Incidence of PTSD in COVID-19 Survivors of Critical Illness and the Therapeutic Efficacy of Steroids in the Prevention of PTSD

Abstract

RATIONALE: Post Traumatic Stress Disorder (PTSD) is characterized by intense, disturbing thoughts and flashbacks to traumatic events that can significantly reduce quality of life. An estimated 25-44% of survivors of critical illness develop clinically significant PTSD. Trauma leads to decreased glucocorticoid levels and upregulation of the cortisol receptor sensitivity, which may explain the hyper-arousal and avoidance seen in PTSD. Exogenous steroids may help attenuate this change. Previously published studies demonstrate steroids' efficacy in preventing PTSD when given during hospitalization. Data on PTSD specifically in patients hospitalized with Coronavirus-19 (COVID-19) remains sparse whilst utilization of corticosteroid in these patients is growing. Here we describe the incidence of PTSD in critically ill survivors of COVID-19 and explore steroids' role in the prevention of PTSD. METHODS: This is a multicenter retrospective cohort study of patients admitted to the University of Maryland Medical System for critical illness due to COVID-19 between March-December, 2020 and seen for follow up in the post-COVID clinic. Patient's demographic data, underlying medical conditions, and therapies received during hospitalization were collected and manually extracted through retrospective chart review. Patients were screened for PTSD via PTSD Checklist 5 (PCL-5) in outpatient setting. Those with PCL-5 score of 33 or greater were considered to have probable PTSD. We calculated descriptive statistics of demographic and clinical characteristics and performed nonparametric comparisons between groups using the Fishers exact test for categorical variables and the Mann Whitney U test for discrete variables. RESULTS: Twenty-eight patients were included in the study. Age ranged from 29 to 75 years old. Half of patients were female, 50% were African American, 28.6% Caucasian, 10.7% were Hispanic or Latino, and 10.7% were Asian. Four patients (14.3%) required extracorporeal membrane oxygenation (ECMO), seventeen (60.7%) required mechanical ventilation. The majority (78.6%) of the patients received solumedrol, hydrocortisone, prednisone, or dexamethasone as therapy for Acute Respiratory Distress Syndrome (ARDS), shock, or COVID-19 pneumonia. Seven patients developed PTSD (25%). There was no difference in demographics, past medical history, or ECMO utilization when comparing patients with and without PTSD. There was no difference in the usage of steroids (dose or duration) when comparing patients with and without PTSD. CONCLUSION: The incidence of PTSD in COVID-19 survivors is in line with the historical rate of PTSD in the general population of critical illness survivors. The use of corticosteroids had no effect on reducing the incidence of PTSD or the PCL-5 scores in this cohort of patients.