PTSD in Long COVID

PTSD. What is it?

What is it?

Post-traumatic stress disorder (PTSD) may develop following exposure to an extremely threatening or horrific event or series of events¹.  PTSD manifests itself as recurring distressing memories, flashbacks and other symptoms after having or witnessing a traumatic incident.  PTSD in Long COVID can occur as part of Post-Intensive Care Syndrome amongst those that have been hospitalized and needed Intensive Care Unit (ICU) admission for their COVID-19 infection² and the Long Hauler that was never hospitalized for their SARS-CoV-2 infection.

What are the symptoms?

• Painful recurring ideas, recollections, visions, dreams, or flashbacks to the event daily.

• You make an effort to stay away from any ideas, discussions, situations, people, activities, or locations that can bring up memories of the trauma since they upset or unnerve you.

• Feeling cut off from other people and emotionally numb. It could be hard for you to feel and think lovingly.

• You have a negative attitude on life most of the time. It’s possible that you’ll get disinterested in past hobbies and find it challenging to make future plans.

• Elevated arousal that was absent prior to the trauma. This could consist of:

            Having trouble falling or staying asleep.

            Being easily agitated, which could result in angry outbursts.

            Having an inability to concentrate.

            An increase in vigilance.

            Being more susceptible to shock than you previously were. It is common to feel upset immediately following a trauma, for many the distress gradually subsides. The difference with PTSD is that the upsetting sensations and symptoms persist for at least one month⁴ and cause significant problems in personal, family, social, educational, occupational and other important areas of functioning^1,3.

Who gets it?

Long COVID is a severe illness.  The sudden occurrence of a severe illness in an individual can be classed as a traumatic event – so Long Haulers are amongst the list of people that can develop PTSD⁴.  Other people are first responders (fire fighters, police, paramedics).  Other examples of traumatic events that lead to PTSD are car accident, war, rape, domestic abuse, child abuse, imprisonment, childbirth.

Other factors that increase your risk for developing PTSD are poverty, being female, being in an ethnic minority, having poor education, having a past history of trauma, being in a younger age group⁴. 

Having prior mental health issues such as anxiety and depression are also factors and having PTSD also increases your risk of developing anxiety and depression. 

In “The Impact of Long COVID-19 on Mental Health: Observational 6-month study”,

37% of Long Haulers were at risk of PTSD at 3 months and 27% at 6 months.  These figures were comparable in hospitalised and non-hospitalised patients.  Given that PTSD can occur months or even years after the traumatic event and approximately 70-80 million people are suffering with Long COVID globally, not only is more study needed over a longer timeline, but we also now have a global major mental health crisis with this pandemic!

Long Covid can lead to Post-Traumatic Stress Disorder (PTSD), characterized by intrusive memories, avoidance behaviors, and negative mood changes following the illness. Symptoms include flashbacks, nightmares, and heightened arousal, impacting daily life. PTSD in Long Covid patients warrants attention for comprehensive management and support.

Long Covid The Answers

Relief:

A significant proportion of people suffering from PTSD will recover spontaneously of those that don’t. Talking therapies seem to help the most.

• Seek help from your Family Physician or other health care professional such as a psychologist, counsellor or Long COVID Rehabilitation team/clinic.
• Seek help from supportive family and friends.
• Join a support group for other PTSD sufferers, particularly a health provider-led Long COVID support group.
• Individual Trauma Focused Cognitive Behavioural Therapy can help under the supervision of a qualified healthcare provider.
• Eye Movement Desensitisation and reprocessing (EMDR) therapy practised by a trained psychologist has been shown to be a successful form of treatment for those with quite severe PTSD.
• Medication such as paroxetine or mirtazapine may help if prescribed and managed by a qualified and licensed healthcare practitioner – such as a Family Physician or Psychiatrist.

Credible sources of information:

1. WHO ICD-11 Definition of Post Traumatic Stress Disorder

• Colbenson GA, Johnson A, Wilson ME. Post-intensive care syndrome: impact, prevention, and management. Breathe. 2019 Jun 1;15(2):98-101.

• Patient.info leaflet Post-Traumatic Stress Disorder – Peer reviewed by Dr Krishna    Vakharia, MRCGPLast updated by Dr Hayley Willacy, FRCGP Last updated 10 Sept 2023 (Some information on managing PTSD in children & teenagers)

• Houben-Wilke S, Goërtz Y, Delbressine J, Vaes A, Meys R, Machado F, van Herck M, Burtin C, Posthuma R, Franssen F, Vijlbrief H, Spies Y, van ‘t Hul A, Spruit M, Janssen D.  The Impact of Long COVID-19 on Mental Health: Observational 6-Month Follow-Up Study JMIR Ment Health 2022;9(2):e33704

• Traumatic Events. Healthline.  Medically reviewed by Matthew Boland, PhD & Jacquelyn Cafasso – updated 14^th April 2023

• Post-Traumatic Stress Disorder (PTSD) medically reviewed by Kendra Kubal, PSYD; Psychology by Maureen Donohue Feb 2022 (Some information on managing PTSD in children & teenagers)

• Dunn H, Balas MC, Hetland B, Krupp A. Post-intensive care syndrome: A review for the primary care NP. The Nurse Practitioner. 2022 Nov 1;47(11):15-22.

• 2018 UK NICE Guidelines for Post-traumatic Stress Disorder – extensive information about the diagnosis and management of PTSD in adults, young adults and children.