Post-Traumatic Stress Disorder and Complex Post-Traumatic Stress Disorder in people with long COVID, ME/CFS, and controls 2023 Sanal-Hayes et al

[Andy]

Background
Prevalences of Post-Traumatic Stress Disorder (PTSD) and Complex Post-Traumatic Stress Disorder (CPTSD) have not previously been compared between individuals with long COVID and individuals with Myalgic Encephalomyelitis/ Chronic Fatigue Syndrome (ME/CFS), and healthy age-matched controls. For these reasons, this study aimed to determine the prevalence of PTSD and CPTSD in individuals with long COVID (n=21) and ME/CFS (n=20) and age-matched controls (n=20).

Methods
A case-case-control approach was employed, participants completed the International Trauma Questionnaire (ITQ), a self-report measure of the International Classification of Diseases (ICD-11) of PTSD and CPTSD consisting of 18 items. Scores were calculated for each PTSD and Disturbances in Self-Organization (DSO) symptom cluster and summed to produce PTSD and DSO scores. PTSD was diagnosed if the criteria for PTSD were met but not DSO, and CPTSD was diagnosed if the criteria for PTSD and DSO were met. Moreover, each cluster of PTSD and DSO were compared among individuals with long COVID, ME/CFS and healthy controls.

Results
Individuals with long COVID (PTSD= 5%, CPTSD= 33%) had more prevalence of PTSD and CPTSD than individuals with ME/CFS (PTSD= 0%, CPTSD= 20%) and healthy controls (PTSD= 0%, CPTSD= 0%). PTSD and CPTSD prevalence was greater in individuals with long COVID and ME/CFS than controls. Individuals with long COVID had greater values controls for all PTSD values. Moreover, individuals with long COVID had greater values than controls for all DSO values. Individuals with ME/CFS had greater values than controls for all DSO values. Both long COVID and ME/CFS groups differed in overall symptom scores compared to controls.

Conclusion
Findings of this study demonstrated that individuals with long COVID generally had more cases of PTSD and CPTSD than individuals with ME/CFS and healthy controls.

Paywall, https://www.amjmed.com/article/S0002-9343(23)00756-8/fulltext#

 

[EndME]

Same group that published People With Long COVID and Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) Exhibit Similarly Impaired Vascular Function, 2023, McLaughlin+.

I don't have access to this paper, but their previous paper didn't mention which diagnostic criteria were being used. Still a good result to see that even with possibly a bad diagnostic criterium rates of PTSD and CPTSD are comparably low in ME/CFS patients. The Long-Covid result primarily depends on which definition of Long-Covid is being used and what cohorts they are looking at, if they are looking at "anything 4 weeks after an infection" then this will naturally include all sorts of things.

 

[SNT Gatchaman]

The introduction focuses on the psychological impacts of hospitalisation, leading to ± complex PTSD.

The long-term course of the symptoms such as anxiety, depression, insomnia and trauma related symptoms in COVID-19 survivors reveals a trajectory characterised by exacerbation over time, particularly in the case of conditions associated with posttraumatic stress disorder (PTSD). Individuals who have faced a fear of survival remain vulnerable to post-traumatic stress symptoms (PTSS), and hospitalisation during COVID-19 is a well-recognised risk factor for PTSD. Several studies have documented a rapid onset of severe PTSS in COVID-19 survivors following hospital discharge. Mazza et al. documented the rapid onset of severe PTSS in COVID-19 survivors, typically within one month following hospital discharge. [...] Tu et al. reported the persistence of PTSS in COVID-19 studies indicate larger gray matter volumes and increased functional activities in the bilateral hippocampus and amygdala of COVID-19 survivors, two regions associated with the pathophysiology of PTSS.

Cao and colleagues demonstrated that one year on after COVID-19, the prevalence of possible posttraumatic stress disorder was 12.4% and this finding seemed to match up with socio-demographic factors.

Only one in three people fully recover from COVID-19 a year after hospital discharge. [...] Long COVID share similarities and several overlapping symptoms with another condition known as Myalgic Encephalomyelitis (ME), Chronic Fatigue Syndrome (CFS), and/or ME/CFS. [...] Moreover, it has been revealed that there is a link between childhood trauma exposure and an increased risk of long COVID, possibly attributed to immune responses, peripheral dysfunction, and central sensitisation. Nishimi et al. reported that higher psychological resilience to trauma reduced the likelihood of COVID-19 infection but was not associated with COVID-19 severity or long COVID, but only associated with lower likelihood of COVID-19 infection over time. In terms of the association between PTSD and Chronic Fatigue Syndrome (CFS), Simani et al. found no significant association between PTSD and increased risk of CFS in COVID-19 patients.

