Nightmares mediate the association between traumatic event exposure and suicidal ideation in frontline medical workers exposed to COVID-19

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Abstract

Background

: Trauma experience increases the risk of suicidal ideation, but little is known about potentially psychological mechanisms underlying this relationship. This study aims to examine the relationship between coronavirus disease 2019 (COVID-19)-related traumatic event (CTE) exposure and suicidal ideation among hospital workers, and identify mediating roles of sleep disturbances in this relationship.

Methods

: Workers in seven designated hospitals in Wuhan, China, were invited to participate in an online survey from May 27, 2020, to July 31, 2020. Participants completed a self-report questionnaire to evaluate demographic characteristics, level of CTE exposures, nightmare frequency, insomnia severity, symptoms of depression and anxiety, and suicidal ideation. A series of correlation analyses were performed, and a mediation model was generated to examine correlations between CTE exposure, sleep disturbances, and suicidal ideation.

Results

: A total of 16,220 hospital workers were included in the final analysis, 13.3% of them reported suicidal ideation in the past month. CTE exposure was significantly associated with insomnia severity, nightmare frequency, and suicidal ideation. After controlling potential confounders, nightmares but not insomnia, depression, or anxiety were shown to be independent risk factors for suicidal ideation. Pathway analyses showed that the relationship between CTE exposure and suicidal ideation was fully mediated by nightmares (proportion mediated 66.4%) after adjusting for demographic characteristics and psychological confounders.

Limitations

: Cross-sectional design precluded the investigation of causal relationships.

Conclusions

: CTE exposure increases risk of hospital workers’ suicidal ideation that is mediated by nightmares, suggesting nightmares intervention might be considered as a component when developing suicide prevention strategies.

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Most cited references 61

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The PHQ-9: validity of a brief depression severity measure.

K Kroenke, R L Spitzer, J. Williams (2001)

While considerable attention has focused on improving the detection of depression, assessment of severity is also important in guiding treatment decisions. Therefore, we examined the validity of a brief, new measure of depression severity. The Patient Health Questionnaire (PHQ) is a self-administered version of the PRIME-MD diagnostic instrument for common mental disorders. The PHQ-9 is the depression module, which scores each of the 9 DSM-IV criteria as "0" (not at all) to "3" (nearly every day). The PHQ-9 was completed by 6,000 patients in 8 primary care clinics and 7 obstetrics-gynecology clinics. Construct validity was assessed using the 20-item Short-Form General Health Survey, self-reported sick days and clinic visits, and symptom-related difficulty. Criterion validity was assessed against an independent structured mental health professional (MHP) interview in a sample of 580 patients. As PHQ-9 depression severity increased, there was a substantial decrease in functional status on all 6 SF-20 subscales. Also, symptom-related difficulty, sick days, and health care utilization increased. Using the MHP reinterview as the criterion standard, a PHQ-9 score > or =10 had a sensitivity of 88% and a specificity of 88% for major depression. PHQ-9 scores of 5, 10, 15, and 20 represented mild, moderate, moderately severe, and severe depression, respectively. Results were similar in the primary care and obstetrics-gynecology samples. In addition to making criteria-based diagnoses of depressive disorders, the PHQ-9 is also a reliable and valid measure of depression severity. These characteristics plus its brevity make the PHQ-9 a useful clinical and research tool.

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Validation of the Insomnia Severity Index as an outcome measure for insomnia research.

C. Bastien (2001)

Background: Insomnia is a prevalent health complaint that is often difficult to evaluate reliably. There is an important need for brief and valid assessment tools to assist practitioners in the clinical evaluation of insomnia complaints.Objective: This paper reports on the clinical validation of the Insomnia Severity Index (ISI) as a brief screening measure of insomnia and as an outcome measure in treatment research. The psychometric properties (internal consistency, concurrent validity, factor structure) of the ISI were evaluated in two samples of insomnia patients.Methods: The first study examined the internal consistency and concurrent validity of the ISI in 145 patients evaluated for insomnia at a sleep disorders clinic. Data from the ISI were compared to those of a sleep diary measure. In the second study, the concurrent validity of the ISI was evaluated in a sample of 78 older patients who participated in a randomized-controlled trial of behavioral and pharmacological therapies for insomnia. Change scores on the ISI over time were compared with those obtained from sleep diaries and polysomnography. Comparisons were also made between ISI scores obtained from patients, significant others, and clinicians.Results: The results of Study 1 showed that the ISI has adequate internal consistency and is a reliable self-report measure to evaluate perceived sleep difficulties. The results from Study 2 also indicated that the ISI is a valid and sensitive measure to detect changes in perceived sleep difficulties with treatment. In addition, there is a close convergence between scores obtained from the ISI patient's version and those from the clinician's and significant other's versions.Conclusions: The present findings indicate that the ISI is a reliable and valid instrument to quantify perceived insomnia severity. The ISI is likely to be a clinically useful tool as a screening device or as an outcome measure in insomnia treatment research.

