The effects of COVID-19 continuous traumatic stressors on mental health and cognitive functioning: A case example from Turkey

Abstract

There is a need to accurately assess the specific impacts of the various traumatic stressors caused by COVID-19 on mental health. The goal was to evaluate the impact of different types of COVID-19 stressors (infection fears, lockdown, and economic stressors) on mental health and cognitive functioning. We used a sample of 262 Turkish adults. We administered an online questionnaire that included measures of COVID-19 traumatic stressors, PTSD, depression, anxiety, executive function deficits, and cumulative stressors and traumas (CST). The analyses included correlations, hierarchical regression, path analysis, and PROCESS mediation analysis. All COVID-19 traumatic stressors types and their cumulative load predicted PTSD, depression, anxiety, and executive function deficits after controlling for previous cumulative stressors and traumas and COVID-19 infection. COVID-19 lockdown’s stressors were the strongest predictors, compared to COVID-19 fears and economic stressors. Path analysis and PROCESS mediation results indicated that COVID-19 traumatic stressors had direct effects on working memory deficits, direct and indirect effects on PTSD, depression, and anxiety, and indirect effects on inhibition deficits. Anxiety, depression, and inhibition deficits mediated its indirect effects on PTSD. The results have conceptual and clinical implications. COVID-19 continuous posttraumatic stress syndrome that includes comorbid PTSD, depression, anxiety, and executive function deficits is different and does not fit within the current trauma frameworks. There is a need for a paradigm shift in current stress and trauma frameworks to account for the COVID-19 continuous global stressors and for clinical innovations in intervention to help its victims. Supplementary Information The online version contains supplementary material available at 10.1007/s12144-021-01743-2.

Research on Posttraumatic Stress Disorder in the Context of the COVID-19 Pandemic: A Review of Methods and Implications in General Population Samples

“…Snowball sampling, in which research subjects recruit other subjects, was the most frequently used method to enroll general population study participants. The proportion of women in such samples ranged from 24.9% in Turkey 28 to 91.4% in China, 74 with nearly half of the study samples reporting a proportion of women >70%. In addition, the samples tended to mostly include young adults, though studies often reported mean age rather than the median age.…”

“…Another widely used instrument was the PTSD Checklist PCL-5, 27 which assesses PTSD symptoms experienced in the past month. The use of cutoff scores tended to be homogeneous, typically 31 28,29 or 33, 30,31 scores that have been previously validated in military veterans. 32 Some used symptom-criteria either alone 33,34 or in combination with a cutoff score.…”

“…In the present review, only 8 studies (22.2%) assessed prior exposure to some form of a stressful event. 10,28,29,47,[61][62][63][64] The remaining studies did not report assessing prior exposure to stressful experiences when examining pandemic-related PTSD or PTSD symptoms. In terms of ongoing stressors, pandemic-related lockdowns have been shown to drive an increase in domestic violence.…”

The relationship of COVID‐19 traumatic stress, cumulative trauma, and race to posttraumatic stress disorder symptoms

“…The onset of coronavirus disease 2019 (COVID‐19) and its numerous sequelae have led to a growing body of research addressing the mental health outcomes for exposure to the pandemic. Responding to Holmes et al ( 2020 ) call for research regarding the mental health effects of the COVID‐19 pandemic, many studies have found evidence for elevated levels of anxiety, depression, posttraumatic stress disorder symptoms, and distress in residents of China (e.g., Qiu et al, 2020 ), Italy (Forte et al, 2020 ), Spain (Gonzalez‐Sanguino et al, 2020 ), Germany (Bäuerle et al, 2020), India (Varshney et al, 2020 ), Egypt (El‐Zoghby et al, 2020 ), Turkey (Kira, Alpay, et al, 2021 ), Hong Kong (Choi et al, 2020 ), and the USA (Liu, Zhang, Wong, et al, 2020 ). These studies offer evidence for conceptualizing the experience of COVID‐19 as a potentially traumatic experience (e.g., Kira et al, 2020b ) with severe mental health outcomes.…”

The association of WTELS as a master motivator with higher executive functioning and better mental health

“…The current study added that while WTELS is directly associated with lower depression, anxiety, PTSD, and the novel COVID-19 traumatic stress syndrome, its positive effects on executive functions mediate its indirect effects. Recent studies found that COVID-19 traumatic stress is associated with increased executive function deficits (Kira, Alpay, Ayna, et al, 2021a;Kira, Alpay, Turkeli, et al, 2021b).…”