key: cord-0899091-vuvc634p
authors: Armitage, Christopher J.; Dawes, Piers; Munro, Kevin J.
title: Prevalence and correlates of COVID-19-related traumatic stress symptoms among older adults: A national survey
date: 2021-12-27
journal: J Psychiatr Res
DOI: 10.1016/j.jpsychires.2021.12.054
sha: 655babf9ccb07d8034d4f9270a8a51bfa2b43fd5
doc_id: 899091
cord_uid: vuvc634p

Coronavirus pandemics increase the incidence of posttraumatic stress disorder (PTSD), which requires intensive treatment and is related to several long-term psychiatric disorders. Older adults are particularly vulnerable to COVID-19 and hence trauma symptoms. It is not known what is the prevalence of trauma symptoms relating to COVID-19 specifically among older adults nor what may be the markers for the emergence of trauma symptoms. The aim of the present research was to estimate the prevalence, and identify correlates of, traumatic stress symptoms attributable to COVID-19 among older adults in the UK. A cross-sectional survey was conducted with a sample of 3012 adults aged 60 years and older who were representative of the UK population assessed COVID-19-related trauma symptoms and demographic data. Data were analysed descriptively and using multiple/logistic regression. 36.5% of the sample (n = 1100) reported experiencing clinically meaningful traumatic stress symptoms that could lead to as many as 27.4% of the sample may go on to develop PTSD. Women and younger older adults were particularly likely to experience clinically meaningful symptoms of traumatic stress. Work is urgently required to prepare services to address what may be substantial numbers of people presenting with posttraumatic stress disorder once the worst of the pandemic is past.

Research on coronavirus outbreaks suggest they are associated with increases in the incidence of posttraumatic stress disorder due to potential exposure to a new deadly infection and mitigation measures, such as quarantine (Wu et al., 2005) . For example, an outbreak of Severe Acute Respiratory Syndrome (SARS CoV) in 2003 showed that the numbers of people suffering posttraumatic stress disorder was similar to the numbers reported following natural disasters such as earthquakes and hurricanes (Hawryluck et al., 2004) . Initial data suggest that SARS CoV2 is no different and is associated with heightened levels of anxiety and depression (Gao et al., 2020) , as well as a high prevalence of challenges to mental and physical health caused by economic uncertainty and job insecurity (Keyworth et al., 2021) associated with adherence to government lockdown-type instructions and also observed during economic crises (e.g., Frasquilho et al., 2015) .

Given that posttraumatic stress symptoms are unlikely to disappear unaided and are associated with other long term psychiatric disorders (Dansky et al., 1998; Goenjian et al., 2005) it is vital for public health planners to gauge the likely demand for services. It is further notable that, in a study of vicarious traumatisation due to COVID-19, Li et al. (2020) found significantly higher levels among the general public than front-line nurses A recent systematic review (Salehi et al., 2021) of posttraumatic stress disorder symptoms in coronavirus pandemics estimated a prevalence of 9% for COVID-19, which was significantly lower than for SARS (18%) although the data were highly heterogenous, half of the studies were of poor quality and none used measures adapted to address COVID-19. In particular, older adults tended to be under-represented, which is an important omission because age is the biggest risk factor for COVID-19, to the extent that the roll out of the UK's vaccine programme is almost wholly governed by age (NHS, 2021) rather than other potentially relevant factors. The implication is that demand for treatment services might be greatest among older adults, and within that cohort it would be valuable to identify subgroups who may need particular attention such as minority group status and occupational exposure (Armitage et al., 2021) . Of the studies that have examined older people's experiences of the COVID-19 pandemic, a picture is emerging of peritraumatic symptoms being experienced by older adults (e.g., Shrira et al., 2020) , and significantly more so by older women than by older men (e.g., Jimenez et al., 2021) , although these studies are limited by opportunity sampling.

We were able to identify one prevalence study in which Egyptian adults aged 60 years and older were randomly sampled from the population: is, furthermore, important to collect data that assess the proportions of populations who meet (or fail to meet) key diagnostic criteria. This is the first study to: (1) estimate the prevalence of traumatic stress symptoms among older adults, and (2) identify the sociodemographic characteristics of older adults who may need targeted early interventions to avoid post-traumatic stress disorder.

The data on which the present analyses are based is part of a wider survey examining public attitudes to hearing stigma. The data were collected 23-29 January 2021. A sample of adults aged 60+ was invited to take part in an online questionnaire distributed by YouGov, an online survey panel company who retain a database of people who are representative of the UK population for public opinion surveying. Participants were incentivised in accordance with YouGov's points system, whereby respondents accumulate points for taking part in online surveys. Data were sent securely to the research team for analysis. Ethical approval was obtained from University of Manchester Research Ethics Committee (2020-10597-17109) and participants gave informed consent at the beginning of the survey.

Demographic variables included age, gender, ethnicity, and social grade were taken using standard UK Office for National Statistics (ONS, 2020) measures.

Traumatic stress symptoms were measured using the impact of event scale (Horowitz et al., 1979) , a reliable and valid tool (Sundin & Horowitz, 2002) adapted by Vanaken et al. (2020) for use in assessing the impact of COVID-19. There is some debate as to the best way to assess traumatic stress symptoms, but the impact of events scale is the only one with sufficient reliability and validity to be used currently as a screening tool (e.g., Umberger, 2019). A further advantage to the impact of events scale is that it will allow future meta-analysts the opportunity to compare directly the impact of COVID-19 compared with other traumatic events. The scale comprises 15 items, all of which are rated on 4-point scales labelled not at all, seldom, sometimes, and often, which are assigned scores of 0, 1, 3 and 5, respectively. Higher scores indicate greater trauma symptoms. Four measures can be computed: Total (sum of all 15 items), intrusion subscale (sum of 7 items, e.g., "I thought about it when I didn't mean to"), avoidance (sum of 8 items, e.g., "I avoided letting myself get upset when I J o u r n a l P r e -p r o o f COVID-19-related traumatic stress symptoms 5 thought about it or was reminded of it") and a clinical cut-off, with total scores of 27 or higher considered a cut-off with a 75% chance of a diagnosis of post-traumatic stress disorder (Horowitz et al., 1979) .

Data were weighted to ensure analyses properly reflected the UK population. Descriptive statistics were used to characterize the population. Linear multiple regression was used to assess factors associated with total scores as well as intrusion and avoidance subscales. Multiple logistic regression was used to identify factors associated with clinical cut-off.

Consistent with the sampling frame, the sample was broadly representative of older adults in the UK (Table 1) . Most participants were white (97.8%) and slightly more than half were women (53.3%).

There were more people who had been in non-manual (71.2%) than manual occupations (28.8%).

Mean age was 70.9 years (SD = 6.8; 60-93 years).

The majority of participants did not meet the clinical cut-off of scoring >= 27 on the total scale, and 122 participants reported experiencing no symptoms of intrusion or avoidance. However, a minority (36.5%) did meet the clinical cut-off, of whom 75% (825/1100) are highly likely to develop posttraumatic stress disorder (Table 1) . Thus, across the sample as whole, 27.4% (825/3012) might develop post-traumatic stress disorder, which would be a significant burden if extrapolated to the population as a whole.

The four indices of trauma symptoms were regressed on demographic variables and revealed that, among this sample of older adults, younger people and women were more likely to experience 

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