Predicting Post-Traumatic Stress Disorder Based on Mental Health, Covid-19 Anxiety and Sleep Quality in University Students

Document Type : Original Article

Authors

1 Department of Educational Psychology, Faculty of Educational Sciences and Psychology, Alzahra University, Tehran, Iran

2 Behavioral Science Research Center, Lifestyle Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran

3 Neuroscience Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran

4 Azerbaijan Shahid Madani University, Faculty of Educational sciences and Psychology, Tabriz, Iran

Abstract

Introduction: Studying the predictors of Post-Traumatic Stress Disorder (PTSD) during the Covid-19 pandemic is a new research field.  The current study was conducted in order to evaluate the predictors of PTSD based on mental health, Covid-19 anxiety and sleep quality in the students of the Lorestan province, Iran.
Method: In order to carry out this study, 200 students (143 females and 57 males) were selected by convince sampling and participated in this study. The participants completed the Pittsburgh Sleep Quality Index (PSQI), Covid-19 Anxiety Scale, Post-Traumatic Stress Disorder Checklist, General Health Questionnaire (GHQ-12) and demographic information questionnaire. The data was analyzed by independent t-student and stepwise regression using SPSS 24.
Results: Findings revealed that there is a significant positive relationship between Covid-19 anxiety, general sleep quality and mental health with PTSD symptoms (p<0.05). Also, stepwise regression analysis showed that sleep quality and mental health were predictors of PTSD and mental health is the best predictor of PTSD and could determine 0.27 of PTSD variance. Finally, the 46.5 % prevalence of PTSD symptoms in students was an important finding of this study.
Conclusion: Necessity to pay attention to dimensions of mental health as an influential factor in the spread of other psychological disorders is recommended. Due to the high prevalence of PTSD symptoms, the inclusion of health-oriented programs becomes more important.

