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Predictors of traumatic experiences among individuals experiencing pandemic-related stressors: a cross-sectional study in Europe during the COVID-19 crisis

Abstract

The COVID-19 pandemic is a manifestation of trauma exposure that could eventuate in psychological distress, anxiety, depression, and various mental health disturbances, especially in people who have experienced an additional stressor such as a traumatic event. This cross-sectional study assessed the relationship between pandemic-related stressors, post-traumatic stress disorder (PTSD), the risk for severe or life-threatening symptoms, and resilience among individuals with a traumatic history amidst the coronavirus disease. This study is part of a longitudinal pan-European research, the ADJUST study. The present study consisted of 14.106 participants. The questionnaires utilized included: sociodemographics, health aspects, the Criterion A section of the PTSD Checklist for DSM-5 (PCL-5), the Primary Care PTSD Screen for DSM-5 (PC-PTSD-5), the Pandemic Stressor Scale (PaSS), and the Resilience Evaluation Scale (RES). For the analysis, descriptive statistics and logistic regression analysis were applied. 29% of the respondents reported a traumatic history. Fear of infection, burden of infection, crisis management and communication, restricted activity, risk for severe or life-threatening symptoms of the coronavirus disease, PTSD, and resilience were the predictive factors in the trauma-exposed population. This research provides insights into the stressors that individuals with a traumatic background might experience through the COVID-19 pandemic. Future interventions and worldwide health policies should target trauma-exposed populations to enhance psychological health amidst COVID-19 and other stressful events.

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Data availability

The detailed sociodemographic information of the dataset does not fully protect the anonymity of the respondents. For this reason, the entire dataset cannot be made publicly available. Εxcerpts of the data can be provided upon reasonable request by the first author and if approved by all co-authors.

References

  • Abdo, C., Miranda, E. P., Santos, C. S., Júnior, JdeB., & Bernardo, W. M. (2020). Domestic violence and substance abuse during COVID-19: A systematic review. Indian Journal of Psychiatry, 62(3), 337-S342. https://doi.org/10.4103/psychiatry.IndianJPsychiatry_1049_20

    Article  Google Scholar 

  • Ai, X., Yang, J., Lin, Z., & Wan, X. (2021). Mental health and the role of physical activity during the COVID-19 pandemic. Frontiers in Psychology, 12, 759987. https://doi.org/10.3389/fpsyg.2021.759987

  • Ashby, J. S., Rice, K. G., Kira, I. A., & Davari, J. (2021). The relationship of COVID‐19 traumatic stress, cumulative trauma, and race to post-traumatic stress disorder symptoms. Journal of Community Psychology, 22762. https://doi.org/10.1002/jcop.22762

  • Bansal, S., Roy, M., Chatterjee, T., & Roy, A. K. (2021). Deaths due to delayed presentation to the hospital from fear of contracting COVID-19 during lockdown period: A tertiary care center experience. Journal of Community Hospital Internal Medicine Perspectives, 11(3), 299–301. https://doi.org/10.1080/20009666.2021.1918440

    Article  PubMed  PubMed Central  Google Scholar 

  • Bargain, O., & Aminjonov, U. (2020). Trust and compliance to public health policies in times of COVID-19. Journal of Public Economics, 192, 104316. https://doi.org/10.1016/j.jpubeco.2020.104316

    Article  PubMed  PubMed Central  Google Scholar 

  • Bell, V., Robinson, B., Katona, C., Fett, A.-K., & Shergill, S. (2019). When trust is lost: The impact of interpersonal trauma on social interactions. Psychological Medicine, 49(6), 1041–1046. https://doi.org/10.1017/S0033291718001800

    Article  PubMed  Google Scholar 

  • Blevins, C. A., Weathers, F. W., Davis, M. T., Witte, T. K., & Domino, J. L. (2015). The post-traumatic stress disorder checklist for DSM-5 (PCL-5): Development and initial psychometric evaluation. Journal of Traumatic Stress, 28(6), 489–498. https://doi.org/10.1002/jts.22059

