Chronic pain and post-traumatic stress in older patients with psychiatric disorders during the Covid-19 pandemic: co-occurrence and influence of attachment and personality factors
H. Saint-Martin, J.-M. Dorey, M. Herrmann, B. Laurent, C. Lebrun-Givois, C. Perrot, A. Edjolo, L. Ouss, E. Pongan, I. RouchIntroduction
The Covid-19 pandemic context may have had numerous effects on the health of older patients with psychiatric disorders (PD), confronting them with a new source of stress and hindering their access to care. These effects could have included the onset of post-traumatic stress (PTSD) symptoms — as well as chronic pain (CP), which often occurs alongside trauma.
CP and PTSD share a common pathological mechanism and numerous studies have highlighted the frequent co-occurrence of CP and PTSD.
Explanatory models for this link still lack evidence . Furthermore, they have not been tested in older and/or PD populations .
Objectives
The aim of this study was to assess the long-term effects of the pandemic on both CP and PTSD ; the comorbidity of the two disorders; and to identify common psychological risk factors.
Methods
Design: Medical interviews were conducted during and after (12 and 18 months later) the first lockdown.
Setting: The STERACOVID longitudinal cohort study, conducted in two French hospitals.
Participants: 71 patients aged 65 or over; treated in an outpatient psychiatric service; and free of major neurocognitive disorders.
Measurements: Validated scales were used to assess CP (ICD-11 criteria); PTSD (PCL-S); personality traits (BFI-Fr); attachment style (RSQ); and coping strategies (BRIEF-COPE). χ² and Student’s t-tests, analyses of variance and logistic regression were used to compare patients with or without CP and/or PTSD, in terms of attachment styles, personality traits and coping strategies.
Results
Prevalence of :
CP : 17% at T1 to 55% at T2, p = .005*
PTSD : 31% at T2
Association between CP and PTSD : PTSD frequency : 41% of CP2+ patients vs. 19% of CP2- patients, p = .043*
Attachment style: CP1-CP2+ more fearful than CP1-CP2- (OR = 2.71, p = 0.046*)
PTSD2+ more fearful (3.40 vs. 2.90, F = 2.43, p = 0.020*) and preoccupied (2.53 vs. 2.12, F = 5.66, p = 0.026*) than PTSD2-
CP2+PTSD2+ and CP2+PTSD2- more fearful than CP2-PTSD2-
Personality factors: CP1+ more extraverted than CP1-CP2- (OR = 3.61, p = 0.050*)
PTSD2+ more neurotic than PTSD2- (3.81 vs. 3.31, F = 6.35, p = 0.014*)
CP2+PTSD2- more extraverted than CP-PTSD2-
Coping strategies: no associations
Conclusions
CP and PTSD were frequent and often co-occurring , 18 months after the first lockdown. Our study identified factors associated with a higher risk of developing CP and/or PTSD in the pandemic context :
Attachment styles: insecure-anxious profiles were more likely to develop CP and/or PTSD
Personality traits: extraversion predicted CP, neuroticism predicted PTSD but not CP
These results are in line with the anxiety sensitivity hypothesis: common vulnerability etiology for CP and PTSD, predicted by neuroticism and extraversion traits, and insecure-anxious attachment styles.
Disclosure of Interest
None Declared