Taken together, past research suggests a link between PTSS and COVID-19 survivors especially the hospitalised cases, and one year on after COVID-19, the prevalence of possible post-traumatic stress disorder is demonstrated to be about 12.4%. Moreover, past research suggests a link between long COVID and PTSS, and childhood trauma exposure and increased long COVID risk. Given that most hospitalised COVID-19 survivors do not fully recover from COVID-19 and develop long COVID, we sought to examine the prevalence of post-traumatic stress disorder (PTSD) and complex post-traumatic stress disorder (CPTSD) in individuals with long COVID. Furthermore, given the considerable overlap between long COVID and ME/CFS, we sought to examine prevalence of PTSD and CPTSD in individuals with ME/CFS. For that reason, the objective of this case-control study was to investigate the prevalence of PTSD and CPTSD in individuals with long COVID, individuals with ME/CFS and healthy age-matched controls. We hypothesised that individuals with long COVID would display higher prevalence and cluster scores of PTSD and CPTSD compared to the individuals with ME/CFS and age-matched healthy controls.

Despite all this they do not (anywhere that I could find) indicate that their LC cohort consisted of previously hospitalised patients and that the ME cohort didn't.

Following institutional ethics approval, sixty-one participants; 21 individuals with long COVID (aged M= 47 years, SD=10 years, duration of illness; M= 16 years, SD=6 months), 20 individuals with ME/CFS ( aged M=50 years, SD=10 years, duration of illness; M=16 years, SD=11 years) and 20 healthy controls ( aged M=49 years, SD=10 years, and no known illness) were recruited via social media (e.g. Twitter/X and Facebook/Meta) and attended the University of the West of Scotland Lanarkshire campus laboratories once between March 2022 and January 2023.

Also note that the mean duration of LC was apparently 16 years, longer than the ME/CFS mean

There was no control group of patients hospitalised with something other than Covid, only healthy controls without PTSD.

Participants completed the English version of the ITQ, this 18 question self-report measure that focuses on core features of PTSD and CPTSD consistent with ICD-11. The 18-item ITQ has six PTSD items, six DSO items and three functional impairment items related to each symptom cluster.

The first section of the 18-item ITQ is dedicated to three PTSD symptom clusters (P.1-P.6); reexperiencing of the trauma (P1-P.2), avoidance of internal or external trauma reminders (P.3-P.4), and a sense of current threat (P.5-P.6). These are measured by two items each. In this section, respondents reported how much they have been bothered by the symptoms in the past month. In the three functional impairment items related to PTSD (P.7-P.9), respondents reported how the above problems affected their relationship or social life, work or ability to work, and other important part of their life such as parenting or school or work etc.

The second section consists of three main symptom clusters of DSO (C.1-C.6; affective dysregulation (C.1-C.2), negative self-concept (C.3-C.4) and disturbances in relationships (C.5-C.6). In the three functional impairment items (C.7-C.9), respondents reported how they typically felt about their relationships or social life, if work or ability to work had been affected, and how this affected other important parts of their lives such as parenting or school or work or other important activities.

For people with long COVID, six mentioned the experience of COVID (29%), five mentioned long COVID (24%), three mentioned health (14%), two mentioned fatigue (9%), two mentioned pain (9%), one mentioned brain fog (5%), one mentioned childbirth (5%), and one mentioned no reason for their experience (5%).

For people with ME/CFS, ten mentioned ME/CFS (50%), two mentioned no reason for their experience (10%), two mentioned health (10%), one mentioned fatigue (5%), one mentioned illness (5%), one mentioned surgery (5%), one mentioned upbringing (5%), one mentioned work stress (5%) and one mentioned work dismissal (5%) as a reason behind their experience.

HCs also declared traumatic experiences (without scoring high enough to qualify for PTSD of CPTSD.

Among the 20 healthy control participants no one met the criteria for CPSTD* or PTSD. For the reason behind the experience, seven mentioned health (35%), three mentioned no reason (15%), three mentioned bereavement (15%), two mentioned flying (10%), one mentioned cancer diagnosis of family member (5%), one mentioned injury (5%), one mentioned giving birth (5%), one mentioned illness of family member (5%), and one mentioned premature birth of family member (5%).

For experts in PTSD, it's impressive they've managed to say "PSTD" no less than 3 times in the manuscript.

 

[dave30th]

years

I assume that was supposed to be 16 months--at least, I hope so!

but I haven't heard of complex PTSD before.