A longitudinal study of post-traumatic stress, depressive, and anxiety symptoms trajectories in subjects with bipolar disorder during the COVID-19 pandemic

Abstract

Background Bipolar disorder (BD) is recognized to be at high risk for developing negative psychopathological sequelae to potentially traumatic events. Nevertheless, scant data are still available about the effects of the COVID-19 emergency on the clinical course of BD. The present study examined prospectively the development and trajectories of post-traumatic stress, depressive, and anxiety symptoms among subjects with BD that were followed in an outpatient psychiatric clinic at the time of pandemic onset. Methods A cohort of 89 subjects with BD was enrolled during the first wave of the COVID-19 pandemic, and assessed at baseline (T0), 2-months (T1), and 6-months (T2) follow-up. A K-means cluster analysis was used to identify distinct trajectories of depressive, anxiety, and post-traumatic stress symptoms during the three time points. Results We identified three trajectories: the Acute reaction (13.5%); the Increasing severity (23.6%); and the Low symptoms (62.9%) groups, respectively. In the Acute reaction group a significant prevalence of female gender was reported with respect to the Low symptoms one. Subjects in the Increasing severity group reported significantly lower employment rate, and higher rate of relatives at risk for COVID-19 medical complications. Subjects in the Increasing Severity group reported higher rates of previous hospitalization and manic symptoms at baseline than those included in the Low symptoms one. Conclusions Our results describe three distinct symptom trajectories during the COVID-19 emergency in a cohort of subjects suffering from BD, suggesting the need of a long-term follow-up for detecting the impact of the COVID-19 pandemic in this vulnerable population.

Validation of the Spanish Version of the Trauma and Loss Spectrum Self-Report (TALS-SR): A Study on Healthcare Workers Facing the COVID-19 Pandemic

“… 40–46 Our finding supports the evidence of previous studies revealing higher levels of functioning impairment among individuals with post-traumatic stress symptoms with respect to those without, with these latter found as predictive factors of impairment in each domain of functioning analyzed in a sample of HCWs facing the COVID-19 pandemic. 35 …”

“…The TALS-SR questionnaire, since its validation, was in fact adopted in clinical samples, such as patients with PTSD, caregivers of children with chronic illnesses, Emergency unit personnel, as well as in general population samples. 8 , 20 , 35 , 47 , 48 This approach allows also to assess partial symptomatologic PTSD, demonstrated to be clinically relevant as well as full-blown presentations of the disease. Overall, this wider dimensional approach may influence the possible assessment, preventive and treatment strategies for individuals affected.…”

“…[40][41][42][43][44][45][46] Our finding supports the evidence of previous studies revealing higher levels of functioning impairment among individuals with post-traumatic stress symptoms with respect to those without, with these latter found as predictive factors of impairment in each domain of functioning analyzed in a sample of HCWs facing the COVID-19 pandemic. 35 The present study has some limitations to note. First, although the positive feedback from participants about the fact that the questionnaire focuses on many features of post-traumatic stress spectrum symptoms related to their work duties during the COVID-19 emergency, the effective length of the questionnaire must be taken into account.…”

“…Some evidence also pointed out the burden of functional impairment associated with Post-Traumatic Stress dimensions among HCWs. 20,35,36 Previous viral outbreaks showed HCWs at increased risk of psychological adverse effects [36][37][38][39] during and after the epidemics and, also in the framework of COVID-19 outbreak, HCWs were shown to be at increased risk of negative mental health outcomes, among which PTSD. [40][41][42][43][44][45][46] Our finding supports the evidence of previous studies revealing higher levels of functioning impairment among individuals with post-traumatic stress symptoms with respect to those without, with these latter found as predictive factors of impairment in each domain of functioning analyzed in a sample of HCWs facing the COVID-19 pandemic.…”

Long COVID: The latest manifestations, mechanisms, and potential therapeutic interventions

“…The prevalence of post‐traumatic stress disorder (PTSD) was significantly higher in COVID‐19 patients than in normal population, 35 and decreased during 3 months follow‐up 36 . Unlike anxiety and depression, a lower prevalence of long COVID PTSD was reported in female, 37 and degree of PTSD was independent of the severity of COVID‐19 36,38 …”