key: cord-290694-jmav8xi4
authors: Bridgland, Victoria M. E.; Moeck, Ella K.; Green, Deanne M.; Swain, Taylor L.; Nayda, Diane; Matson, Lucy A.; Hutchison, Nadine P.; Takarangi, Melanie K.T.
title: Why the COVID-19 pandemic is a traumatic stressor
date: 2020-09-22
journal: bioRxiv
DOI: 10.1101/2020.09.22.307637
sha: 
doc_id: 290694
cord_uid: jmav8xi4

The COVID-19 pandemic does not fit into prevailing Post-traumatic Stress Disorder (PTSD) models, or diagnostic criteria, yet emerging research shows traumatic stress symptoms as a result of this ongoing global stressor. Current pathogenic event models focus on past, and largely direct, trauma exposure to certain kinds of life-threatening events. Nevertheless, among a sample of online participants (N = 1,040) in five western countries, we found participants had PTSD-like symptoms for events that had not happened and when participants had been directly (e.g., contact with virus) or indirectly exposed to COVID-19 (e.g., via media). Moreover, 13.2% of our sample were likely PTSD-positive, despite types of COVID-19 “exposure” (e.g., lockdown) not fitting DSM-5 criteria. The emotional impact of “worst” experienced/anticipated events best predicted PTSD-like symptoms. Our findings add to existing literature supporting a pathogenic event memory model of traumatic stress.

Posttraumatic Stress Disorder Checklist-5 (PCL-5 (22)), adapted to measure pre/peri/post-145 traumatic reactions, and measures of general emotional reactions, well-being, psychosocial 146 functioning, and depression, anxiety, and stress symptoms. Importantly, although emerging 147 research on COVID-19 and traumatic stress reactions has typically not specified whether 148 participants anchored their reactions to COVID-19 itself (e.g., (23) ), we asked our 149 participants to respond to the PCL-5 in relation to COVID-19. these populations (e.g., non-naivete, worker inattention, fraudulent responses and worker 172 treatment). To minimize "bots"/server farmers completing the survey (31,32), participants 173 had to pass a captcha, a simple arithmetic question (presented as an image to make it 174 difficult for bots to read), and score at least 8/10 on an English proficiency test. We are 175 confident that these entry requirements screened out almost all bots/server farmers; in one 176 estimate, the addition of an English proficiency test screened out 96% of bots/server 177 farmers (33). In addition to these entry requirements, participants had to pass at least one Caucasian 59.9%. Others were of Asian (13.4%); African (including "Black", 4.7%);

Middle Eastern (including "Eurasian", 0.8%); European (3.5%); and Hispanic (1.2%) 184 descent, or Indigenous (0.3%); Pacific Islander (0.1%); Mixed (3.3%) ethnicity. Some 185 participants provided nationality (e.g., "Australian" 12.8%) or no answer (0.2% four additional--and modify 10--categories. We recategorized seven "other" responses 208 into new categories and 37 into modified/existing categories. We then re-presented the 209 same list of events, but asked participants to select events they were concerned about 210 happening in the future ("other" events led to three additional categories [seven responses The PTSD Checklist (PCL-5 (22)). Participants rated how much they have been 219 bothered by 20 DSM-5 PTSD symptoms (e.g., "having difficulty concentrating"; 0 = not at 220 all, 4 = extremely; current study α = .92). We made three modifications: measured 221 symptoms in relation to COVID-19 experiences, over the past week (rather than month) 222 due to the rapidly changing circumstances, and asked participants to indicate if each 223 symptom (rated > 0) related to something that happened in the past, was currently 224 happening, or may happen in the future.

The 5-item World Health Organization Well-Being Index (WHO-5 (36)). 226 Participants rated how five statements (e.g., "I have felt calm and relaxed") applied to them Depression, Anxiety and Stress Scale (DASS-21 (38)). Participants rated the 235 degree to which each statement (e.g., "I felt down-hearted and blue") applied to them over 236 the past week (0 = did not apply to me at all, 3 = applied to me very much). Current study:

Depression, α = .92; Anxiety, α = .86; Stress, α = .90.

For context, over our 12 days of data collection, confirmed cases worldwide 240 increased from ~1.7 to ~2.5 million (deaths from ~102,000 to ~170,000). In the US, total 241 cases jumped from 500,000 to over 750,000, President Trump released the "Opening Up WHY COVID-19 IS A TRAUMATIC STRESSOR 243 Minister Johnson was released after hospitalization for COVID-19, the Queen addressed 244 the nation, and lockdown restrictions were extended. In Canada, deaths reached 1,500, and 245 an unrelated shooting occurred in Nova Scotia. In Australia/NZ, lockdown procedures 246 were introduced or maintained, and both countries showed signs of reduced COVID-19 247 spread from the first wave. 248 We ran analyses using Null-Hypothesis Significance Tests (α = .05) in SPSS Table 1 . Third, we examined evidence that PTSD-like symptoms occur for events that do 344 not involve actual or threatened death, injury, or sexual violation. Arguably, none of our 345 events/categories meet Criterion A; medically-based trauma is limited to sudden 346 catastrophe (e.g., waking during surgery, anaphylactic shock (5)). Even our most extreme direct exposure variables (e.g., being hospitalized in a critical condition) do not qualify. Step 2, and emotion variables at Step 3. After controlling for demographics, exposure Table 2 ). The final model explained 32.4% of the 385 variance in PCL total (F (10, 1027) = 50.23, p <.001), and, notably, experienced event 386 totals was no longer a significant predictor. 

Vicarious traumatization in the 515 general public, members, and non-members of medical teams aiding in COVID-19 516 control

Media use and acute psychological outcomes 518 during COVID-19 outbreak in China

Fear of the coronavirus 520 (COVID-19): Predictors in an online study conducted in

Financial and social circumstances and the 523 incidence and course of PTSD in Mississippi during the first two years after Hurricane 524

Post-traumatic stress disorder and cancer

Stress, functioning, and coping during the 528

COVID-19 pandemic: Results from an online convenience sample

The PTSD 531 Checklist for DSM-5 (PCL-5)

Post-traumatic stress disorder and 533 psychological distress in Chinese youths following the COVID-19 emergency

At what sample size do correlations stabilize?

Evaluating effect size in psychological research: Sense and 591 nonsense

Memory in posttraumatic stress disorder: Properties 593 of voluntary and involuntary, traumatic and nontraumatic autobiographical memories 594 in people with and without posttraumatic stress disorder symptoms

Anxiety disorders: why they persist and how to treat them

Synthesis of the psychometric properties of the 599 PTSD checklist (PCL) military, civilian, and specific versions

Hedonic relativism and planning the good society

World Health Organization. Mental health and psychosocial considerations during the 605

Psychometric Evaluation in Military Veterans

Traumatic stress in the age of COVID-19: A call to close 613 critical gaps and adapt to new realities