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The coronavirus disease 2019 (COVID-19) pandemic and associated lockdown could be considered a ‘perfect storm’ for increases in emotional distress. Such increases can only be identified by studies that use data collected before and during the pandemic. Longitudinal data are also needed to examine (1) the roles of previous distress and stressors in emotional distress during the pandemic and (2) how COVID-19-related stressors and coping strategies are associated with emotional distress when pre-pandemic distress is accounted for.
Data came from a cohort study (N = 768). Emotional distress (perceived stress, internalizing symptoms, and anger), COVID-19-related stressors, and coping strategies were measured during the pandemic/lockdown when participants were aged 22. Previous distress and stressors were measured before COVID-19 (at age 20).
On average, participants showed increased levels of perceived stress and anger (but not internalizing symptoms) during the pandemic compared to before. Pre-COVID-19 emotional distress was the strongest predictor of during-pandemic emotional distress, followed by during-pandemic economic and psychosocial stressors (e.g. lifestyle and economic disruptions) and hopelessness, and pre-pandemic social stressors (e.g. bullying victimization and stressful life events). Most health risks to self or loved ones due to COVID-19 were not uniquely associated with emotional distress in final models. Coping strategies associated with reduced distress included keeping a daily routine, physical activity, and positive reappraisal/reframing.
In our community sample, pre-pandemic distress, secondary consequences of the pandemic (e.g. lifestyle and economic disruptions), and pre-pandemic social stressors were more consistently associated with young adults' emotional distress than COVID-19-related health risk exposures.
Home treatment has been proposed as an alternative to acute in-patient care for mentally ill patients. However, there is only moderate evidence in support of home treatment.
To test whether and to what degree home treatment services would enable a reduction (substitution) of hospital use.
A total of 707 consecutively admitted adult patients with a broad spectrum of mental disorders (ICD-10: F2–F6, F8–F9, Z) experiencing crises that necessitated immediate admission to hospital, were randomly allocated to either a service model including a home treatment alternative to hospital care (experimental group) or a conventional service model that lacked a home treatment alternative to in-patient care (control group) (trial registration at ClinicalTrials.gov: NCT02322437).
The mean number of hospital days per patient within 24 months after the index crisis necessitating hospital admission (primary outcome) was reduced by 30.4% (mean 41.3 v. 59.3, P<0.001) when a home treatment team was available (intention-to-treat analysis). Regarding secondary outcomes, average overall treatment duration (hospital days + home treatment days) per patient (mean 50.4 v. 59.3, P = 0.969) and mean number of hospital admissions per patient (mean 1.86 v. 1.93, P = 0.885) did not differ statistically significantly between the experimental and control groups within 24 months after the index crisis. There were no significant between-group differences regarding clinical and social outcomes (Health of the Nation Outcome Scales: mean 9.9 v. 9.7, P = 0.652) or patient satisfaction with care (Perception of Care questionnaire: mean 0.78 v. 0.80, P = 0.242).
Home treatment services can reduce hospital use among severely ill patients in acute crises and seem to result in comparable clinical/social outcomes and patient satisfaction as standard in-patient care.
Long-term data on post-traumatic stress disorder (PTSD) following
accidents are scarce.
To assess and predict PTSD in people 3 years after severe accidental
Severely injured patients were recruited consecutively from the intensive
care unit (n=121) and assessed within 1 month of the
trauma. Follow-up interviews were conducted 6 months, 12 months and 36
months later; 90 patients participated in all four interviews. Symptoms
were assessed using the Clinician-Administered PTSD Scale.
Post-traumatic stress disorder was diagnosed in 6% of patients 2 weeks
after the accident, in 2% after 1 year and in 4% after 3 years. Robust
predictors of later PTSD symptom level were intrusive symptoms shortly
after the accident and biographical risk factors. There were individual
changes over time between the categories PTSD, sub-threshold PTSD and no
PTSD. Whereas PTSD symptom severity was low or decreased for most of the
patients, some of them showed an increase or a delayed onset. Patients
with persisting PTSD symptoms at 6 months and patients with delayed onset
of symptoms are at risk of long-term PTSD.
The prevalence of PTSD was low over the whole period of 3 years.
Research on posttraumatic stress disorder (PTSD) relies mainly on self-reports of exposure to trauma and its consequences.
To analyse the consistency of the reporting of potentially traumatic events (PTEs) over time.
A community-based cohort, representative of the canton of Zurich, Switzerland, was interviewed at the ages of 34–35 years (in 1993) and 40–41 years (in 1999). A semi-structured diagnostic interview, including a section on PTSD, was administered.
Of the 342 participants who attended both interviews, 169 reported some PTE (1993, n=110; 1999, n=120). In 1999, 56 participants (33.1%) reported for the first time PTEs that actually occurred before 1993, but which had not been reported in the 1993 interview. In total, 68 participants (40.2%) who had reported a PTE in 1993 did not report it in 1999. The overall frequency of inconsistent reporting was 63.9%.
The high level of inconsistency in the reporting of PTEs has implications for therapy as well as for research.
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