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Validation and standardization of the Generalized Anxiety Disorder Screener (GAD-7) in the general population.

Bernd Löwe, Oliver Decker, Stefanie H. Müller … (2008)

The 7-item Generalized Anxiety Disorder Scale (GAD-7) is a practical self-report anxiety questionnaire that proved valid in primary care. However, the GAD-7 was not yet validated in the general population and thus far, normative data are not available. To investigate reliability, construct validity, and factorial validity of the GAD-7 in the general population and to generate normative data. Nationally representative face-to-face household survey conducted in Germany between May 5 and June 8, 2006. Five thousand thirty subjects (53.6% female) with a mean age (SD) of 48.4 (18.0) years. The survey questionnaire included the GAD-7, the 2-item depression module from the Patient Health Questionnaire (PHQ-2), the Rosenberg Self-Esteem Scale, and demographic characteristics. Confirmatory factor analyses substantiated the 1-dimensional structure of the GAD-7 and its factorial invariance for gender and age. Internal consistency was identical across all subgroups (alpha = 0.89). Intercorrelations with the PHQ-2 and the Rosenberg Self-Esteem Scale were r = 0.64 (P < 0.001) and r = -0.43 (P < 0.001), respectively. As expected, women had significantly higher mean (SD) GAD-7 anxiety scores compared with men [3.2 (3.5) vs. 2.7 (3.2); P < 0.001]. Normative data for the GAD-7 were generated for both genders and different age levels. Approximately 5% of subjects had GAD-7 scores of 10 or greater, and 1% had GAD-7 scores of 15 or greater. Evidence supports reliability and validity of the GAD-7 as a measure of anxiety in the general population. The normative data provided in this study can be used to compare a subject's GAD-7 score with those determined from a general population reference group.

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Author and article information

Journal

Journal ID (nlm-ta): J Affect Disord

Journal ID (iso-abbrev): J Affect Disord

Title: Journal of Affective Disorders

Publisher: Elsevier B.V.

ISSN (Print): 0165-0327

ISSN (Electronic): 1573-2517

Publication date PMC-release: 15 February 2022

Publication date (Electronic): 15 February 2022

Affiliations

[a ]Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China

[b ]Faculty of Medicine, Department of Psychiatry, Chinese University of Hong Kong, Sha Tin, Hong Kong SAR, China

[c ]National Institute on Drug Dependence and Beijing Key Laboratory on Drug Dependence Research, Peking University, Beijing, China

[d ]Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, China

[e ]Department of Neurology, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China

[f ]Department of Pediatrics, Zhongnan Hospital of Wuhan University, Wuhan, China

[g ]Affiliated Wuchang Hospital, Wuhan University of Science and Technology, Wuhan, China

[h ]Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China

[i ]Wuhan Children's Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China

[j ]Department of Psychiatry, Affiliated Wuhan Mental Health Center, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China

[k ]Department of Social Work and Social Administration, University of Hong Kong, Hong Kong, China

Author notes

[* ]Corresponding author: Prof. Lin Lu, MD, PhD, Institute of Mental Health and Peking University Sixth Hospital, 51 Huayuanbei Road, Beijing, 100191, China, Tell: +86-10-82805308, Fax: +86-10-62026310

[** ]Corresponding author: Prof. Yan-Ping Bao, PhD, National Institute on Drug Dependence and Beijing Key Laboratory on Drug Dependence Research, Peking University, 38 Xueyuan Road, Beijing, 100191, China, Tell: +86-10-82802470-412; Fax: +86-10- 62032624

[1]

These authors contributed equally to this work

Article

Publisher Item ID: S0165-0327(22)00185-9

DOI: 10.1016/j.jad.2022.02.033

PMC ID: 8843324

SO-VID: a1c7d0f7-dd34-43a7-824e-17ac6dcd4a33

License:

Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

History

Date received : 7 August 2021

Date revision received : 4 December 2021

Date accepted : 13 February 2022

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Nightmares mediate the association between traumatic event exposure and suicidal ideation in frontline medical workers exposed to COVID-19

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Abstract

Background

Methods

Results

Limitations

Conclusions

Related collections

Novel Coronavirus Disease COVID-19

Most cited references 61

The PHQ-9: validity of a brief depression severity measure.

Validation of the Insomnia Severity Index as an outcome measure for insomnia research.

Validation and standardization of the Generalized Anxiety Disorder Screener (GAD-7) in the general population.

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Cited by 4

Most referenced authors 948