    Article  PubMed  Google Scholar 

  • Boyraz, G., & Legros, D. N. (2020). Coronavirus disease (COVID-19) and traumatic stress: probable risk factors and correlates of post-traumatic stress disorder. Journal of Loss and Trauma, 25(6–7), 503–522. https://doi.org/10.1080/15325024.2020.1763556

    Article  Google Scholar 

  • Bridgland, V. M. E., Moeck, E. K., Green, D. M., Swain, T. L., Nayda, D. M., Matson, L. A., Hutchison, N. P., & Takarangi, M. K. T. (2021). Why the COVID-19 pandemic is a traumatic stressor. PLOS ONE, 16(1), e0240146. https://doi.org/10.1371/journal.pone.0240146

    Article  PubMed  PubMed Central  Google Scholar 

  • Brooks, S. K., Webster, R. K., Smith, L. E., Woodland, L., Wessely, S., Greenberg, N., & Rubin, G. J. (2020). The psychological impact of quarantine and how to reduce it: Rapid review of the evidence. Lancet, pp. 912–920. https://doi.org/10.1016/S0140-6736(20)30460-8

  • Campion, J., Javed, A., Sartorius, N., & Marmot, M. (2020). Addressing the public mental health challenge of COVID-19. The Lancet Psychiatry, 7(8), 657–659. https://doi.org/10.1016/S2215-0366(20)30240-6

    Article  PubMed  PubMed Central  Google Scholar 

  • Connor, K. M., & Davidson, J. R. T. (2003). Development of a new resilience scale: The Connor-Davidson Resilience Scale (CD-RISC). Depression and Anxiety, 18, 76–82. https://doi.org/10.1002/da.10113

    Article  Google Scholar 

  • De Bellis, M. D., & Zisk, A. (2014). The biological effects of childhood trauma. Child and Adolescent Psychiatric Clinics of North America, 23(2), 185–vii. https://doi.org/10.1016/j.chc.2014.01.002

  • Dubey, S., Biswas, P., Ghosh, R., Chatterjee, S., Dubey, M. J., Chatterjee, S., Lahiri, D., & Lavie, C. J. (2020). Psychosocial impact of COVID-19. Diabetes & Metabolic Syndrome, 14(5), 779–788. https://doi.org/10.1016/j.dsx.2020.05.035

    Article  Google Scholar 

  • Dutheil, F., Mondillon, L., & Navel, V. (2021). PTSD as the second tsunami of the SARS-Cov-2 pandemic. Psychological Medicine, 51(10), 1773–1774. https://doi.org/10.1017/S0033291720001336

    Article  PubMed  Google Scholar 

  • Feder, A., Haglund, M., Wu, G., Southwick, S. M., & Charney, D. S. (2013). The neurobiology of resilience. In Neurobiology of mental illness (4th ed., pp. 1144–1170). Oxford University Press. https://doi.org/10.1093/med/9780199934959.003.0088

  • Feder, A., Nestler, E. J., & Charney, D. S. (2009). Psychobiology and molecular genetics of resilience. Nature Reviews. Neuroscience, 10(6), 446–457. https://doi.org/10.1038/nrn2649

    Article  PubMed  PubMed Central  Google Scholar 

  • Fiorillo, A., & Gorwood, P. (2020). The consequences of the COVID-19 pandemic on mental health and implications for clinical practice. European Psychiatry: The Journal of the Association of European Psychiatrists, 63(1), 32. https://doi.org/10.1192/j.eurpsy.2020.35

    Article  Google Scholar 

  • Fishere, M., & Bartoli, E. (2022). COVID-19 and risk of retraumatization in adults with a past exposure to potentially traumatic events: A cross-cultural exploration across Egypt, Germany, and Italy. Journal of Community Psychology, 50(6), 2578–2596. https://doi.org/10.1002/jcop.22815

  • Griffin, G. (2020). Defining trauma and a trauma-informed COVID-19 response. Psychological Trauma: Theory, Research, Practice, and Policy, 12(1), S279–S280. https://doi.org/10.1037/tra0000828

    Article  PubMed  Google Scholar 

  • Herringa, R. J. (2017). Trauma, PTSD, and the developing brain. Current Psychiatry Reports, 19(10), 69. https://doi.org/10.1007/s11920-017-0825-3

  • Herman, J. L. (1992). Trauma and recovery (276). Basic Books/Hachette Book Group.

