Generic placeholder image

Current Psychiatry Research and Reviews

Editor-in-Chief

ISSN (Print): 2666-0822
ISSN (Online): 2666-0830

Research Article

Comorbidity and Association of Posttraumatic Stress, Depression, Anxiety, and Somatic Complaints in COVID-19 Georgian Patients at the Beginning of Pandemic

Author(s): Giorgi Sikharulidze*, Levan Ratiani, Mariam Sordia, Elene Sikharulidze, Tinatin Khutsishvili, Khatuna Lejava and Eric Vermetten

Volume 18, Issue 3, 2022

Published on: 30 August, 2022

Page: [236 - 247] Pages: 12

DOI: 10.2174/2666082218666220713122430

Price: $65

Abstract

Background: The global pandemic which the world has been facing for the past two years has demonstrated the need to study the effects of this virus on mental health. Various studies showed that COVID-19 could be a threat to people's mental health and physical health, yet the findings are still very limited. The purpose of the study was to fill an existing gap in the corresponding literature by analyzing Post Traumatic Stress Disorder (PTSD) symptoms, somatic complaints, depression, and anxiety in COVID-19 patients and studying their comorbidity to determine the impact of the virus on the patients’ mental well-being.

Methods: Patients diagnosed with COVID-19 took part in the study one month after their discharge from the hospital, accounting for 10% of all COVID-19 patients across Georgia during the research. PTSD Checklist (PCL-5) was used. Depression, somatic symptoms, and anxiety were assessed using the Patient Health Questionnaire (PHQ).

Results: The results have shown that COVID-19, as a traumatic event, presents an association with PTSD, depression, anxiety, and somatic complaints. A high prevalence of depression (38,6%), anxiety (34,9%), and somatic symptoms (47%) was displayed. The overall indirect effect of PTSD on somatic symptoms was significant through depression and anxiety: 0.16, 95% CI [0.08, 0.26]. According to the report, the indirect effect of PTSD on somatic symptoms of depression was 0.12, 95% CI [0.05, 0.20].

Conclusion: The study presents important findings on the relations between COVID-19 and patients mental health. Somatic complaints, depression, anxiety, and PTSD symptoms were prevalent in participants even after a month since they had COVID-19. Correlations between somatic complaints, anxiety, depression, and PTSD were also demonstrated. Even though there are various limitations to this study, how COVID-19 could affect mental health warrants further, more detailed research, which is necessary.

Keywords: COVID-19, PTSD, depression, anxiety, somatic complaints, pandemic.

