The COVID-19 pandemic has come and stationed itself in the world for over a year now. The world population has experienced not only physical and financial distress but also emotional and psychological distress. A major psychological outcome of this pandemic has been PTSD in patients who have experienced severe symptoms and near-death experiences and social isolation.

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Psychological trauma and PTSD

Psychological trauma is so common that it is widely experienced by almost 60 to 85% of people at least once in their lifetime. Reactions to trauma can include nightmares, self-blame, anxiety, intrusive thoughts, having concerns for safety, having trouble sleeping, irritability, and concentration problems.

Trauma and COVID-19

Throughout the history of mankind, pandemics have killed an estimated 300 million to 500 million people. Despite high-end advances in medicine, COVID-19 has caused more than 2 million deaths worldwide in the last one year. It has emerged to become a global health emergency over the last one year and has resulted in not only physical health concerns but also major psychological concerns as people are exposed to unexpected deaths or near-death experiences.

The healthcare workers who are in close proximity with COVID patients are not only exposed to the virus on a regular basis, but also witness increased illnesses, deaths, and supply shortages. In addition, patients admitted to the hospital with COVID-19 experience physical discomfort, social isolation, and fear of death. These exposures increase the risk of developing PTSD. In addition, the risk may further be aggravated during the subsequent weeks when these individuals lack social support and are subjected to social stigma due to the need to self-quarantine.

COVID-19 has led to diverse mental health problems, including anxiety, depression, posttraumatic stress disorder, and other trauma- and stress-related disorders. People have experienced this pandemic in different ways; those who have themselves suffered from the illness and potential death; individuals who, as family members and healthcare workers, have witnessed others’ suffering and death; individuals who have learned about the death or risk of death of a family member or friend due to the virus; and individuals who have experienced extreme exposure to aversive details (eg, journalists, first responders, medical examiners, and hospital personnel).

Among healthcare workers, strains include lack of personal protective equipment (PPE), fears of virus exposure, burnout, patients perishing despite heroic efforts to save them, and difficult decisions about which patients should receive limited resources.

PTSD evaluations: How prevalent is it?

A study published in JAMA Psychiatry concluded that the pandemic was associated with PTSD diagnosed in post-illness stages, with a prevalence of 32.2%. The study was done on a group of patients with COVID who sought treatment at the emergency department, most of whom required hospitalisation, eventually recovered, and were subsequently referred to a post-acute care service for multidisciplinary assessment.

A study of nurses in China exposed to COVID-19 found a PTSD incidence of 16.8%, with the highest scores in avoidance symptoms. The authors recommended supporting nurses who are having difficulty coping with their work by providing counselling.

A study of 900 health professionals caring for hospitalized patients with COVID-19 in Singapore and India found relatively low symptoms of anxiety (15.7%), depression (10.6%), and stress (5.2%).

United Kingdom military healthcare workers were assessed for the effects of inadequate safety equipment on their mental health during the COVID-19 medical response. Those with inadequate equipment had greater odds of having common mental health disorders (2.49), PTSD (2.99), poorer global health (2.09), and emotional problems (1.69).

A chart review of hospitalised patients with COVID-19 in Spain found more than half of the 841 patients hospitalised with COVID-19 had a neurological symptom. Of these, non-specific neurological symptoms were identified, as well as disorders of consciousness (19.6%), mostly in elderly patients and in those with severe COVID-19 disease; myopathy (3.1%); dysautonomia (2.5%); and other less frequent symptoms. Neuropsychiatric symptoms were reported by 19.9% of these patients, including insomnia, anxiety, depression and psychosis.

How to prevent COVID-19 from affecting mental health

1. To support medical caregivers assigned to the front line during the pandemic, experts advise addressing burnout, as prolonged problems may overlap and lead to acute stress disorder and PTSD. Suggestions have ranged from practical measures (such as ensuring adequate PPE, handwashing, and decontamination of surfaces) to developing personnel policies that reassign at-risk medical personnel away from high-risk sites, ensure the safety of their family members, and stress the importance of self-care.
2. Also recommended is providing health care workers access to child care services during expanded work hours and school closures. Workers should have adequate rest and breaks, be excused from less-essential tasks, and have regular information and feedback sessions with managers and the community.
3. Professional organisations offer physician wellness programs to provide free, confidential sessions to deal with burnout, adjustment problems, family issues, and other mental health sequelae.
4. The increasing number of people who were seriously ill with COVID-19 should be assessed for physical symptoms of chronic pain, with physical therapy and medications adjusted to avoid opioid dependence.
5. Survivors of ARDS should receive evidence-based medications, cognitive behavioural therapy, and other psychotherapies for PTSD, panic, depression, and other mental disorders.

It has been over a year since the pandemic has hit the world. It is high time the long term effects are curbed and killed at this very time before it gains its prevalence in the majority of the world population.