Keywords


  1. Holmes EA, O'Connor RC, Perry VH, Tracey I, Wessely S, Arseneault L, et al. Multidisciplinary research priorities for the COVID-19 pandemic: a call for action for mental health science. The Lancet Psychiatry. 2020.
  2. Horesh D, Brown AD. Traumatic stress in the age of COVID-19: A call to close critical gaps and adapt to new realities. Psychological Trauma: Theory, Research, Practice, and Policy. 2020;12(4):331.
  3. Mak IWC, Chu CM, Pan PC, Yiu MGC, Chan VL. Long-term psychiatric morbidities among SARS survivors. General hospital psychiatry. 2009;31(4):318-26.
  4. Islam MS, Potenza MN, van Os J. Posttraumatic stress disorder during the COVID-19 pandemic: upcoming challenges in Bangladesh and preventive strategies. International Journal of Social Psychiatry. 2020:0020764020954469.
  5. Zhu Y, Zhang L, Zhou X, Li C, Yang D. The impact of social distancing during COVID-19: A conditional process model of negative emotions, alienation, affective disorders, and post-traumatic stress disorder. Journal of affective disorders. 2021;281:131-7.
  6. Shorey RC, Fite PJ, Menon SV, Cohen JR, Stuart GL, Temple JR. The association between PTSD symptoms and IPV perpetration across 6 years. Journal of interpersonal violence. 2018:0886260518800310.
  7. Nussbaumer-Streit B, Mayr V, Dobrescu AI, Chapman A, Persad E, Klerings I, et al. Quarantine alone or in combination with other public health measures to control COVID‐19: a rapid review. Cochrane Database of Systematic Reviews. 2020(9).
  8. Tang F, Liang J, Zhang H, Kelifa MM, He Q, Wang P. COVID-19 related depression and anxiety among quarantined respondents. Psychology & health. 2021;36(2):164-78.
  9. Van Rheenen TE, Meyer D, Neill E, Phillipou A, Tan EJ, Toh WL, et al. Mental health status of individuals with a mood-disorder during the COVID-19 pandemic in Australia: Initial results from the COLLATE project. Journal of affective disorders. 2020;275:69-77.
  10. Haderlein TP, Wong MS, Yuan A, Llorente MD, Washington DL. Association of PTSD with COVID-19 testing and infection in the Veterans Health Administration. Journal of psychiatric research. 2020.
  11. Asmundson GJ, Taylor S. Coronaphobia: Fear and the 2019-nCoV outbreak. Journal of anxiety disorders. 2020;70:102196.
  12. Tandon R. COVID-19 and mental health: preserving humanity, maintaining sanity, and promoting health. Asian journal of psychiatry. 2020.
  13. Ojiaku CM, Iorfa S, Mefoh PC, Ezeuzo O, Odinko IC. COVID-19-Induced Anxiety and Covid-19 Precautionary Measures as Predictors of Mental Wellbeing of Nigerians. International Journal of Behavioral Sciences. 2020;14(3):149-54.
  14. Felix G. Mediating Effect of Coping Strategies between Personality and Anxiety during COVID-19. International Journal of Behavioral Sciences. 2021;14(4):225-31.
  15. Yip PS, Cheung Y, Chau PH, Law Y. The impact of epidemic outbreak: the case of severe acute respiratory syndrome (SARS) and suicide among older adults in Hong Kong. Crisis: The Journal of Crisis Intervention and Suicide Prevention. 2010;31(2):86.
  16. Wheaton MG, Abramowitz JS, Berman NC, Fabricant LE, Olatunji BO. Psychological predictors of anxiety in response to the H1N1 (swine flu) pandemic. Cognitive Therapy and Research. 2012;36(3):210-8.
  17. Alshehri FS, Alatawi Y, Alghamdi BS, Alhifany AA, Alharbi A. Prevalence of post-traumatic stress disorder during the COVID-19 pandemic in Saudi Arabia. Saudi Pharmaceutical Journal. 2020;28(12):1666-73.
  18. Chamberlain SR, Grant JE, Trender W, Hellyer P, Hampshire A. Post-traumatic stress disorder symptoms in COVID-19 survivors: online population survey. BJPsych open. 2021;7(2).
  19. Altena E, Baglioni C, Espie CA, Ellis J, Gavriloff D, Holzinger B, et al. Dealing with sleep problems during home confinement due to the COVID‐19 outbreak: Practical recommendations from a task force of the European CBT‐I Academy. Journal of Sleep Research. 2020;29(4):e13052.
  20. Casagrande M, Favieri F, Tambelli R, Forte G. The enemy who sealed the world: Effects quarantine due to the COVID-19 on sleep quality, anxiety, and psychological distress in the Italian population. Sleep medicine. 2020;75:12-20.
  21. Wright KM, Britt TW, Bliese PD, Adler AB, Picchioni D, Moore D. Insomnia as predictor versus outcome of PTSD and depression among Iraq combat veterans. Journal of clinical psychology. 2011;67(12):1240-58.
  22. Yin Q, Sun Z, Liu T, Ni X, Deng X, Jia Y, et al. Posttraumatic stress symptoms of health care workers during the corona virus disease 2019. Clinical psychology & psychotherapy. 2020;27(3):384-95.
  23. Liu N, Zhang F, Wei C, Jia Y, Shang Z, Sun L, et al. Prevalence and predictors of PTSS during COVID-19 outbreak in China hardest-hit areas: Gender differences matter. Psychiatry research. 2020;287:112921.
  24. Li Y, Zhao J, Ma Z, McReynolds LS, Lin D, Chen Z, et al. Mental Health Among College Students During the COVID-19 Pandemic in China: A 2-Wave Longitudinal Survey. Journal of affective disorders. 2021;281:597-604.
