Immediate Effects of COVID-19 Outbreak on Psychiatric Outpatients: Post-traumatic Stress and Influencing Factors

  1. Burç Çağrı Poyraz
  2. Cana Aksoy Poyraz
  3. Şenol Turan
  4. Ömer Faruk Demirel
  5. Yasin Kavla
  6. Ersel Bulu
  7. İrem Hacısalihoğlu
  8. Elif Burcu Ersungur

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Abstract

Objective: Immediate effects of coronavirus disease 2019 outbreak on psychiatric patients are unknown. In this study, we aimed to investigate the impact of the coronavirus disease 2019 outbreak and public health measures on the psychological well-being of patients with psychiatric disorders. Methods: This cross-sectional study assessed 436 outpatients recruited from a tertiary psychiatry clinic in Istanbul, Turkey, nearly 1 month after the government introduced strict measures of lockdown against the ongoing outbreak. Respondents completed a web-based survey on sociodemographic data, subjective sleep quality, and a range of psychiatric symptoms using the Impact of Events Scale-Revised and Hospital Anxiety and Depression Scale. Results: Respondents reported high frequencies of clinically significant post-traumatic stress disorder symptoms (32.6%, Impact of Events Scale-Revised score ≥ 33), anxiety (36.4%, Hospital Anxiety and Depression Scale anxiety score > 10), and depression symptoms (51%, Hospital Anxiety and Depression Scale score > 10). In total, 20.5% of respondents described that their psychological status worsened during the coronavirus disease 2019 outbreak, and 12.1% of respondents described poor or very poor sleep in the prior month. Positive predictors of increased post-traumatic stress disorder symptoms included chronic medical diseases, knowing someone in the social vicinity diagnosed with the coronavirus disease 2019 infection, job loss or being on temporary leave after the outbreak, and increased exposure time to television or social media. In contrast, male gender, older age, higher educational attainment, and psychiatric diagnoses of schizophrenia, and (to a lesser degree) bipolar disorder were the negative predictors. Conclusion: Our results suggest that patients with psychiatric disorders are prone to substantial psychological distress during the coronavirus disease 2019 outbreak, and various individual, behavioral, and social factors mediate this effect. Covid-19 Salgınının Psikiyatri Polikliniği’nde Ayakta Tedavi Gören Hastalar Üzerindeki Erken Dönem Etkileri: Travma Sonrası Stres ve Onunla İlişkili Etmenler Amaç: Covid-19 salgınının psikiyatri hastaları üzerindeki erken dönem etkileri henüz bilinmiyor. Bu çalışmanın amacı Covid-19 salgınının, salgın sürecinde alınan halk sağlığı önlemlerinin psikiyatrik rahatsızlığı olan bireylerin ruhsal durumları üzerine etkilerini araştırmaktır. Yöntemler: Türkiye’de pandemi dolayısıyla alınan karantina kararından yaklaşık bir ay sonra yürütülen bu çalışmaya, Istanbul’da bir üniversite hastanesinin psikiyatri polikliniğinde ayakta tedavi gören 436 hasta katılmıştır. Çalışmada, Web tabanlı bir anket yollanarak katılımcıların sosyodemografik bilgileri, öznel uyku kaliteleri, Olayların Etkisi Ölçeği (IES-R) ile, Hastane Anksiyete ve Depresyon (HADS) ölçekleri aracılığıyla psikiyatrik bulguları değerlendirilmiştir. Bulgular: Katılımcılar yüksek sıklıkta ve klinik olarak anlamlı düzeyde travma sonrası stres bozukluğu belirtileri gösterdiklerini bildirdiler. Bulgular şöyledir: (TSSB) (%32,6, IES-R puanı ≥ 33), anksiyete (%36,4, HADS kaygı puanı > 10) ve depresyon (%51, HADS depresyon puanı > 10). Ankete katılanların %20,5'i Covid-19 salgını sırasında ruhsal durumlarının kötüleştiğini, %12,1'i de son bir ay içinde uyku kalitelerinin kötü ya da çok kötü düzeyde olduğunu belirttiler. TSSB semptomlarını öngören değişkenler şunlar: kişinin kronik bir hastalığı olması, toplumsal çevresinde Covid-19 enfeksiyonu teşhisi konan birini tanıması, salgından sonra işini kaybetmesi yahut geçici olarak işten ayrılmış olması ile televizyon kanalları ya da sosyal medyada salgın gündemini daha uzun bir süre takip etmesi olarak saptandı. Buna karşılık, erkek cinsiyet etmeni, ileri yaş, yüksek öğrenim düzeyi ile şizofreni ve bipolar bozukluk (daha düşük derecede) hastalığı olması koruyucu etmenler olarak saptandı. Sonuç: Elde ettiğimiz sonuçlar, psikiyatrik bozukluğu olan hastaların Covid-19 salgını sırasında önemli ruhsal sıkıntılar geçirmeye eğiliminde oldukları, bu eğilimin çeşitli bireysel, davranışsal ve toplumsal etmenlerce körüklendiğini gösteriyor. Cite this article as: Poyraz BÇ, Poyraz CA, Turan Ş, et al. Immediate effects of COVID-19 outbreak on psychiatric outpatients: Post-traumatic stress and influencing factors. Neuropsychiatr Invest. 2021;59(3):61-69.

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  1. Version published to 10.5152/neuropsychiatricinvest.2021.08-30
  2. ScreenIT

    SciScore for 10.1101/2020.08.12.20173468: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board StatementConsent: An electronic informed consent form was presented on the first page of the survey citing the purposes and the voluntary nature of the survey, and that all information provided by the participants would be kept confidential, and they could withdraw from the survey at any time.
    IRB: The Ethics Committee of Cerrahpaşa Medical Faculty approved this study. 2.1. Subjects: We sent online invitations to each patient who had visited the above department’s outpatient clinics in the preceding three months and who were aged 18 years or above and who could be contacted via WhatsApp messages.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    Statistical analysis was performed using SPSS Statistic 23.0 (IBM SPSS Statistics, New York, United States).
    SPSS
    suggested: (SPSS, RRID:SCR_002865)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    However, there are several limitations to our study. First, we used a convenience sample, and caution must be exercised in generalization of our findings to the broader population of patients with psychiatric disorders. Second, this was a cross-sectional study which limits our ability to infer causality and also to conclude about the long term mental health consequences of the COVID-19 pandemic. Third, this study depended on self-report of patients instead of a structured clinical interview which could provide a better picture of the psychological distress in our patients. Finally, subjects in this study were mostly from an urban area, and this can limit generalization of the findings to subjects from rural environments. In summary, patients with psychiatric disorders reported a high rate of psychological distress as an immediate response to the COVID-19 outbreak. In parallel, a significant number of patients described that their psychological status worsened during the outbreak. PTSD symptoms and comorbid depression, as well as anxiety, and impaired sleep comprise a substantial part of the distress described by these individuals. Various personal (i.e., age, educational attainment, gender, psychiatric diagnosis, chronic medical disease), behavioral (i.e., duration of media exposure) and social factors (i.e., infection prevalence in the social vicinity, and job loss during the outbreak) are likely to mediate the mental health effects in the context of COVID-19.

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  3. Version published to 10.1101/2020.08.12.20173468 on medRxiv