  • Kessler, R. C., Aguilar-Gaxiola, S., Alonso, J., Bromet, E. J., Gureje, O., Karam, E. G., Koenen, K. C., Lee, S., Liu, H., Pennell, B.-E., Petukhova, M. V., Sampson, N. A., Shahly, V., Stein, D. J., Atwoli, L., Borges, G., Bunting, B., de Girolamo, G., Gluzman, S. F., …, & Zaslavsky, A. M. (2018). The associations of earlier trauma exposures and history of mental disorders with PTSD after subsequent traumas. Molecular Psychiatry, 23(9), 1892–1899. https://doi.org/10.1038/mp.2017.194

  • Kimhi, S., Eshel, Y., Marciano, H., & Adini, B. (2020). Distress and resilience in the days of COVID-19: Comparing two ethnicities. International Journal of Environmental Research and Public Health, 17(11), 3956. https://doi.org/10.3390/ijerph17113956

    Article  PubMed  PubMed Central  Google Scholar 

  • Kinser, P. A., Jallo, N., Amstadter, A. B., Thacker, L. R., Jones, E., Moyer, S., Rider, A., Karjane, N., & Salisbury, A. L. (2021). Depression, anxiety, resilience, and coping: The experience of pregnant and new mothers during the first few months of the COVID-19 pandemic. Journal of Women’s Health, 30(5), 654–664. https://doi.org/10.1089/jwh.2020.8866

    Article  PubMed  PubMed Central  Google Scholar 

  • Lahav, Y. (2020). Psychological distress related to COVID-19 – the contribution of continuous traumatic stress. Journal of Affective Disorders, 129–137. https://doi.org/10.1016/j.jad.2020.07.141

  • Lee, A. M., Wong, J. G. W. S., McAlonan, G. M., Cheung, V., Cheung, C., Sham, P. C., Chu, C.-M., Wong, P.-C., Tsang, K. W. T., & Chua, S. E. (2007). Stress and psychological distress among SARS survivors 1 year after the outbreak. Canadian Journal of Psychiatry. Revue Canadienne De Psychiatrie, 52(4), 233–240. https://doi.org/10.1177/070674370705200405

    Article  PubMed  Google Scholar 

  • Lei, L., Zhu, H., Li, Y., Dai, T., Zhao, S., Zhang, X., Muchu, X., & Su, S. (2021). Prevalence of post-traumatic stress disorders and associated factors one month after the outbreak of the COVID-19 among the public in southwestern China: A cross-sectional study. BMC Psychiatry, 21(1), 545. https://doi.org/10.1186/s12888-021-03527-1

    Article  PubMed  PubMed Central  Google Scholar 

  • Liu, C. H., Zhang, E., Wong, G. T. F., Hyun, S., & Hahm, H. C. (2020). Factors associated with depression, anxiety, and PTSD symptomatology during the COVID-19 pandemic: Clinical implications for U.S. young adult mental health. Psychiatry Research, 290, 113172. https://doi.org/10.1016/j.psychres.2020.113172

    Article  PubMed  PubMed Central  Google Scholar 

  • Lotzin, A., Ketelsen, R., Zrnic, I., Lueger-Schuster, B., Böttche, M., & Schäfer, I. (2022). The Pandemic Stressor Scale: Factorial validity and reliability of a measure of stressors during a pandemic. BMC Psychology, 10(1), 92. https://doi.org/10.1186/s40359-022-00790-z

    Article  PubMed  PubMed Central  Google Scholar 

  • Lotzin, A., Krause, L., Acquarini, E., Ajdukovic, D., Ardino, V., Arnberg, F., Böttche, M., Bragesjö, M., Dragan, M., Figueiredo-Braga, M., Gelezelyte, O., Grajewski, P., Anastassiou-Hadjicharalambous, X., Javakhishvili, J. D., Kazlauskas, E., Lenferink, L., Lioupi, C., Lueger-Schuster, B., Tsiskarishvili, L., …, & ADJUST Study Consortium. (2021). Risk and protective factors, stressors, and symptoms of adjustment disorder during the COVID-19 pandemic – first results of the ESTSS COVID-19 pan-European ADJUST study. European Journal of Psychotraumatology, 12(1), 1964197. https://doi.org/10.1080/20008198.2021.1964197