Graphical Abstract
[1]
Qi R, Chen W, Liu S, et al. Psychological morbidities and fatigue in patients with confirmed COVID-19 during disease outbreak: Prevalence and associated biopsychosocial risk factors. medRxiv 2020.
[http://dx.doi.org/10.1101/2020.05.08.20031666]
[2]
Xiang YT, Yang Y, Li W, et al. Timely mental health care for the 2019 novel coronavirus outbreak is urgently needed. Lancet Psychiatry 2020; 7: 228-9.
[http://dx.doi.org/10.1016/S2215-0366(20)30046-8]
[3]
Mak IWC, Chu CM, Pan PC, Yiu MGC, Chan VL. Long-term psychiatric morbidities among SARS survivors. Gen Hosp Psychiatry 2009; 31(4): 318-26.
[http://dx.doi.org/10.1016/j.genhosppsych.2009.03.001] [PMID: 19555791]
[4]
Lee AM, Wong JGWS, McAlonan GM, et al. Stress and psychological distress among SARS survivors 1 year after the outbreak. Can J Psychiatry 2007; 52(4): 233-40.
[http://dx.doi.org/10.1177/070674370705200405] [PMID: 17500304]
[5]
Dubey S, Biswas P, Ghosh R, et al. Psychosocial impact of COVID-19. Diabetes Metab Syndr 2020; 14(5): 779-88.
[http://dx.doi.org/10.1016/j.dsx.2020.05.035] [PMID: 32526627]
[6]
Tutsoy O. COVID-19 epidemic and opening of the schools: Artificial intelligence-based long-term adaptive policy making to control the pandemic diseases. IEEE Access 2021; 9: 68461-71.
[http://dx.doi.org/10.1109/ACCESS.2021.3078080]
[7]
Liu D, Baumeister RF, Veilleux JC, et al. Risk factors associated with mental illness in hospital discharged patients infected with COVID-19 in Wuhan, China. Psychiatry Res 2020; 292: 113297.
[http://dx.doi.org/10.1016/j.psychres.2020.113297] [PMID: 32707218]
[8]
Taquet M, Luciano S, Geddes JR, Harrison PJ. Bidirectional associations between COVID-19 and psychiatric disorder: Retrospective cohort studies of 62 354 COVID-19 cases in the USA. Lancet Psychiatry 2021; 8(2): 130.
[PMID: 33181098]
[9]
Sekowski M, Gambin M, Hansen K, et al. Risk of developing post-traumatic stress disorder in severe COVID-19 survivors, their families and frontline healthcare workers: What should mental health specialists prepare for? Front Psychiatry 2021; 12: 562899.
[http://dx.doi.org/10.3389/fpsyt.2021.562899] [PMID: 34163377]
[10]
Boyraz G, Legros DN. Coronavirus disease (COVID-19) and traumatic stress: Probable risk factors and correlates of posttraumatic stress disorder. J Loss Trauma 2020; 25(6–7): 503-22.
[http://dx.doi.org/10.1080/15325024.2020.1763556]
[11]
Mazza MG, De Lorenzo R, Conte C, et al. Anxiety and depression in COVID-19 survivors: Role of inflammatory and clinical predictors. Brain Behav Immun 2020; 89: 594-600.
[http://dx.doi.org/10.1016/j.bbi.2020.07.037] [PMID: 32738287]
[12]
Ma YF, Li W, Deng HB, et al. Prevalence of depression and its association with quality of life in clinically stable patients with COVID-19. J Affect Disord 2020; 275: 145-8.
[http://dx.doi.org/10.1016/j.jad.2020.06.033] [PMID: 32658818]
[13]
Karatzias T, Shevlin M, Murphy J, et al. Posttraumatic stress symptoms and associated comorbidity during the COVID-19 pandemic in ireland: A population-based study. J Trauma Stress 2020; 33(4): 365-70.
[http://dx.doi.org/10.1002/jts.22565] [PMID: 32662129]
[14]
Bener A, Al-Kazaz M, Ftouni D, Al-Harthy M, Dafeeah EE. Diagnostic overlap of depressive, anxiety, stress and somatoform disorders in primary care. Asia-Pac Psychiatry 2013; 5(1): E29-38.
[http://dx.doi.org/10.1111/j.1758-5872.2012.00215.x]
[15]
Compas BE, Boyer MC, Stanger C, et al. Latent variable analysis of coping, anxiety/depression, and somatic symptoms in adolescents with chronic pain. J Consult Clin Psychol 2006; 74(6): 1132-42.
[http://dx.doi.org/10.1037/0022-006X.74.6.1132] [PMID: 17154742]
[16]
Finitsis D. Stress, Anxiety, and somatic symptoms: A comparison of biomarkers in a clinical sample 2013.
[17]
Haftgoli N, Favrat B, Verdon F, et al. Patients presenting with somatic complaints in general practice: Depression, anxiety and somatoform disorders are frequent and associated with psychosocial stressors. BMC Fam Pract 2010; 11(1): 67.
[http://dx.doi.org/10.1186/1471-2296-11-67] [PMID: 20843358]
[18]
Lavigne JV, Saps M, Bryant FB. Models of anxiety, depression, somatization, and coping as predictors of abdominal pain in a community sample of school-age children. J Pediatr Psychol 2014; 39(1): 9-22.
