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In a single-center Italian study, about 30% of patients who recovered from COVID-19 developed posttraumatic stress disorder (PTSD), researchers found.

Among the 381 patients who were followed, those who developed PTSD were more likely to be women (55.7%), had higher rates of history of psychiatric disorder (34.8%), and were more likely to have had delirium or agitation during their acute illness (16.5%), Delfina Janiri, MD, of Gemelli University Hospital in Rome, and colleagues reported in .

They also had more persistent medical symptoms after their initial illness (62.6%), the researchers found.

"Further longitudinal studies are needed to tailor therapeutic interventions and prevention strategies," they wrote, noting that their finding of 30.2% is consistent with rates seen for other coronaviruses SARS and MERS.

Janiri and colleagues enrolled participants who presented to the emergency department for COVID-19, and who had a post-recovery health check, between April and October 2020. Patients were offered both medical and psychiatric assessments. PTSD was diagnosed using the gold-standard CAP-5 scale.

The mean age of their sample was 55, all patients were white, and most had been hospitalized during their illness (81.1%), with a mean hospital stay of 18.41 days.

In addition to PTSD, researchers also found that 17.3% had depressive episodes and 7% had generalized anxiety disorder.

Regression analyses found that risk factors included sex (P=0.02), delirium/agitation (P=0.02), and persistent medical symptoms (P=0.002).

Factors with no significant impact on PTSD included being hospitalized, length of hospital stay, ICU admission, being on oxygen, and having noninvasive or mechanical ventilation, they reported.

According to a previous study in the Lancet Respiratory Medicine, more than 50% of COVID-19 patients admitted to an ICU have experienced delirium -- a common phenomenon for all intensive care patients.

Megan Hosey, PhD, a rehabilitation psychologist at Johns Hopkins, who wasn't involved in the research, noted that ICU delirium can arise from feeling a lack of control over the body and being disoriented by surroundings. This sensation only intensifies when patients are being given various medications and can only come into contact with a handful of PPE-clad hospital staff, Hosey said.

"Many patients have hallucinations where they believe that medical providers are trying to harm them," Hosey told 麻豆传媒. "We've had patients tell us things like 'I thought I was being buried alive' when they were being put into an MRI."

For patients who have experienced extreme respiratory distress, Hosey added, the persistent feeling of breathlessness -- even if a patient's lungs are fully recovered -- can be a trigger for PTSD symptoms.

Jim Jackson, PsyD, assistant director of the at Vanderbilt University Medical Center in Nashville, cautioned that one problem with post-COVID PTSD is that survivors may not realize they have it.

"Part of the challenge that we see with COVID survivors is that some percentage of them have meaningful PTSD, but they really don't even know it," Jackson said, explaining that this may in part be due to the common associations between PTSD and violence sustained in combat or sexual assault.

"They know something is quite wrong, but they think they didn't have exposures associated with PTSD, so they think that must not be what they have," he said.

Jackson said that the good news for survivors, however, is that PTSD can respond well to treatment. Apart from support groups -- which he regularly leads for patients who've had long ICU stays -- Jackson said more therapies have gained scientific validation, including Cognitive Processing Therapy, Eye Movement Desensitization and Reprocessing, and Prolonged Exposure Therapy.

The biggest issue going forward, in Jackson's view, will be figuring out how to connect the growing number of COVID-19 survivors to mental health professionals who are skilled in treating PTSD.

"If a third of COVID survivors have PTSD," he said, "that's a demand that utterly outstrips the supply that we have."

Experts told 麻豆传媒 that more attention should be paid to preventing PTSD in the ICU.

"This is a very obvious call for mental health in medical clinics," Jessi Gold, MD, a psychiatrist at Washington University in St. Louis, told 麻豆传媒. If someone in a medical clinic screens positive for PTSD, for instance, they should be able to get a same-day appointment with a counselor in that clinic, Gold said.

Rana Awdish, MD, is a critical care physician with Henry Ford Health System in Detroit who has survived several ICU stays for her own critical illness.

"I worry that we already know what to do to prevent this," she told 麻豆传媒, explaining that she worries the take-away from the pandemic will only be on recovery from the trauma that COVID patients experience, without addressing the root cause of the trauma before critical care treatment even begins.

Awdish also called for an awareness of the trauma experienced by ICU medical staff themselves.

"That undoubtedly influences the kind of care that we're able to provide," Awdish said, "so I think there needs to be healing on all sides."

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