  • McCoy, K., Peterson, A., Tian, Y., & Sang, Y. (2020). Immunogenetic association underlying severe COVID-19. Vaccines, 8(4). https://doi.org/10.3390/vaccines8040700

  • McGowan, I. W., Fisher, N., Havens, J., & Proudlock, S. (2021). An evaluation of eye movement desensitization and reprocessing therapy delivered remotely during the Covid–19 pandemic. BMC Psychiatry, 21(1), 560. https://doi.org/10.1186/s12888-021-03571-x

    Article  PubMed  PubMed Central  Google Scholar 

  • Płomecka, M. B., Gobbi, S., Neckels, R., Radziński, P., Skórko, B., Lazzeri, S., Almazidou, K., Dedić, A., Bakalović, A., Hrustić, L., Ashraf, Z., Haghi, S. E., Rodríguez-Pino, L., Waller, V., Jabeen, H., Alp, A. B., Behnam, M. A., Shibli, D., Barańczuk-Turska, Z., …, & Jawaid, A. (2020). Mental health impact of COVID-19: A global study of risk and resilience factors. Frontiers in Psychiatry, 11. https://doi.org/10.1101/2020.05.05.20092023

  • Prins, A., Bovin, M. J., Smolenski, D. J., Marx, B. P., Kimerling, R., Jenkins-Guarnieri, M. A., Kaloupek, D. G., Schnurr, P. P., Kaiser, A. P., Leyva, Y. E., & Tiet, Q. Q. (2016). The primary care PTSD screen for DSM-5 (PC-PTSD-5): Development and evaluation within a veteran primary care sample. Journal of General Internal Medicine, 31(10), 1206–1211. https://doi.org/10.1007/s11606-016-3703-5

    Article  PubMed  PubMed Central  Google Scholar 

  • Qiu, D., Li, Y., Li, L., He, J., Ouyang, F., & Xiao, S. (2021). Prevalence of post-traumatic stress symptoms among people influenced by coronavirus disease 2019 outbreak: A meta-analysis. European Psychiatry : The Journal of the Association of European Psychiatrists, 64(1), e30. https://doi.org/10.1192/j.eurpsy.2021.24

  • Rhodes, H. X., Petersen, K., Lunsford, L., & Biswas, S. (2020). COVID-19 resilience for survival: Occurrence of domestic violence during lockdown at a rural American college of surgeons verified level one trauma center. Cureus. https://doi.org/10.7759/cureus.10059

  • Salari, N., Hosseinian-Far, A., Jalali, R., Vaisi-Raygani, A., Rasoulpoor, S., Mohammadi, M., Rasoulpoor, S., & Khaledi-Paveh, B. (2020). Prevalence of stress, anxiety, depression among the general population during the COVID-19 pandemic: A systematic review and meta-analysis. Globalization and Health, 16(1), 57. https://doi.org/10.1186/s12992-020-00589-w

    Article  PubMed  PubMed Central  Google Scholar 

  • Sampogna, G., Del Vecchio, V., Giallonardo, V., Luciano, M., Albert, U., Carmassi, C., Carrà, G., Cirulli, F., Dell’Osso, B., Menculini, G., Nanni, M., Pompili, M., Sani, G., Volpe, U., Bianchini, V., & Fiorillo, A. (2021). What is the role of resilience and coping strategies on the mental health of the general population during the COVID-19 pandemic? Results from the Italian Multicentric COMET Study. Brain Sciences, 11(9). https://doi.org/10.3390/brainsci11091231

  • Schock, K., Rosner, R., & Knaevelsrud, C. (2015). Impact of asylum interviews on the mental health of traumatized asylum seekers. European Journal of Psychotraumatology, 6. https://doi.org/10.3402/ejpt.v6.26286