[http://dx.doi.org/10.1093/jpepsy/jst060] [PMID: 23942993]
[19]
Elklit A, Christiansen DM. Predictive factors for somatization in a trauma sample. Clin Pract Epidemiol Ment Health 2009; 5: 1.
[http://dx.doi.org/10.1186/1745-0179-5-1]
[20]
Hoge CW, Terhakopian A, Castro CA, Messer SC, Engel CC. Association of posttraumatic stress disorder with somatic symptoms, health care visits, and absenteeism among Iraq war veterans. Am J Psychiatry 2007; 164(1): 150-3.
[http://dx.doi.org/10.1176/ajp.2007.164.1.150] [PMID: 17202557]
[21]
Asmundson GJG, Coons MJ, Taylor S, Katz J. PTSD and the experience of pain: Research and clinical implications of shared vulnerability and mutual maintenance models. Can J Psychiatry 2002; 47(10): 930-7.
[http://dx.doi.org/10.1177/070674370204701004] [PMID: 12553128]
[22]
McFarlane AC, Atchison M, Rafalowicz E, Papay P. Physical symptoms in post-traumatic stress disorder. J Psychosom Res 1994; 38(7): 715-26.
[http://dx.doi.org/10.1016/0022-3999(94)90024-8] [PMID: 7877126]
[23]
Otis JD, Keane TM, Kerns RD. An examination of the relationship between chronic pain and post-traumatic stress disorder. J Rehabil Res Dev 2003; 40(5): 397-405.
[http://dx.doi.org/10.1682/JRRD.2003.09.0397] [PMID: 15080224]
[24]
Jakupcak M, Osborne T, Michael S, Cook J, Albrizio P, McFall M. Anxiety sensitivity and depression: Mechanisms for understanding somatic complaints in veterans with posttraumatic stress disorder. J Trauma Stress 2006; 19(4): 471-9.
[http://dx.doi.org/10.1002/jts.20145] [PMID: 16929501]
[25]
Rauch SAM, Favorite T, Giardino N, Porcari C, Defever E, Liberzon I. Relationship between anxiety, depression, and health satisfaction among veterans with PTSD. J Affect Disord 2010; 121(1-2): 165-8.
[http://dx.doi.org/10.1016/j.jad.2009.05.026] [PMID: 19535152]
[26]
Iversen AC, van Staden L, Hughes JH, et al. The prevalence of common mental disorders and PTSD in the UK military: Using data from a clinical interview-based study. BMC Psychiatry 2009; 9(1): 68.
[http://dx.doi.org/10.1186/1471-244X-9-68] [PMID: 19878538]
[27]
Simon GE, VonKorff M, Piccinelli M, Fullerton C, Ormel J. An international study of the relation between somatic symptoms and depression. N Engl J Med 1999; 341(18): 1329-35.
[http://dx.doi.org/10.1056/NEJM199910283411801] [PMID: 10536124]
[28]
MacDonald C, Chamberlain K, Long N. Posttraumatic stress disorder (PTSD) and its effects in Vietnam veterans: The New Zealand experience. Anxiety: I 1995; 24(2): 63-8.
[29]
Sayar Ak, Sayar K, Ak I, Sayar Ak, et al. The predictors of somatization: A review. Klinik Psikofarmakol BBülteni 2001; 11(4): 266-71.
[30]
Merikangas KR, Pine D. Genetic and other vulnerability factors for anxiety and stress disorders. Neuropsychopharmacology: The Fifth Generation of Progress 2002; 867-82.
[31]
Taylor S, Koch WJ, McNally RJ. How does anxiety sensitivity vary across the anxiety disorders? J Anxiety Disord 1992; 6(3): 249-59.
[http://dx.doi.org/10.1016/0887-6185(92)90037-8]
[32]
Sikharulidze G, van Geloven N, Lelashvili E, Kalandarishvili G, Gugushvili N, Vermetten E. Posttraumatic stress disorder and somatic complaints in a deployed cohort of georgian military personnel: Mediating effect of depression and anxiety. J Trauma Stress 2017; 30(6): 626-34.
[http://dx.doi.org/10.1002/jts.22235] [PMID: 29193294]
[33]
WMA General Assembly. World Medical Asssociation Declaration of Helsinki World Medical Association 1964.
[34]
Blevins CA, Weathers FW, Davis MT, Witte TK, Domino JL. The posttraumatic stress disorder checklist for DSM-5 (PCL-5): Development and initial psychometric evaluation. J Trauma Stress 2015; 28(6): 489-98.
[http://dx.doi.org/10.1002/jts.22059] [PMID: 26606250]
[35]
Otis JD, Gregor K, Hardway C, Morrison J, Scioli E, Sanderson K. An examination of the co-morbidity between chronic pain and posttraumatic stress disorder on U.S. Veterans. Psychol Serv 2010; 7(3): 126-35.
[http://dx.doi.org/10.1037/a0020512]
[36]
Rice V, Tree R, Boykin G. Posttraumatic stress disorder and somatization among U.S. service members and military veterans. Procedia Manuf 2015; 3: 5342-9.
[http://dx.doi.org/10.1016/j.promfg.2015.07.643]
[37]
