Risk and protective factors for posttraumatic stress disorder in trauma-exposed individuals during the COVID-19 pandemic – findings from a pan-European study

Abstract

Background: The COVID-19 pandemic is a health emergency resulting in multiple stressors that may be related to posttraumatic stress disorder (PTSD). Objective: This study examined relationships between risk and protective factors, pandemic-related stressors, and PTSD during the COVID-19 pandemic. Methods: Data from the European Society of Traumatic Stress Studies (ESTSS) ADJUST Study were used. N = 4,607 trauma-exposed participants aged 18 years and above were recruited from the general populations of eleven countries (Austria, Croatia, Georgia, Germany, Greece, Italy, Lithuania, the Netherlands, Poland, Portugal, and Sweden) from June to November 2020. We assessed sociodemographic (e.g. gender), pandemic-related (e.g. news consumption), and health-related (e.g. general health condition) risk and protective factors, pandemic-related stressors (e.g. fear of infection), and probable PTSD (PC-PTSD-5). The relationships between these variables were examined using logistic regression on multiple imputed data sets. Results: The prevalence of probable PTSD was 17.7%. Factors associated with an increased risk for PTSD were younger age, female gender, more than 3 h of daily pandemic-related news consumption (vs. no consumption), a satisfactory, poor, or very poor health condition (vs. a very good condition), a current or previous diagnosis of a mental disorder, and trauma exposure during the COVID-19 pandemic. Factors associated with a reduced risk for PTSD included a medium and high income (vs. very low income), face-to-face contact less than once a week or 3–7 times a week (vs. no contact), and digital social contact less than once a week or 1–7 days a week (vs. no contact). Pandemic-related stressors associated with an increased risk for PTSD included governmental crisis management and communication, restricted resources, restricted social contact, and difficult housing conditions. Conclusion: We identified risk and protective factors as well as stressors that may help identify trauma-exposed individuals at risk for PTSD, enabling more efficient and rapid access to care. HIGHLIGHTS N = 4,607 trauma-exposed adult participants were recruited from the general population during the first year of the COVID-19 pandemic. The prevalence for probable posttraumatic stress disorder was 17.7%. We identified risk factors (e.g. poor health condition) and protective factors (e.g. social contact) associated with posttraumatic stress disorder.

On the path to recovery: traumatic stress research during the COVID-19 pandemic 2021–2023

“…A systematic review and meta-analysis that assessed the prevalence of anxiety, depression, posttraumatic symptoms, stress, and sleep problems in the early pandemic period reported that posttraumatic stress symptoms were the most prevalent presentation in COVID-19 infected individuals, though the rates of all mental health problems among COVID-19 infected individuals were uniformly high (Dragioti et al, 2022 ). In the ADJUST study by Lotzin and colleagues ( 2022 ) published in this Special Issue, the estimated prevalence of PTSD among trauma-exposed general population adults recruited from 11 countries was 17.7%, more than twice the base rate of PTSD in the non-COVID era. Using a new assessment to identify pandemic-specific stressors, Lotzin et al ( 2022 ) found that non-modifiable risk (e.g., younger age, female sex) and modifiable risk (e.g., poor health status) and protective (e.g., social contact) factors were associated with PTSD, underlining the importance of brief early targeted interventions for both full and subclinical PTSD.…”

“…In the ADJUST study by Lotzin and colleagues ( 2022 ) published in this Special Issue, the estimated prevalence of PTSD among trauma-exposed general population adults recruited from 11 countries was 17.7%, more than twice the base rate of PTSD in the non-COVID era. Using a new assessment to identify pandemic-specific stressors, Lotzin et al ( 2022 ) found that non-modifiable risk (e.g., younger age, female sex) and modifiable risk (e.g., poor health status) and protective (e.g., social contact) factors were associated with PTSD, underlining the importance of brief early targeted interventions for both full and subclinical PTSD. While this cross-sectional study could not support causal inferences on vulnerability and protective factors, it highlights touchpoints for future mental health pandemic preparedness with respect to screening and early intervention (Lotzin et al, 2021 ).…”

“…As the largess of data has shown, individuals, populations and countries have been differentially affected by COVID-19 (Bapolisi et al, 2022 ; Berkhout et al, 2022 ; Zhang et al, 2022 ; Zhang & Chen, 2021 ), and ‘evidence-based mapping of risk and protective factors’ has been ‘important to inform governance of the pandemic’ (Lotzin et al, 2022 ). Nimble pivoting to tele-mental health services and rollout of e-health interventions, the higher demand for mental health services, the normalisation of mental distress and the reduction in stigma, and enhanced help-seeking, all have had unexpectedly positive and far-reaching effects (BinDhim et al, 2021 ).…”

“… 10. Lotzin et al ( 2022 ). Dealing with the COVID-19 pandemic in Europe: five lessons from the European Society for Traumatic Stress Studies Based on emerging research from five European countries a panel of experts conclude that mental health symptoms are increasing but there is no increase in severe mental health disorders, and the pandemic has affected the mental health of entire countries as well as individuals based on the stressors experienced and on the systemic healthcare responses and innovations.…”

Crises in the Anthropocene

“…The year 2022 might be characterized by cascading and intersecting crises that culminated in traumatic stress for billions of individuals worldwide. While the COVID-19 pandemic still has an impact on the mental health of children and adults in large parts of the world (e.g., BinDhim et al, 2021 ; Lotzin et al, 2022 ; Olff et al, 2021 ; Richardson et al, 2022 ; Vasileva et al, 2021 ), 2022 will be remembered as the year of the Russian invasion in Ukraine. It has caused unimaginable amounts of traumatic stress in the people directly affected and among all age groups and genders in Europe and around the world (e.g., Schwartz et al, 2022 ).…”