  • Schultebraucks, K., Sijbrandij, M., Galatzer-Levy, I., Mouthaan, J., Olff, M., & van Zuiden, M. (2021). Forecasting individual risk for long-term Post-traumatic Stress Disorder in emergency medical settings using biomedical data: A machine learning multicenter cohort study. Neurobiology of Stress, 14, 100297. https://doi.org/10.1016/j.ynstr.2021.100297

    Article  PubMed  PubMed Central  Google Scholar 

  • Shigemura, J., Ursano, R. J., Morganstein, J. C., Kurosawa, M., & Benedek, D. M. (2020). Public responses to the novel 2019 coronavirus (2019-nCoV) in Japan: Mental health consequences and target populations. Psychiatry and Clinical Neurosciences, 74(4), 281–282. https://doi.org/10.1111/pcn.12988

    Article  PubMed  PubMed Central  Google Scholar 

  • Song, S., Yang, X., Yang, H., Zhou, P., Ma, H., Teng, C., Chen, H., Ou, H., Li, J., Mathews, C. A., Nutley, S., Liu, N., Zhang, X., & Zhang, N. (2021). Psychological resilience as a protective factor for depression and anxiety among the public during the outbreak of COVID-19. Frontiers in Psychology, 11, 618509. https://doi.org/10.3389/fpsyg.2020.618509

  • Sun, L., Sun, Z., Wu, L., Zhu, Z., Zhang, F., Shang, Z., Jia, Y., Gu, J., Zhou, Y., Wang, Y., Liu, N., & Liu, W. (2021). Prevalence and risk factors for acute post-traumatic stress disorder during the COVID-19 outbreak. Journal of Affective Disorders, 283, 123–129. https://doi.org/10.1016/j.jad.2021.01.050

    Article  PubMed  PubMed Central  Google Scholar 

  • van der Meer, C. A. I., Te Brake, H., van der Aa, N., Dashtgard, P., Bakker, A., & Olff, M. (2018). Assessing psychological resilience: Development and psychometric properties of the english and dutch version of the resilience evaluation scale (RES). Frontiers in Psychiatry, 9, 169. https://doi.org/10.3389/fpsyt.2018.00169

  • Vannini, P., Gagliardi, G. P., Kuppe, M., Dossett, M. L., Donovan, N. J., Gatchel, J. R., Quiroz, Y. T., Premnath, P. Y., Amariglio, R., Sperling, R. A., & Marshall, G. A. (2021). Stress, resilience, and coping strategies in a sample of community-dwelling older adults during COVID-19. Journal of Psychiatric Research, 138, 176–185. https://doi.org/10.1016/j.jpsychires.2021.03.050

    Article  PubMed  PubMed Central  Google Scholar 

  • Wang, C., Pan, R., Wan, X., Tan, Y., Xu, L., McIntyre, R. S., Choo, F. N., Tran, B., Ho, R., Sharma, V. K., & Ho, C. (2020). A longitudinal study on the mental health of general population during the COVID-19 epidemic in China. Brain, Behavior, and Immunity, 87, 40–48. https://doi.org/10.1016/j.bbi.2020.04.028

  • Wathelet, M., Fovet, T., Jousset, A., Duhem, S., Habran, E., Horn, M., Debien, C., Notredame, C.-E., Baubet, T., Vaiva, G., & D’Hondt, F. (2021). Prevalence of and factors associated with post-traumatic stress disorder among French university students 1 month after the COVID-19 lockdown. Translational Psychiatry, 11(1), 327. https://doi.org/10.1038/s41398-021-01438-z

    Article  PubMed  PubMed Central  Google Scholar 

  • Xiong, J., Lipsitz, O., Nasri, F., Lui, L. M. W., Gill, H., Phan, L., Chen-Li, D., Iacobucci, M., Ho, R., Majeed, A., & McIntyre, R. S. (2020). Impact of COVID-19 pandemic on mental health in the general population: A systematic review. Journal of Affective Disorders, 277, 55–64. https://doi.org/10.1016/j.jad.2020.08.001

  • Yao, H., Chen, J.-H., & Xu, Y.-F. (2020). Patients with mental health disorders in the COVID-19 epidemic. The Lancet Psychiatry, 7(4), e21. https://doi.org/10.1016/S2215-0366(20)30090-0

