key: cord-0738724-sgadonw8 authors: Concerto, Carmen; Rodolico, Alessandro; Sturiale, Serena; Caligiore, Guido; Signorelli, Maria Salvina; Petralia, Antonino; Battaglia, Fortunato; Aguglia, Eugenio title: Prevalence and Factors Associated With PTSD-Like Symptoms Linked to the COVID-19 Pandemic Among Patients With Major Depressive Disorders Seeking Emergency Care date: 2022-03-29 journal: J Nerv Ment Dis DOI: 10.1097/nmd.0000000000001468 sha: 76aa929f3b8426e35b71f52c2255dc9b806dba74 doc_id: 738724 cord_uid: sgadonw8 The aim of this study was to evaluate the psychological impact and coping strategies experienced by depressed inpatients during the second wave of the COVID-19 pandemic in Italy. We recruited 75 depressed inpatients. Logistic regression was used to determine predictors of PTSD-like symptoms measured with Impact of Event Scale–Revised. Predicting variables were age, sex, the Coping Orientation to Problems Experienced subscales scores, the Anxiety Status Inventory total score, and the Patient Health Questionnaire-9 total score. The prevalence of PTSD-like stress symptoms was 41.33%. Age, social and avoidance coping strategies, and anxiety levels were significant predictors of PTSD-like symptoms. Our findings suggest that the COVID-19 pandemic in depressed inpatients is associated with PTSD-like stress symptoms, anxiety, and maladaptive coping. I n Italy, COVID-19 virus circulated since February 2020, producing a state of emergency and the implementation of extraordinary measures to limit viral transmission. Major disasters, such as a pandemic, have important effects on the mental health of the general population (Balasubramanian et al., 2020) and are associated with a high prevalence of posttraumatic stress disorder-like (PTSD-like) symptoms (29.5%) (Moccia et al., 2020) . Life changes due to fear of the infection and to extraordinary measures to limit viral transmission, such as restrictions of movement and social contacts, might facilitate relapses and need for emergency care of patients with a previous diagnosis of a psychiatric disease (Ferrando et al., 2021) . To date, there is a lack of data regarding the impact of the COVID-19 stressors in patients with major depressive disorders (MDDs) in need of emergency care. Furthermore, coping with the stress associated with the COVID-19 outbreak may be more challenging for people with MDD (Hao et al., 2020) , and there are no studies that investigated this important topic in inpatients with MDD. In this study, we aimed to evaluate coping strategies and the occurrence of pandemic-related PTSD-like distress in COVID-19-negative MDD patients admitted to a psychiatric unit during the second wave of the pandemic in Italy. This prospective study was carried out at the University Hospital "Policlinico Gaspare Rodolico" of Catania, Italy, from September 2020 to December 2020. Sequential recruitment technique was applied. Inclusion criteria included age between 18 and 65, have a diagnosis of MDD, being psychiatric inpatients, being able to read and understand questionnaires, clinical stability (questionnaires were administered in the same day of the discharge). We excluded patients with personality disorder, organic mental disorders, and a PTSD caused by other stressful events other than the COVID-19 pandemic. We administered the following instruments: 1. The Impact of Event Scale-Revised (IES-R) is a 22-item self-report measure of the subjective distress caused by a traumatic event. A score of 33 is considered as candidate cutoff value for PTSD-like symptoms (Pietrantonio et al., 2003) . Version (COPE-NVI) is a 60-item self-administered scale used to measure individual coping skills in the presence of stressful events, developed on the basis of the original COPE scale (Sica et al., 2008) . (Zung, 1971 ). 4. The Patient Health Questionnaire-9 (PHQ-9) is a brief self-reported scale used to measure depression severity (Mazzotti et al., 2003) . Normality was assessed with the Kolmogorov-Smirnov test. Age, sex, the COPE subscales scores, the ASI total score, and the PHQ-9 total score were used as predicting variables of PTSD-like symptoms using a logistic regressions analysis. Results were considered statistically significant at the p < 0.05 level. Statistical analyses were performed with SPSS Version 25. We recruited 75 depressed inpatients. Demographic variables are reported in Table 1 . A total of 3.1% had a previous COVID-19 infection. The IES-R scale median score was 25 (IQR, 19-49), and 31 subjects scored above cutoff, suggesting PTSD-like symptoms. Binary logistic regression indicates that age (Exp[B] = 1.277), social support coping strategies (Exp[B] = 1.263), avoidance coping strategies (Exp[B] = 1.317), and anxiety levels (Exp[B] = 1.153) are significant predictors of PTSD-like symptoms (χ 2 = 45.846, df = 18, and p < 0.00). The whole model "explains" 73.1% of the variability of presence of PTSD-like symptoms. The model correctly predicted 87.5% of cases where there was no PTSD-like symptomatology and 88.5 of cases where there was PTSD-like symptomatology, giving an overall percentage correct prediction rate of 87.5% (Table 2) . In this pilot study, we found that PTSD-like stress symptoms are very common in inpatients with MDD. Higher prevalence of PTSD-like stress during the COVID-19 pandemic has been previously reported in health care workers (Rodríguez-Rey et al., 2020) and university students (Wathelet et al., 2021) , and in the general population (Zhang et al., 2021) . Based on the results of the present study, the development of PTSD-like symptoms in MDD inpatients is associated with specific coping strategies. For instance, both avoidant and social support strategies were positive predictors. Our results are in keeping with previous studies, indicating the association of avoidant coping with the severity of depression (Rudnicki et al., 2001) . Consistently with the results of the current study, it was demonstrated that both avoidant coping and COPE social support are associated with higher distress during a pandemic (Teasdale et al., 2012) . Social support coping, which typically moderates the effect of a stressful event on the severity of depression (Tandon et al., 2013) , may be maladaptive in case or restrictions that prevent social contacts generating, in this way, more anxiety. This was a pilot carried out at a single institution. Multicentric studies enrolling a larger patient population and including more variables are warranted. Our results suggest that traditional and informal care (telehealth) focused on reducing anxiety, enhancing adaptive coping, and promoting general health might mitigate the traumatic effect of the pandemic in MDD patients reducing, in this way, the odds of psychiatric deterioration requiring hospital admission. The study was not funded. This study was conducted in accordance with the Declaration of Helsinki and was approved by the Research Ethics Committee of the University of Catania. The authors declare no conflict of interest. Impact of COVID-19 on the mental health of surgeons and coping strategies Psychiatric emergencies during the height of the COVID-19 pandemic in the suburban New York City area Do psychiatric patients experience more psychiatric symptoms during COVID-19 pandemic and lockdown? A case-control study with service and research implications for immunopsychiatry II Patient Health Questionnaire (PHQ) per lo screening dei disturbi psichiatrici: Uno studio di validazione nei confronti della Intervista Clinica Strutturata per il DSM-IVasse I (SCID-I) Affective temperament, attachment style, and the psychological impact of the COVID-19 outbreak: An early report on the Italian general population The impact of event scale: Validation of an Italian version Working in the times of COVID-19. Psychological impact of the pandemic in frontline workers in Spain Social support and avoidant coping: Correlates of depressed mood during pregnancy in minority women Coping orientation to the problems experiences-new Italian version Coping, stress, and social support associations with internalizing and externalizing behavior among urban adolescents and young adults: Revelations from a cluster analysis The importance of coping appraisal in behavioural responses to pandemic flu Prevalence of and factors associated with post-traumatic stress disorder among French university students 1 month after the COVID-19 lockdown The prevalence of post-traumatic stress disorder in the general population during the COVID-19 pandemic: A systematic review and single-arm meta-analysis A rating instrument for anxiety disorders