and 7), altered mood and cognition (questions 8 to 14), symptoms of hypervigilance (questions 15 to 20). Score from 0 (not at all) to 4 (extremely) for each item. An item scored equal to or greater than 2 was considered an approved symptom; a total greater than or equal to 33 was considered to indicate a post-traumatic stress picture.
  • 4 questions from the Pittsburgh Sleep Quality Index (PSQI), Chinese version: "How good is the quality of your sleep?", "Do you wake up easily during night and / or early morning? "," do you have trouble falling asleep? "," what is your current sleep time? ". Each answer was scored from 0 to 3.
- Inclusion criteria: caregivers, aged 18 to 60, able to understand the questions, who were not the subject of psychiatric diagnoses such as depression, anxiety disorders, post traumatic stress disorder; exclusion if questionnaire completed in less than 100 seconds.

- Statistical analysis: Chi2 test for categorical variables; nonparametric test for comparisons of sleep scores (non-normal distribution); hierarchical multiple regression applied to the PCL-5 score (normally distributed); bilateral tests with ɑ = 0.05.

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