Post-COVID-19 PTSD: Who Is Most At Risk Of Coronavirus-Related Post-Traumatic Stress Disorder, And What Treatment Is Available?

Stress, research shows, distorts the way in which we perceive the passing of time. You may simultaneously feel like almost no time has passed since COVID-19 was first identified in Wuhan, China, in December 2019, and think back on the "good old pre-coronavirus days" that now seem light years away.

In eight months, more than 16,000,000 people have been confirmed to have fallen ill with COVID-19, and it's becoming clearer and clearer that it's not uncommon to be left with long-term health complications even if you survive the virus.

Over 650,000 people have lost their lives to COVID-19, which means many more lost a loved one.

As the world was plunged into a global coronavirus-induced economic recession, millions lost their jobs, or face financial and existential insecurity.

Across the globe, the landscape of everyday life has changed drastically, and lockdowns, curfews, working from home, and learning from home have had a tremendously negative impact on countless people's mental states.

What is Post-Traumatic Stress Disorder?

Post-traumatic stress disorder is a mental disorder that causes anxiety, is associated with faulty memory processing, and can have a severe negative impact on daily functioning. PTSD strikes a minority of people who have experienced a psychological trauma — defined by the American Psychological Association as exposure to actual or threatened death, serious injury, or sexual violence.

Someone may develop post-traumatic stress disorder after directly experiencing a traumatic event (as a victim), witnessing it, learning that traumatic events happened to a loved one (especially in the case of young children), or repeatedly being exposed to the details of someone else's trauma (as a first responder or detective, for instance). 

Although most people experience at least some of the symptoms consistent with PTSD immediately after they suffered a trauma, many will develop coping mechanisms and recover without psychological treatment. Post-traumatic stress disorder can be diagnosed in those people who meet the diagnostic criteria, as laid out in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) for at least a month. 

The symptoms of PTSD are:

• Experiencing at least one intrusion symptom: 1. Repeated, involuntary, and distressing memories of the traumatic event, 2. Nightmares about the trauma, 3. Flashbacks or other dissociative reactions in which the person feels like they are reexperiencing the traumatic event in the present, 4. Emotional distress when reminded of the trauma, and 5. Physical distress when reminded of the trauma — such as a rapid heartbeat and excessive sweating.
• Persistent efforts to avoid reminders of the trauma. These reminders may be places, people, or circumstances, but also feelings and thoughts.
• Changes in mood and thought that can include fear, guilt, shame, distrust in others and self, being unable to remember important aspects of the trauma, a loss of motivation, feeling unable to connect with other people, and losing the ability to experience positive emotions.
• Arousal symptoms that point to a state of mind in which you are always ready for new threats, and may perceive them even in safe situations. Examples are irritable and aggressive feelings and behavior, a quick startle response, risky or self-destructive behavior, and hypervigilance, where you scan your environment for danger to extreme levels.

What does science tell us about COVID-19 and the risk of PTSD?

Confirmed risk factors for post-traumatic stress disorder related to COVID-19 include:

• Having been diagnosed with COVID-19 at some point. Although this is still being investigated, it very much appears that those patients who were hospitalized for COVID-19 and had life-threatening symptoms have a higher risk of PTSD. This is consistent with data from the SARS outbreak, as well.
• Having a close friend or relative who was confirmed positive for COVID-19. Again, research is still underway to determine whether those who lost a loved one to COVID-19 have a higher risk of PTSD than those people whose loved ones recovered from the virus, but this seems likely and would be consistent with previous findings relating to PTSD after infectious outbreaks.
• Research on the effects of COVID-19 quarantines is still underway. However, a sample of people who were quarantined during the SARS outbreak reveals that quarantine increases the risk of depression as well as the odds of developing PTSD. We also know that social isolation has a profound effect on people of all ages, from children to senior citizens.
• Socially disadvantaged and marginalized people who are, alongside COVID-19, dealing with further stresses are more likely to develop PTSD. This would include people living in poverty and people living with disabilities.
• Essential workers, including not only medical professionals but also low-income workers who cannot perform their duties from home (such as retail, fast-food, and janitorial workers) have an increased risk of post-traumatic stress disorder. This is in large part fueled by the fact that such jobs increase the person's risk of exposure to the coronavirus, essentially leading to a situation wherein they risk their lives every time they report for work.
• Women and older adults have been found to have higher rates of COVID-related PTSD as well.

Interestingly enough, it appears that COVID-19 survivors have a significantly higher risk of developing PTSD than do survivors of other one-time traumatic events, such as a vehicle accident or a one-time sexual assault. The whole world is changing, nobody remains untouched, and COVID-19 does not only provide numerous "windows of opportunity" to experience trauma, but also over a prolonged period of time. Prolonged trauma is more likely to cause PTSD than short-term trauma. 

Treatment for PTSD: What can you do if you think you have post-traumatic stress disorder?

The most efficient psychotherapeutic approaches to post-traumatic stress disorder include cognitive processing therapy, prolonged exposure therapy, and stress inoculation training. Though these therapies work in different ways, they ultimately help you process your memories, work to desensitize you, and offer tools to boost your resilience.

Medications are used in the treatment of PTSD, too, on occasion — almost always antidepressants, and most often from the SSRI family. 

In the present situation, with the pandemic still ongoing, it will be hard (and potentially additionally traumatizing) to seek in-person talk therapy. Teletherapy is becoming increasingly common, and it may have the added advantage of making more therapists who specialize in trauma available to you, since geography is not a limiting factor in this context. 

For those who suspect they have COVID-related PTSD who do not have access to therapy, for financial or other reasons, seeking support from people in similar situations can be beneficial in working toward healing.