  25. Afkham Ebrahimi A, Bandi G, Salehi M, Tafti K, Vakili Y, Farsi A. Sleep parameters and the factors affecting the quality of sleep in patients attending selected clinics of Rasoul-e-Akram hospital. Razi Journal of Medical Sciences. 2008;15:31-8.
  26. Ağargün MY, Kara H, Anlar Ö. The validity and reliability of the Pittsburgh Sleep Quality Index. Turk Psikiyatri Derg. 1996;7(2):107-15.
  27. Alipour A, Ghadami A, Alipour Z, Abdollahzadeh H. Preliminary validation of the Corona Disease Anxiety Scale (CDAS) in the Iranian sample. Quarterly Journal of Health Psychology. 2020;8(4):163-75.
  28. Ashbaugh AR, Houle-Johnson S, Herbert C, El-Hage W, Brunet A. Psychometric validation of the English and French versions of the Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5). PloS one. 2016;11(10):e0161645.
  29. Kheramin S, Shakibkhah I, Ashrafganjooie M. Prevalence of PTSD Symptoms Among Iranian Red Crescent Disaster Workers Participated in Rescue and Collection Operation of the Tehran-Yasuj Airplane Crash. Iranian Red Crescent Medical Journal. 2019;21(10).
  30. Ibrahim H, Ertl V, Catani C, Ismail AA, Neuner F. The validity of Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5) as screening instrument with Kurdish and Arab displaced populations living in the Kurdistan region of Iraq. BMC psychiatry. 2018;18(1):1-8.
  31. Goldberg D, Williams P. General health questionnaire. Granada Learning Group; 1988.
  32. El-Metwally A, Javed S, Razzak HA, Aldossari KK, Aldiab A, Al-Ghamdi SH, et al. The factor structure of the general health questionnaire (GHQ12) in Saudi Arabia. BMC health services research. 2018;18(1):1-11.
  33. Montazeri A, Harirchi AM, Shariati M, Garmaroudi G, Ebadi M, Fateh A. The 12-item General Health Questionnaire (GHQ-12): translation and validation study of the Iranian version. Health and quality of life outcomes. 2003;1(1):1-4.
  34. Magruder KM, Frueh BC, Knapp RG, Johnson MR, Vaughan Iii JA, Carson TC, et al. PTSD symptoms, demographic characteristics, and functional status among veterans treated in VA primary care clinics. Journal of traumatic stress. 2004;17(4):293-301.
  35. Khoury L, Tang YL, Bradley B, Cubells JF, Ressler KJ. Substance use, childhood traumatic experience, and posttraumatic stress disorder in an urban civilian population. Depression and anxiety. 2010;27(12):1077-86.
  36. Kingston S, Raghavan C. The relationship of sexual abuse, early initiation of substance use, and adolescent trauma to PTSD. Journal of Traumatic Stress: Official Publication of The International Society for Traumatic Stress Studies. 2009;22(1):65-8.
  37. Mills KL, Teesson M, Ross J, Peters L. Trauma, PTSD, and substance use disorders: findings from the Australian National Survey of Mental Health and Well-Being. American Journal of Psychiatry. 2006;163(4):652-8.
  38. Neuner F, Schauer M, Karunakara U, Klaschik C, Robert C, Elbert T. Psychological trauma and evidence for enhanced vulnerability for posttraumatic stress disorder through previous trauma among West Nile refugees. BMC psychiatry. 2004;4(1):1-7.
  39. Campbell SB, Renshaw KD. Posttraumatic stress disorder and relationship functioning: A comprehensive review and organizational framework. Clinical Psychology Review. 2018;65:152-62.
  40. Danielson CK, Amstadter AB, Dangelmaier RE, Resnick HS, Saunders BE, Kilpatrick DG. Trauma-related risk factors for substance abuse among male versus female young adults. Addictive behaviors. 2009;34(4):395-9.
  41. Gurera JW, Isaacowitz DM. Emotion regulation and emotion perception in aging: A perspective on age-related differences and similarities. Progress in brain research. 2019;247:329-51.
  42. Flory JD, Yehuda R. Comorbidity between post-traumatic stress disorder and major depressive disorder: alternative explanations and treatment considerations. Dialogues in clinical neuroscience. 2015;17(2):141.
  43. Hoskins M, Pearce J, Bethell A, Dankova L, Barbui C, Tol WA, et al. Pharmacotherapy for post-traumatic stress disorder: systematic review and meta-analysis. The British Journal of Psychiatry. 2015;206(2):93-100.
  44. van Minnen A, Zoellner LA, Harned MS, Mills K. Changes in comorbid conditions after prolonged exposure for PTSD: A literature review. Current psychiatry reports. 2015;17(3):17.
  45. Mancebo MC, Grant JE, Pinto A, Eisen JL, Rasmussen SA. Substance use disorders in an obsessive compulsive disorder clinical sample. Journal of anxiety disorders. 2009;23(4):429-35.
  46. Ornell F, Moura HF, Scherer JN, Pechansky F, Kessler FHP, von Diemen L. The COVID-19 pandemic and its impact on substance use: Implications for prevention and treatment. Psychiatry research. 2020;289:113096.
  47. Gonçalves PD, Moura HF, do Amaral RA, Castaldelli-Maia JM, Malbergier A. Alcohol Use and COVID-19: Can we Predict the Impact of the Pandemic on Alcohol Use Based on the Previous Crises in the 21st Century? A Brief Review. Frontiers in Psychiatry. 2020;11:1456.
  48. Kleber RJ. Trauma and public mental health: A focused review. Frontiers in psychiatry. 2019;10:451.