The prevalence of PTSD symptoms (41.3%) in this study is much higher than the previously reported lifetime prevalence level in the general population (2–9%) . A systematic review showed the pooled prevalence of PTSD among participants during the COVID-19 pandemic to be 21.94% . A study conducted between April 4 and 6, 2020, among the medics working in Wuhan upon their return after work indicated overall prevalence of clinically concerned PTSD symptoms of 31.6% , by the same scale (IES-R). A survey-based cross-sectional study performed from January 29 to February 7, 2020, in Wuhan, China, showed an estimated PTSD prevalence of 9.8% . In our study, this prevalence of PTSD was even higher. Exact comparisons are difficult to make because some of the other research have used different measures. However, it is suggested that although Beijing is not an area with the highest risk of COVID-19, the prevalence of PTSD symptoms in psychiatric patients in Beijing is high, indicating the susceptibility of this group. Clinicians must be aware that these patients may experience higher rates and severity of post-traumatic stress disorder than the general population .
In this study, there was no significant difference between the severity of the total PTSD score among different patients with mental disorders. This may indicate that patients with different diseases share similar psychological characteristics, including vulnerability and susceptibility, causing similar effects during the COVID-19 pandemic. However, the scores of the PTSD hyperarousal symptoms were higher in patients with major depressive disorder than in those with anxiety disorder or schizophrenia. Evidence suggests that the associations between PTSD and depression are complex, involving bidirectional causality, common risk factors, and common vulnerabilities [23, 41, 42]. Hyperarousal includes irritability, anger, difficult concentrating, hypervigilance, and a heightened startle response . The results of this study suggested that more attention should be paid to the characteristics of high arousal in patients with major depressive disorder.
The study found evidence for the second hypothesis that demographic characteristics were associated with PTSD symptoms. This study showed that age was an associated factor for the total PTSD score, intrusion, and avoidance. Since the COVID-19 virus is more serious and with higher mortality rate in older people , they may have more severe PTSD. Retirement was a shared associated factor for both the total PTSD score and intrusion in the study, indicating that retirement may be a protective factor for PTSD. A possible explanation is that retirees may need to travel less during the epidemic and have higher financial security, therefore being less stressed by the epidemic .
The third hypothesis, COVID-19 related factors are associated with PTSD symptoms, was well supported by the data. Fear of the pandemic were shared associated factors for both PTSD symptoms and its subscales. There have been reports of anxiety and fear often co-existing and comorbid with PTSD [44, 45]. Mental health guidance during the pandemic was a unique associated factor, while clinical treatment during pandemic, or medication barriers due to pandemic were not significant associated factors for PTSD symptoms, which might indicate that mental health interventions and resources could help psychiatry patients reduce the stress caused by the epidemic and the incidence of PTSD.
The fourth hypothesis, psychosomatic factors are significant associated factors with PTSD symptoms, was supported by the data. Anxiety symptoms was shared associated factors for both PTSD symptoms and its subscales. Recent neuroscience research suggested that higher sensitivity to anxiety tends to increase the severity of PTSD . Individuals with higher stress/fear levels may become impatient, feel upset or agitated, and experience difficulty relaxing, all of which have a negative impact on PTSD symptoms . Depression symptoms were associated factors for the total PTSD score, intrusion and hyperarousal. As depression is the disorder most commonly associated with PTSD [23, 42], people with depressive symptoms may be more likely to develop PTSD, which should be particularly noticed. Quality of life was a unique associated factor for avoidance, implying that patients were more concerned about it. During the epidemic, people's quality of life deteriorated . Self-rated poor health during an outbreak was significantly associated with greater psychological impact and higher levels of stress, according to a study in China .
Another prominent finding was that several unique factors were associated with sub
-dimensions of PTSD. Most obviously, urban residence, increased pressure, loneliness, support from friends and sleep quality were all unique associated factor for hyperarousal but not associated with intrusion or avoidance. These results might indicate that there were differences among the related factors of the three dimensions of PTSD, and hyperarousal require unique attention . During an epidemic, isolation policies and inadequate social support can lead to feelings of loneliness . Previous studies showed that isolation can negatively affect mental health [7, 8]. Our findings correlate to those of other studies on the general population. Social support plays a key role in mitigating the risk of mental health problems . The results also demonstrated that support from friends was associated with a lower incidence of hyperarousal symptoms, while support from family might increase patients’ hyperarousal symptoms. This finding is a reminder that too much unnecessary care from family could increase patients’ hyperarousal symptoms. Thus, “moderate” care from friends is necessary for psychiatric patients. These results have great implications for clinicians in predicting and treating patients with high hyperarousal symptoms.
To the best of our knowledge, this is the first study to screen for PTSD symptoms in patients with a pre-existing psychiatric diagnosis during the COVID-19 pandemic in Beijing, China. Primarily, the prevalence of symptoms of PTSD among psychiatric patients was not encouraging, arousing attentions from medical staff, related psychologists and mental health centers. Next, this study explored some risk factors (e.g., old age, depressive disorder, fear) and protective factors (e.g., retirement, mental health guidance) for PTSD, providing specific reference and guidance for the psychological prevention and intervention among psychiatric patients in face of the COVID-19 pandemic. Furthermore, this study examined PTSD as well as the three subscales, discriminating the difference in the relationship between PTSD subscales and related psychosomatic factors. The uniqueness of hyperarousal factor provided a theoretical reference for better understanding the structure of PTSD symptoms.
This study has several limitations that should be considered when interpreting its findings. First, it adopted a cross-sectional design, so the way PTSD symptoms in psychiatric patients may change over time is unclear. A longitudinal study is required to identify protective factors and the long-term impacts of PTSD in psychiatric patients during the pandemic. Second, the sample was limited to patients in just four psychiatric hospitals in Beijing, China. Therefore, a nationwide or worldwide multicentre study is needed to provide broader data about PTSD symptoms in psychiatry patients during the COVID-19 pandemic. Finally, no objective biological indicators were included for psychosomatic factors. In further research, other indicators such as peripheral blood, heredity, inflammation, immune and metabolic function markers, or brain imaging are necessary.