Psychological Distress and Its Predictors Among Hospital Admitted COVID-19 Patients

Objective Limited evidence is available on the psychological distress among patients hospitalized with COVID -19. We assessed (a) the incidence of psychological distress, posttraumatic symptoms and substance use among patients hospitalized with COVID-19, (b) perceived stress, coping, and social support experienced by distressed and non-distressed patients and the predictors of psychological distress. Method Ours was a hospital-based cross-sectional study, conducted in a Union Territory of India. Patients were assessed (August – September, 2020) at the time of admission (within two days) with standardized instruments (N=250). Results More than 19 percent of respondents had experienced significant psychological distress (probable cases) and nearly 9% reported post traumatic stress symptoms. The cases and non-cases differ in terms of active coping (5.51±0.87 v/s 5.06±1.06; t=3.10, p<0.01), emotional support (5.21±0.87 v/s 4.86±0.79; t=2.57, p<0.01), behavioural disengagement (5.18±0.92 v/s 4.55±1.15; t=3.56, p<0.001), venting (5.42±0.96 v/s 4.80±1.24; t=3.30, p<0.01), acceptance (5.75±1.24 v/s 5.29±1.50; t=2.23, p<0.05), religion (5.43±1.41 v/s 6.06±1.46; t=-2.76, p<0.01) and self-blame (5.65±1.00 v/s 4.82±1.39; t=3.95, p<0.001). Symptoms of post-traumatic stress (OR: 2.058; 95% CI: 1.49-2.84) was the only significant predictor of the psychological distress. Conclusions Nearly one in five hospitalized patients with COVID-19 experience psychological distress. Screening and treatment for trauma and psychological distress should be made an integral component of care for patients with COVID-19

The critical incident inventory: characteristics of incidents which affect emergency medical technicians and paramedics

Background Emergency medical technicians (EMTs) and paramedics experience critical incidents which evoke distress and impaired functioning but it is unknown which aspects of incidents contribute to their impact. We sought to determine these specific characteristics by developing an inventory of critical incident characteristics and testing their relationship to protracted recovery from acute stress, and subsequent emotional symptoms. Methods EMT/paramedics (n = 223) completed a retrospective survey of reactions to an index critical incident, and current depressive, posttraumatic and burnout symptoms. Thirty-six potential event characteristics were evaluated; 22 were associated with peritraumatic distress and were retained. We assigned inventory items to one of three domains: situational, systemic or personal characteristics. We tested the relationships between (a) endorsing any domain item and (b) outcomes of the critical incident (peritraumatic dissociation, recovery from components of the Acute Stress Reaction and depressive, posttraumatic, and burnout symptoms). Analyses were repeated for the number of items endorsed. Results Personal and situational characteristics were most frequently endorsed. The personal domain had the strongest associations, particularly with peritraumatic dissociation, prolonged distressing feelings, and current posttraumatic symptoms. The situational domain was associated with peritraumatic dissociation, prolonged social withdrawal, and current posttraumatic symptoms. The systemic domain was associated with peritraumatic dissociation and prolonged irritability. Endorsing multiple characteristics was related to peritraumatic, acute stress, and current posttraumatic symptoms. Relationships with outcome variables were as strong for a 14-item inventory (situational and personal characteristics only) as the 22-item inventory. Conclusions Emotional sequelae are associated most strongly with EMT/paramedics’ personal experience, and least with systemic characteristics. A14-item inventory identifies critical incident characteristics associated with emotional sequelae. This may be helpful in tailoring recovery support to individual provider needs.

The attachment video-feedback intervention (AVI) combined to the trauma-focused cognitive behavioral therapy (TF-CBT) for sexually abused preschoolers and their parents: A pilot study examining pre- to post-test changes

Child sexual abuse is associated with a range of negative consequences, including behavior problems and dissociative and posttraumatic stress symptoms. Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) has shown to be successful in the treatment of child victims of sexual abuse, but yet presents some challenges with preschoolers. Child sexual abuse has often been associated with insecure attachment among preschool children. Therefore, combining an attachment-based intervention with the TF-CBT may offer a means to optimize therapeutic outcomes. This pilot study examined in a pre/post-test design whether the combination of the Attachment Video-feedback Intervention (AVI) with the TF-CBT led to changes in the well-being of sexually abused preschoolers and their parents. Participants included 33 sexually abused children aged 4 to 6 years old and their non-offending caregivers. Parents completed questionnaires on their child’s behavior problems and dissociative symptoms, and reported on their own psychological distress and posttraumatic symptoms following their child’s disclosure of trauma. Results showed decreases in child internalizing and dissociative symptoms and maternal psychological distress and posttraumatic symptoms after the intervention. This pilot study suggests this combined protocol is a promising tool to foster the recovery of young victims of sexual abuse and their non-offending caregivers.

The critical incident inventory: characteristics of incidents which affect emergency medical technicians and paramedics

Background Emergency medical technicians (EMTs) and paramedics experience critical incidents which evoke distress and impaired functioning but it is unknown which aspects of incidents contribute to their impact. We sought to determine these specific characteristics by developing an inventory of critical incident characteristics and testing their relationship to protracted recovery from acute stress, and subsequent emotional symptoms. Methods EMT/paramedics (n = 223) completed a retrospective survey of reactions to an index critical incident, and current depressive, posttraumatic and burnout symptoms. Thirty-six potential event characteristics were evaluated; 22 were associated with peritraumatic distress and were retained. We assigned inventory items to one of three domains: situational, systemic or personal characteristics. We tested the relationships between (a) endorsing any domain item and (b) outcomes of the critical incident (peritraumatic dissociation, recovery from components of the Acute Stress Reaction and depressive, posttraumatic, and burnout symptoms). Analyses were repeated for the number of items endorsed. Results Personal and situational characteristics were most frequently endorsed. The personal domain had the strongest associations, particularly with peritraumatic dissociation, prolonged distressing feelings, and current posttraumatic symptoms. The situational domain was associated with peritraumatic dissociation, prolonged social withdrawal, and current posttraumatic symptoms. The systemic domain was associated with peritraumatic dissociation and prolonged irritability. Endorsing multiple characteristics was related to peritraumatic, acute stress, and current posttraumatic symptoms. Relationships with outcome variables were as strong for a 14-item inventory (situational and personal characteristics only) as the 22-item inventory. Conclusions Emotional sequelae are associated most strongly with EMT/paramedics’ personal experience, and least with systemic characteristics. A14-item inventory identifies critical incident characteristics associated with emotional sequelae. This may be helpful in tailoring recovery support to individual provider needs.