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Prevalence and Risk Factors of PTSD in Older Survivors of Covid-19 Are The Elderly so Vulnerable?

  • Mathilde Horn
    Correspondence
    Send correspondence and reprint requests to Mathilde Horn, M.D., Ph.D., CHU Lille, Clinique de Psychiatrie, CURE, Lille, France.
    Affiliations
    Univ. Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neurosciences & Cognition, Lille, France

    CHU Lille, Pôle de Psychiatrie, Lille, France
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  • Marielle Wathelet
    Affiliations
    Univ. Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neurosciences & Cognition, Lille, France

    CHU Lille, Pôle de Psychiatrie, Lille, France

    Fédération Régionale de Recherche en Santé Mentale et Psychiatrie (F2RSM), Lille, France

    Centre National de Ressources et de Résilience Lille-Paris (CN2R), Lille, France
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  • Ali Amad
    Affiliations
    Univ. Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neurosciences & Cognition, Lille, France

    CHU Lille, Pôle de Psychiatrie, Lille, France

    Fédération Régionale de Recherche en Santé Mentale et Psychiatrie (F2RSM), Lille, France
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  • Fanny Vuotto
    Affiliations
    Service de Maladies Infectieuses et Tropicales CHU Lille, Equipe OpInfIELD Infections Opportunistes, Immunité, Environnement & Maladies Pulmonaires, Centre Infection et Inflammation, Inserm U1019, CNRS UMR9017, Université de Lille, Institut Pasteur de Lille, CHU de Lille, Lille, France
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  • Karine Faure
    Affiliations
    Service de Maladies Infectieuses et Tropicales CHU Lille, Equipe OpInfIELD Infections Opportunistes, Immunité, Environnement & Maladies Pulmonaires, Centre Infection et Inflammation, Inserm U1019, CNRS UMR9017, Université de Lille, Institut Pasteur de Lille, CHU de Lille, Lille, France
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  • Margot Henry
    Affiliations
    CHU Lille, Pôle de Psychiatrie, Lille, France
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  • Guillaume Vaiva
    Affiliations
    Univ. Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neurosciences & Cognition, Lille, France

    CHU Lille, Pôle de Psychiatrie, Lille, France

    Centre National de Ressources et de Résilience Lille-Paris (CN2R), Lille, France
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  • Thomas Fovet
    Affiliations
    Univ. Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neurosciences & Cognition, Lille, France

    CHU Lille, Pôle de Psychiatrie, Lille, France

    Centre National de Ressources et de Résilience Lille-Paris (CN2R), Lille, France
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  • Fabien D'Hondt
    Affiliations
    Univ. Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neurosciences & Cognition, Lille, France