    Article  PubMed  PubMed Central  Google Scholar 

  • Ye, Z., Yang, X., Zeng, C., Wang, Y., Shen, Z., Li, X., & Lin, D. (2020). Resilience, social support, and coping as mediators between COVID-19-related stressful experiences and acute stress disorder among college students in China. Applied Psychology Health and Well-Being, 12(4), 1074–1094. https://doi.org/10.1111/aphw.12211

    Article  PubMed  PubMed Central  Google Scholar 

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Acknowledgements

The authors thank the collaborators for their support and contribution to the present paper: Ozan Demirok (team Austria); Aleksandra Stevanovic, Helena Bakic, Ines Rezo Bagaric, Tanja Franciskovic (team Croatia); Nino Makhashvili and Sophio Vibliani (team Georgia); Niki Adam, Eleftheria Evgeniou, Eirini Fakoureli, Aristoula Maria Kyratzopoulou, Kostas Messas, Triada Palaiokosta, Eleni Papathanasiou, Konstandina Rapti (team Cyprus/Greece); Ilaria Cinieri, Alessandra Gallo and Chiara Marangio (team Italia); Monika Kvedaraite and Auguste Nomeikaite (team Lithuania); Joanne Mouthaan, Suzan Soydas, Marloes Eidhof, Marie José van Hoof and Simon Groen (team Netherlands); Magdalena Skrodzka and Monika Folkierska-Żukowska (team Poland); Aida Dias, Camila Borges, Diana Andringa, Guida Manuel, Joana Becker and João Veloso, (team Portugal); Kristina Bondjers, Josefin Sveen, Maria Bragesjo, Kerstin Bergh Johannesson and Filip K. Arnberg (team Sweden).

Funding

The data assessment in Poland was supported by the Faculty of Psychology, University of Warsaw, from the funds awarded by the Ministry of Science and Higher Education in the form of a subsidy for the maintenance and development of research potential in 2021 (501-D125-01–1250000 zlec.5011000638) and the Excellence initiative – research university 501-D125-20–0004316. The data assessment in the Netherlands was supported by two insurance companies (DSW and CZ). The remaining countries did not receive specific funding for this research.

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CL conceptualized the study in cooperation with all members of ADJUST consortium. All authors recruited study participants and contributed to the data management of the respective site. AL coordinated the data management. CL and XH designed the data analysis and CL conducted the data analysis. CL drafted the manuscript; all authors revised the draft and approved the final version of the manuscript.

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Correspondence to Chrysanthi Lioupi.

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The study was registered in a study registry before its start (OSF registry, https://doi.org/10.17605/OSF.IO/8XHYG). Each country obtained ethical approval of the study: Ethics Committee of the University of Vienna, 00554. Ethics Committee of the University of Urbino ‘Carlo Bo’, 34, 22/07/2020. Ethics Committee of the Department of Psychology, Faculty of Humanities and Social Sciences, University of Zagreb, 21 May 2020. Ethics Review Board of the Faculty of Social and Behavioural Sciences, Utrecht University, 20–360. Ilia State University Faculty of Arts and Science Research Ethics Committee, 12/06/2020. Local Psychological Ethics Committee at the Centre for Psychosocial Medicine, LPEK-0149. Social Sciences Ethics Review Board (SSERB), University of Nicosia, SSERB 00109. The Swedish Ethical Review Authority, 2020–03217. Vilnius University Ethics Committee of Research in Psychology, 44. Ethics Committee of the Faculty of Psychology, University of Warsaw, 6/7/2020. Ethics Committee of the Medical Faculty, University of Porto and Centro Hospitalar São João, Porto, CE 201–20. The National Ethical Review Board in Sweden, 2020–03217.

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Lioupi, C., Anastassiou-Hadjicharalambous, X., Acquarini, E. et al. Predictors of traumatic experiences among individuals experiencing pandemic-related stressors: a cross-sectional study in Europe during the COVID-19 crisis. Curr Psychol (2023). https://doi.org/10.1007/s12144-023-05036-8

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