Vasterling JJ, Schumm J, Proctor SP, Gentry E, King DW, King LA. Posttraumatic stress disorder and health functioning in a non-treatment-seeking sample of Iraq war veterans: A prospective analysis. J Rehabil Res Dev 2008; 45(3): 347-58.
[http://dx.doi.org/10.1682/JRRD.2007.05.0077] [PMID: 18629744]
[38]
Wortmann JH, Jordan AH, Weathers FW, et al. Psychometric analysis of the PTSD Checklist-5 (PCL-5) among treatment-seeking military service members. Psychol Assess 2016; 28(11): 1392-403.
[http://dx.doi.org/10.1037/pas0000260] [PMID: 26751087]
[39]
Bovin MJ, Marx BP, Weathers FW, et al. Psychometric properties of the PTSD checklist for diagnostic and statistical manual of mental disorders-fifth edition (PCL-5) in Veterans. Psychological Assessment 2015; 28(11): 1379-91.
[40]
Kroenke K, Spitzer RL, Williams JBW. The PHQ-9: Validity of a brief depression severity measure. J Gen Intern Med 2001; 16(9): 606-13.
[http://dx.doi.org/10.1046/j.1525-1497.2001.016009606.x] [PMID: 11556941]
[41]
Comellas RM, Makhashvili N, Chikovani I, et al. Patterns of somatic distress among conflict-affected persons in the Republic of Georgia. J Psychosom Res 2015; 78(5): 466-71.
[http://dx.doi.org/10.1016/j.jpsychores.2015.01.015] [PMID: 25676335]
[42]
Spitzer RL, Kroenke K, Williams JBW, Löwe B. A brief measure for assessing generalized anxiety disorder: The GAD-7. Arch Intern Med 2006; 166(10): 1092-7.
[http://dx.doi.org/10.1001/archinte.166.10.1092] [PMID: 16717171]
[43]
Bleich A, Koslowsky M, Dolev A, et al. The psychological risks of Vietnam for U.S. Veterans: A revisit with new data and methods. JAMA 2006; 25(1): 75-82.
[44]
Hayes A. Introduction to mediation, moderation, and conditional process analysis. New York, NY: The Guilford Press 2013; pp. 3-4.
[45]
Preacher KJ, Hayes AF. Asymptotic and resampling strategies for assessing and comparing indirect effects in multiple mediator models. Behav Res Methods 2008; 40(3): 879-91.
[http://dx.doi.org/10.3758/BRM.40.3.879] [PMID: 18697684]
[46]
Hayes AF. Statistical mediation analysis in the new millennium. Commun Monogr 2009; 76(4): 408-20.
[http://dx.doi.org/10.1080/03637750903310360]
[47]
Preacher KJ, Hayes AF. SPSS and SAS procedures for estimating indirect effects in simple mediation models. Behav Res Methods Instrum Comput 2004; 36(4): 717-31.
[http://dx.doi.org/10.3758/BF03206553] [PMID: 15641418]
[48]
Engel CC Jr, Liu X, McCarthy BD, Miller RF, Ursano R. Relationship of physical symptoms to posttraumatic stress disorder among veterans seeking care for gulf war-related health concerns. Psychosom Med 2000; 62(6): 739-45.
[http://dx.doi.org/10.1097/00006842-200011000-00001] [PMID: 11138991]
[49]
Irwin KC, Konnert C, Wong M, O’Neill TA. PTSD symptoms and pain in Canadian military veterans: The mediating roles of anxiety, depression, and alcohol use. J Trauma Stress 2014; 27(2): 175-81.
[http://dx.doi.org/10.1002/jts.21897] [PMID: 24639069]
[50]
Poundja J, Fikretoglu D, Brunet A. The co-occurrence of posttraumatic stress disorder symptoms and pain: Is depression a mediator? J Trauma Stress 2006; 19(5): 747-51.
[http://dx.doi.org/10.1002/jts.20151] [PMID: 17075919]
[51]
Sikharulidze G, Oniani T, Gugushvili N, Kalandarishvili G, Lelashvili E. Prevalence study of mental disorders in Georgian military personnel participating in peace-keeping missions. Eur Psychiatry 2017; 41(S1): S723-4.
[http://dx.doi.org/10.1016/j.eurpsy.2017.01.1312]
[52]
Bosco MA, Gallinati JL, Clark ME. Conceptualizing and treating comorbid chronic pain and PTSD. Pain Res Treat 2013; 2013: 174728.
[http://dx.doi.org/10.1155/2013/174728] [PMID: 23819047]
[53]
Cameron OG. Understanding comorbid depression and anxiety. Psychiatr Times 2007; 24(14): 2-5.
[54]
Gupta MA. Review of somatic symptoms in post-traumatic stress disorder. Int Rev Psychiatry 2013; 25(1): 86-99.
[http://dx.doi.org/10.3109/09540261.2012.736367] [PMID: 23383670]
[55]
Varghese FP, Brown ES. The hypothalamic-pituitary-adrenal axis in major depressive disorder: A brief primer for primary care physicians. Prim Care Companion J Clin Psychiatry 2001; 3(4): 151-5.
[http://dx.doi.org/10.4088/PCC.v03n0401] [PMID: 15014598]

Rights & Permissions Print Cite
© 2024 Bentham Science Publishers | Privacy Policy