Global Prevalence of Post-Traumatic Stress Disorder During COVID-19 Pandemic and the Effectiveness of Psychotherapies for People with PTSD

Background: More than 70% people in the world exposed to one or more traumatic event during their lifetime. Posttraumatic stress disorder (PTSD) is a common disorder in populations that have been exposed to severe trauma. PTSD was one of the most common mental health problems and long-term consequences of coronavirus outbreaks. COVID-19 affected our mental health in many ways. High numbers of infection and deaths along with social interaction restrictions have negatively impacted the psychological well-being of individual and society. It increases the vulnerability to develop PTSD. Numerous psychotherapies have been developed for people with PTSD. Different approaches applied in facilitating the person to process their traumatic memories. Therefore, there is a need to evaluate the prevalence of PTSD during COVID-19 pandemic and compared the effectiveness of different type of psychotherapies for people with PTSD.
Objectives: The purposes of this study were to (1) determine the prevalence of PTSD during the COVID-19 pandemic among patients/survivors of COVID-19, health professionals, and the population at large, along with the associated risk factors; and (2) explore the comparative effectiveness of psychotherapies for PTSD on immediate, short-and-long-term follow-up measurements retrieved from RCTs studies in all age groups.
Methods:
Study 1: A comprehensive literature review on the prevalence of PTSD was conducted in Cochrane library, CINAHL, Embase, Medline-Ovid, PubMed, Scopus, and Web of Science without language restriction. We included studies evaluating the prevalence of PTSD during the COVID-19 pandemic either in patient/survivors of COVID-19, health professionals, and the population at large. The data were analyzed using logit transformation with random-effects mode using metaprop module in R software version 4.0.2. The quality of studies included were assessed using Hoy and colleagues. While potential publication bias was determined using Peter’s method.
Study 2: Literature search was directed in Cochrane library, Embase, Medline-OVID, PsycInfo, PubMed, and Scopus up to March 2021. Studies focused on determining the clinical effectiveness of cognitive processing therapy (CPT), cognitive therapy (CT), eye movement desensitization reprocessing (EMDR), narrative exposure therapy (NET), prolonged exposure (PE), cognitive behaviour therapy (CBT), present-centered therapy (PCT), brief eclectic psychotherapies (BEP), psychodynamic therapy (PDT) or combination among them compared to no treatment (NT) or treatment as usual (TAU) on people with PTSD were included. Frequentist and Bayesian approach were used for analysis using netmeta modul in R software version 4.0.2. The study quality was determine using GRADE analysis.
Results:
Study 1: A total of 63 studies (n=124,952) from 24 different countries were analyzed. The overall pooled estimate of PTSD prevalence was 17.52% (95% CI 13.89 to 21.86), with no evidence of publication bias (t=-0.22, p-value=0.83). This study found a high prevalence of PTSD among patients with COVID-19 (15.45%; 95% CI 10.59 to 21.99), health professionals (17.23%; 95% CI 11.78 to 24.50), and the population at large (17.34%; 95% CI 12.21 to 24.03). Subgroup analyses showed that those working in COVID-19 units (30.98%; 95% CI, 16.85 to 49.86), nurses (28.22%; 95% CI, 15.83 to 45.10), those living in European countries (25.05 %; 95% CI 19.14 to 32.06), and studies that used Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) (30.18 %, 95% CI 25.78 to 34.98) demonstrated to have the highest PTSD prevalence compared to other groups. Meta-regression analyses revealed that the elderly (above age 65) had lower PTSD prevalence (-1.75, 95% CI -3.16 to -0.34) than the adult population.
Study 2: A total of 141 studies with 8,820 participants. Compared to NT, CPT, CT, NET, EMDR+PE, EMDR, PE, CBT, and PCT were significant to reduce PTSD symptom (SMD range: -1.57 to -0.84) at posttreatment and ranked accordingly. CPT was the only therapy with large effect size (SMD: -1.12) in short-term follow-up, while CPT and NET both did (SMD range: -0.91 to -0.89) in long-term follow-up. For secondary outcomes, all psychotherapies were effective (RR range: 3.18 to 1.98) in remitting the patients.
Conclusions: This study found considerable PTSD prevalence rates in patients/survivors of COVID-19, health professionals, and the population at large. Moderator analysis found age, unit of work, health profession, continent, and PTSD assessment tool as significant moderators. In term of PTSD treatments, CPT, CT, NET, EMDR+PE, EMDR, PE, CBT, PCT showed as effective therapies on PTSD with moderate to large effect in immediate measurement. The remission rates showed all specific psychological treatments tend to decrease the number of people who meet PTSD diagnosis at the treatment endpoint. Moderator analyses different rank of psychotherapies between children-adolescent and adults.