Transdiagnostic considerations of mental health for the post-COVID era: Lessons from the first surge of the pandemic

Abstract

BACKGROUND The Coronavirus disease 19 (COVID-19)-related psychiatric burden partly results from prolonged social stress world-wide. Studies have examined the psychiatric impact of COVID-19 on Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM 5) and International Classification of Diseases 11 th Revision (ICD-11) categories, implicating multiple diagnoses, complicating clinical management. AIM To verify whether COVID-19-related psychopathology spans multiple DSM-5 and ICD-11 diagnoses, but not in a random pattern. Consequently, empirical analysis of the multiple associated symptoms will better describe COVID-19-related psychopathology. METHODS We conducted a bi-national study during the first surge of the pandemic: an Italian sample ( n = 21217, studied March-April 2020); and three representative longitudinal samples from Israel ( n = 1276, 1189, and 1432 respectively, studied May-July 2020). Data in Italy were collected by a national internet-based survey with an initially approached sample of about one million persons and in Israel by the Israeli Central Bureau of Statistics using probability-based national representative sampling. Data analysis focused on the frequency and patterns of reported multiple mental health symptoms. RESULTS Combinations with all symptoms were more prevalent than combinations with fewer symptoms, with no majorities-minorities differences in both countries, demonstrating the generalizability of the transdiagnostic pattern of mental health issues in both nations. A history of previous mental disorder (Italian study) and an increase in symptom prevalence over time (Israel study) were associated with an increased number of symptoms. Conclusions: Based on finding correlated symptom diversity spanning conventional diagnostic categories, we suggest that the pattern of mental health issues associated with the COVID-19 pandemic is transdiagnostic. CONCLUSION The findings have implications for improving prevention and treatment of COVID-19 related psychopathology and for post-pandemic times in conditions resulting from multiplicity of stressors with mixed symptomatology in the clinical picture.

International study of the Complex Stress Reaction Syndrome: Implications for transdiagnostic clinical practice

“…Furthermore, earlier studies reported that at-risk populations do not necessarily meet the full criteria of affective disorders and stress reactivity categories[ 40 , 44 ]. As it arises from the current findings, and according to our previous arguments[ 26 ], the CSRS, Type A identifies, and is sensitive to individual differences in stress reactivity and reduced positive affectivity, within a transdiagnostic spectrum.…”

“…Thus, the CSRS, Type A represents a unique transdiagnostic clinical picture combining symptomatology of affective disorders with stress reactivity[ 16 , 26 , 31 ]. The prevalence of affective disorders spans a wide range of symptomatology, with dramatic cross-cultural differences[ 49 ].…”

“…Specifically, we previously found a unique transdiagnostic pattern of stress reaction in a binational study using large representative samples in two countries, Italy and Israel, executed during the coronavirus disease 2019 (COVID-19) pandemic[ 26 ]. The results showed a transdiagnostic combination of four stress-related symptoms [anxiety, depression, stress symptoms, and post-traumatic stress disorder (PTSD)] that was significantly more prevalent than combinations of fewer symptoms.…”

“…According to WHO reports, 22% of the population develops mental health problems in a dimensional pattern, reactive to emergencies[ 30 ]. Accordingly, we related the CSRS to the COVID-19 situation and included CSRS, Type A (psychiatric symptoms) and Type B (psychiatric and neuropsychiatric symptoms in COVID-infected and recovered individuals, excluding systemic symptoms of long-COVID)[ 26 , 31 ]. However, the possibility that CSRS is relevant in the post-COVID era, to capture the mixed clinical picture resulting from concomitant daily stressors in the general population, has only recently been proposed[ 16 ].…”

“…In a recent paper, we outlined the detailed description of the conceptual development of the CSRS, including its origins in clinical practice and its uniqueness as one transdiagnostic category[ 16 ], rather than a total transdiagnostic denial of the traditional psychiatric classifications as suggested by others. The framework underpinning the current study presents an elaboration of the first validation of the CSRS in our published binational study[ 26 ], by the inclusion of participants located in four continents in this current study, beyond the validation of the CSRS in only two countries.…”