Tens of thousands of Covid-19 survivors should be screened for post-traumatic stress disorder because of their experiences in fighting for their lives, mental health experts have urged.
Leading psychiatrists and psychologists want NHS bosses to ensure that all those who were admitted to hospital when they became seriously ill with the disease is assessed and checked regularly.
Survivors showing signs of PTSD would undergo treatment to prevent nightmares and flashbacks that could blight the rest of their lives.
“For many people hospitalised with Covid-19 it’s been a potentially traumatic experience. Being in intensive care is frightening. There was a particular risk to their own life, because they were very ill. And early in the pandemic we didn’t have treatments available for covid.
“The doctors and nurses treating people in hospital all had to wear protective equipment. People weren’t able to see their relatives. And patients had tubes in them and, if they were intubated, they were in an altered state of consciousness.
“So although they were having life-saving interventions, knowing how dangerous the situation was would have been extremely frightening for anybody. Therefore a huge toll of trauma from that would be expected,” said Dr Michael Bloomfield, an NHS psychiatrist, researcher at University College London and one of the experts calling for automatic screening of all survivors.
Everyone treated for Covid-19 in an intensive care unit, high dependency unit or hospital ward should be assessed for symptoms of PTSD and other mental disorders before they leave hospital and again within a month, the experts say.
Around 100,000 people have been treated in hospital for Covid-19 in England. At least 12,573 patients in England, Wales and Northern Ireland have received intensive care. Of the 9,217 for whom full records are available, 3,791 or 38% died.
Bloomfield and colleagues from UCL, Oxford University, King’s College London, the NHS and Haifa University in Israel have formed a covid trauma response working group to press NHS chiefs and ministers to set up a dedicated UK-wide “screen and treat” service. Doing so brought major benefits to people affected by the 7/7 bombings in London in 2005, the Manchester Arena attack in May 2017 and the Grenfell Tower fire in the capital a month later because their problems were identified early and treated, they say.
They have drawn up guidelines for the identification and treatment of PTSD among what is likely to prove a high proportion of Covid-19 survivors.
The guidelines state: “Given the very frightening and invasive nature of the Covid-19 critical care experience, the high risk of death and the potential for long-term medical complications, those most severely affected by Covid-19 are likely to be at very high risk of developing trauma and stress-related mental health difficulties.”
An estimated one in 20 in the UK have PTSD. Sufferers tend to feel on edge or on their guard because they feel they are under threat, and they avoid things that will remind them of their traumatic experience, such as television news reports that have to potential nightmares or flashbacks.
Research has found that in normal times about 40% of people who are discharged after a spell in intensive care develop symptoms of anxiety, 30% have depression and 20% signs of PTSD. The figures for people who have survived an event that involves mass casualties, such as a terrorist attack or transport disaster, are similar.
Infectious disease outbreaks, however, leave a larger proportion suffering from PTSD. Epidemics lead to “both an immediate impact on mental health and one that emerges over time. For example, rates of diagnosable mental health problems were present in up to 60% of survivors of SARS-CoV up to one year later. Survivors of other Coronavirus outbreaks also report fear of stigma, of contaminating others, of contracting the illness again, as well as chronic fatigue syndromes”, the guidelines say.
Covid-19 patients may be even more likely to suffer PTSD than those who have suffered other infectious diseases because of their isolation while in hospital, Bloomfield said. “There may also be features unique to Covid-19 and its pandemic status that exacerbate its psychological impact, such as being isolated from family during and after hospital admission. Failure to deal with this immediately could lead to serious long-term mental health difficulties,” he said.
The experts say survivors’ families may also need mental health support: “Relatives of people admitted to hospital for severe Covid-19 illness may also experience psychological trauma, such as seeing a sedated and ventilated relative via video link from hospital and may have believed their loved one was going to die.”
Geoff Heyes, the head of health policy and influencing at the mental health charity Mind, backs the call for proactive detection of problems among Covid-19 survivors, but is concerned NHS mental health services may be already too overstretched.
“Going into this pandemic, only one in three people who needed help for their mental health were actually getting any. Coming out we are going to see even higher demand. Any screening programme would need to be matched with a commitment to get people the support they need, when they need it,” he said.
Prof Neil Greenberg of the Royal College of Psychiatrists said screening would help traumatised survivors get speedy help: “Actively monitoring those with trauma-related mental health problems through a ‘screen and treat’ programme can help them access the specialist mental health support they need to recover.
“A similar programme to protect the mental health of survivors of life-threatening COVID-19 infection, who are at high risk of developing mental health problems as a result, could help them access professional care sooner.”.
NHS England said staff were already expected to assess survivors for signs of PTSD and other mental illness, and that survivors could also seek help themselves directly.
An NHS spokesperson said: “Any covid survivor who had to stay in hospital as they were treated for the illness will have a follow-up appointment with either their hospital team or their GP which will include a review on whether they need mental health support.”