Impact of COVID-19 on posttraumatic stress disorder in ICU survivors: a prospective observational comparative cohort study
Authors: Kalfon Pierre , El-Hage Wissam , Geantot Marie-Agnès , Favier Constance , Bodet-Contentin Laetitia , Kuteifan Khaldoun , Olivier Pierre-Yves , Thévenin Didier , Pottecher Julien , Crozon-Clauzel Jullien , Mauchien Bénédicte , Galbois Arnaud , de Varax Roland , Valera Sabine , Estagnasie Philippe , Berric Audrey , Nyunga Martine , Revel Nathalie , Simon Georges , Kowalski Benjamin , Sossou Achille , Signouret Thomas , Leone Marc , Delalé Charles , Seemann Aurélien , Lasocki Sigismond , Quenot Jean-Pierre , Monsel Antoine , Michel Olivier , Page Mathieu , Patrigeon René-Gilles , Nicola Walid , Thille Arnaud W. , Hekimian Guillaume , Auquier Pascal , Baumstarck Karine ,   PTSD-REA Study group, Catry Hortense , Dubus Anne-Laure , Laugery Léa , Lintaff Marion , Lourseyre Mélanie , Merigard Lou , Michel Lisa , Ouhmad Nawal , Petit Solenn , Tricoche Laurence , Beaumale Florent , Scholastique Anne-Sylvie , Mougenot Emmanuelle , Delerue Céline , Feller Marc , Grouille Julien , Rochon Charles-Edouard , Audibert Juliette , Badre Gaëtan , Jourdain Cécile , Lehaie Leslie , Abdelkader Hasni Si , Henry Emilie , Labruyere Marie , Boulle-Geronimi Claire , Beaussard Stéphanie , Nigeon Olivier , Loiez Anthea , Cerro Valérie , Marchand Laetitia , Arbelot Charlotte , Buzelier Karine , Levy Deborah , Leloup Pascale , Messaoudi Karim , Alzina Camille , Nguyen Lee , Nowak Steve , Ichai Carole , Diop Aminata , Brisson Hélène , Constantin Jean-Michel , Lakhal Samia , Oudihat Madjid , Coudroy Rémi , Guyon Carole , Frat Jean-Pierre , Robert René , Lubango Nadine , Villequey Lisa , Hecketsweiler Stéphane , Partouche Nicolas , Ducros Laurent , Gardan Vincent , Rivoire Julie , Deparis-Dusautois Stéphanie , Lamri Lamia , Lavalart Alexandra 
Published: March 2024

Abstract
Background
Posttraumatic stress disorder (PTSD) after a stay in the intensive care unit (ICU) can affect one in five ICU survivors. At the beginning of the coronavirus disease 2019 (COVID-19) pandemic, admission to the ICU for COVID-19 was stressful due to the severity of this disease. This study assessed whether admission to the ICU for COVID-19 was associated with a higher prevalence of PTSD compared with other causes of ICU admission after adjustment for pre-ICU psychological factors.

Methods
This prospective observational comparative cohort study included 31 ICUs. Eligible patients were adult ICU survivors hospitalized during the first wave of COVID-19 pandemic in France, regardless of the reason for admission. The prevalence of presumptive diagnosis of PTSD at 6 months was assessed using the PTSD Checklist for DSM-5 (PCL-5). Sociodemographics, clinical data, history of childhood trauma (Childhood Trauma Questionnaire [CTQ]), and exposure to potentially traumatic events (Life Events Checklist for DSM-5 [LEC-5]) were assessed.

Results
Of the 778 ICU survivors included during the first wave of COVID-19 pandemic in France, 417 and 361 were assigned to the COVID-19 and non-COVID-19 cohorts, respectively. Fourteen (4.9%) and 11 (4.9%), respectively, presented with presumptive diagnosis of PTSD at 6 months (p = 0.976). After adjusting for age, sex, severity score at admission, use of invasive mechanical ventilation, ICU duration, CTQ and LEC-5, COVID-19 status was not associated with presumptive diagnosis of PTSD using the PCL-5. Only female sex was associated with presumptive diagnosis of PTSD. However, COVID-19 patients reported significantly more intrusion and avoidance symptoms than non-COVID patients (39% vs. 29%, p = 0.015 and 27% vs. 19%, p = 0.030), respectively. The median PCL-5 score was higher in the COVID-19 than non-COVID-19 cohort (9 [3, 20] vs. 4 [2, 16], p = 0.034).

Conclusion
Admission to the ICU for COVID-19 was not associated with a higher prevalence of PTSD compared with admission for another cause during the first wave of the COVID-19 pandemic in France. However, intrusion and avoidance symptoms were more frequent in COVID-19 patients than in non-COVID-19 patients.
Trial Registration: Clinicaltrials.gov Identifier NCT03991611, registered on June 19, 2019.