    CHU Lille, Pôle de Psychiatrie, Lille, France

    Centre National de Ressources et de Résilience Lille-Paris (CN2R), Lille, France
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Published:December 10, 2021DOI:https://doi.org/10.1016/j.jagp.2021.12.005
      Numerous studies have highlighted the negative effects of the COVID-19 pandemic on mental health.
      • Vindegaard N
      • Benros ME
      COVID-19 pandemic and mental health consequences: systematic review of the current evidence.
      Several works more specifically focused on older adults because of their high risk for a severe and lethal course of COVID-19. Findings indicate that, although they are likely to express a more pronounced fear of COVID-19,
      • Parlapani E
      • Holeva V
      • Nikopoulou VA
      • et al.
      A review on the COVID-19-related psychological impact on older adults: vulnerable or not?.
      older people appear to be less impacted than younger people by the psychological consequences of the pandemic.
      • Palgi Y.
      • Shrira A.
      • Ring L
      • et al.
      The loneliness pandemic: loneliness and other concomitants of depression, anxiety and their comorbidity during the COVID-19 outbreak.
      Nevertheless, most studies were conducted in the general population whereas a more severe psychological burden has been demonstrated in patients infected with SARS-CoV-2.
      • Krishnamoorthy Y
      • Nagarajan R
      • Saya GK
      • et al.
      Prevalence of psychological morbidities among general population, healthcare workers and COVID-19 patients amidst the COVID-19 pandemic: a systematic review and meta-analysis.
      Only one study has assessed self-reported post-traumatic stress disorder (PTSD) symptoms in older COVID-19 survivors but it included a very small sample of 26 participants, used an online survey when older people are less likely to use the internet, and was conducted while patients were still under quarantine, probably reflecting acute stress symptoms rather than PTSD.
      • Cai X
      • Hu X
      • Ekumi IO
      • et al.
      Psychological distress and its correlates among COVID-19 survivors during early convalescence across age groups.
      The present study assessed the prevalence of and the factors associated with PTSD in a sample of 139 patients over 60 years old (mean age 68 ± 6 years; 42 women) with a laboratory-confirmed COVID-19 who were recruited at the Lille University Hospital Center. A qualified psychiatrist assessed PTSD by phone with the PTSD Checklist for DSM-5 (PCL-5) during the second month after the onset of COVID-19 symptoms. During this evaluation, In line with previous studies
      • Srifuengfung M
      • Thana-Udom K
      • Ratta-Apha W
      • et al.
      Impact of the COVID-19 pandemic on older adults living in long-term care centers in Thailand, and risk factors for post-traumatic stress, depression, and anxiety.
      • Bo HX
      • Li W
      • Yang Y
      • et al.
      Posttraumatic stress symptoms and attitude toward crisis mental health services among clinically stable patients with COVID-19 in China.
      • Horn M
      • Wathelet M
      • Fovet T
      • et al.
      Is COVID-19 associated with posttraumatic stress disorder?.
      • Janiri D
      • Carfì A
      • Kotzalidis GD
      • et al.
      Posttraumatic stress disorder in patients after severe COVID-19 infection.
      we specifically assessed PTSD symptoms related to COVID-19 that were currently experienced by patients during the second month after the onset of COVID-19 symptoms. While in a recent general population study (N = 138; mean age: 53 ± 16), we reported a prevalence of PTSD of 6.5% of the Covid-19 survivors using the same methodology,
      • Horn M
      • Wathelet M
      • Fovet T
      • et al.
      Is COVID-19 associated with posttraumatic stress disorder?.
      only 2.9% [95%CI: 0.9, 7.6] of the 139 followed elderly patients (median PCL-5 score of 5 [interquartile range: 0–11] out of 80) presented a probable PTSD (PCL-5 score ≥ 33). Our findings confirm results from previous studies indicating less intense trauma-related distress in older adults compared to younger populations in non-COVID-19 traumatic contexts and higher levels of resilience.
      • Justo-Alonso A
      • García-Dantas A
      • González-Vázquez AI
      • et al.
      How did different generations cope with the COVID-19 pandemic? Early stages of the pandemic in Spain.
      A possible explanation for this result is that older people might be able to consider the current pandemic in a broader context, relativizing its impact, as they are more likely to have experienced traumatic and stressful events throughout their life.
      • Parlapani E
      • Holeva V
      • Nikopoulou VA
      • et al.
      A review on the COVID-19-related psychological impact on older adults: vulnerable or not?.
      ,
      • Cai X
      • Hu X
      • Ekumi IO
      • et al.
      Psychological distress and its correlates among COVID-19 survivors during early convalescence across age groups.
      As described in Table 1, we used multivariate analysis to identify two factors significantly associated with a higher PCL-5 score: (1) being a woman (d = 7.20 [95%CI: 3.19-11.21], p < 0.001), which is consistent with epidemiological data pointing to higher prevalence rates of PTSD in women than in men
      • Justo-Alonso A
      • García-Dantas A
      • González-Vázquez AI
      • et al.
      How did different generations cope with the COVID-19 pandemic? Early stages of the pandemic in Spain.
      ; and (2) having a relative infected with COVID-19 (d = 4.27 [0.09, 8.45], p = 0.045), which has probably impacted older people not only because of the worry for the health of their family or friends but also because of the increased feeling of loneliness due to the recommendations to maintain physical distancing.
      • Shrira A
      • Hoffman Y
      • Bodner E
      COVID-19-related loneliness and psychiatric symptoms among older adults: the buffering role of subjective age.
      TABLE 1Characteristics of the Sample and Factors Associated With Probable PCL-5 Score According to Multivariate Analyses
      % of the 139 Patientsd [95% CI]p
      Age-0.26 [-0.55, 0.03]0.080
      SexMen69.8%Ref
      Women30.2%7.20 [3.19, 11.21]<0.001
      Recruitment periodFirst41.0%Ref
      Second59.0%−0.10 [−4.26, 4.06]0.962
      Living aloneNo82.0%Ref
      Yes15.8%1.17 [−4.13, 6.47]0.662
      Healthcare workerNo88.5%Ref
      Yes7.2%1.75 [−11.64, 15.15]0.796
      History of psychiatric disorderNo90.6%Ref
      Yes8.6%0.46 [−5.92, 6.85]0.886
      Physical comorbiditiesNo35.3%Ref
      Yes64.7%−0.79 [−4.77, 3.18]0.692
      Type of care for the covid-19 infectionAmbulatory5.0%Ref
      Hospitalization59.0%1.38 [−14.13, 16.89]0.860
      ICU36.0%4.22 [−11.30, 19.74]0.591
      RelativesNone33.8%Ref
      Infected59.0%4.27 [0.09, 8.45]0.045
      Deceased3.6%8.65 [−2.74, 20.04]0.135
      Significant results (p < 0.05) are in bold. Multivariate analyses concerned only 113 patients due to missing data.
      Despite some limitations (the study was conducted only in the northern district of France, with small sample size composed mainly of women, and only assess PTSD symptoms specifically related to COVID-19), this work is the first to examine PTSD symptoms related to COVID-19 in elderly people diagnosed with COVID-19 based on hetero-evaluation. The results confirm previous data suggesting that older people present less PTSD compared to younger populations, even in the pandemic context in which they have been constantly presented as highly vulnerable.

      Author Contributions

      All authors substantially contributed to the conception and design of the study and to the acquisition of data. MW performed the analysis. MH, AA, TF, and FDH interpreted the data and drafted the work; all authors performed critical revision of the paper for important intellectual content and finally approved of the version to be published.
      All authors agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

      DISCLOSURES

      We would like to thank the Fondation de France for the financial support to the consultation-liaison psychiatry service of the University Hospital Center of Lille during this unprecedented sanitary crisis. The authors report no conflicts with any product mentioned or concept discussed in this article.

      DATA STATEMENT

      The data has not been previously presented orally or by poster at scientific meetings.

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