Determinants of Post-Traumatic Stress Disorders in Italian university students during the Covid-19 outbreak: the leading role of sex, health concerns, and health engagement
Keywords:
COVID-19 outbreak, Post-Traumatic Stress Disorder, PTSD, Psychological distress, Risk and protective factors, University studentsAbstract
Background. The unprecedented changes in daily-life caused by Covid-19 restrictions had many psychological and adverse effects, not only in sufferers but also in the general population, including university students. To date, little is known about Post-Traumatic Stress Disorder symptoms experienced by university students during the peak of Covid-19 in Italy. Thus, the study describes Post-Traumatic Stress Disorders related to the Covid-19 outbreak among Italian university students and identifies the psychological distress risk and protective factors.
Study design. A multicentre observational cross-sectional study.
Methods. Data collection was involved in a self-reported web questionnaire, using the on-line platform Qualtrics®, in March and April 2020, involving convenience and consecutive sampling of Italians university students in different Italy regions.
Results. A sample of 720 Italian university students was enrolled. Data analysis highlighted the leading role of sex, health concerns, and health engagement as negative or positive determinants of Post-Traumatic Stress Disorders in Italian university students during the Covid-19 outbreak. In particular, it is very insightful having discovered that health engagement is a protective factor of students’ mental health.
Conclusions. This is the first study identifying sex, health issues and health commitment as positive or negative determinants of Post-Traumatic Stress Disorders symptoms in Italian university students during the Covid-19 epidemic. Accordingly, this new achievement could be the starting point for the development of awareness campaigns for the psychological health of Italian university students.
References
1. The Lancet. Emerging understandings of 2019nCoV. Lancet 2020; 395(10221): 311. doi: 10.1016/S0140-6736(20)30186-0. Epub 2020 Jan 24.
2. Odone A, Lugo A, Amerio A, et al. COVID-19 lockdown impact on lifestyle habits of Italian adults. Acta Biomed. 2020; 91(9-S): 87-9. doi: 10.23750/abm.v91i9-S.10122. Epub 2020 Jul 20.
3. Amerio A, Brambilla A, Morganti A, et al. COVID-19 Lockdown: Housing Built Environment’s Effects on Mental Health. Int J Environ Res Public Health. 2020; 17(16): E5973. doi: 10.3390/ijerph17165973. Epub 2020 Aug 17.
4. Chi X, Becker B, Yu Q, et al. Prevalence and Psychosocial Correlates of Mental Health Outcomes Among Chinese College Students During the Coronavirus Disease (COVID-19) Pandemic. Front Psychiatry. 2020; 11: 803. doi: 10.3389/ fpsyt.2020.00803.
5. Marelli S, Castelnuovo A, Somma A, et al. Impact of COVID-19 lockdown on sleep quality in university students and administration staff. J Neurol. 2020; 268(1): 8-15. doi: 10.1007/ s00415-020-10056-6. Epub 2020 Jul 11.
6. Huang Y, Zhao N. Generalized anxiety disorder, depressive symptoms and sleep quality during COVID-19 outbreak in China: a web-based crosssectional survey. Psychiatry Res. 2020; 288: 112954. doi: 10.1016/j.psychres.2020.112954. Epub 2020 Apr 12.
7. Cao W, Fang Z, Hou G, et al. The psychological impact of the COVID-19 epidemic on college students in China. Psychiatry Res. 2020; 287: 112934. doi: 10.1016/j.psychres.2020.112934. Epub 2020 Mar 20.
8. Deja M, Denke C, Weber-Carstens S, Schröder J, et al. Social support during intensive care unit stay might improve mental impairment
and consequently health-related quality of life in survivors of severe acute respiratory distress syndrome. Crit Care. 2006; 10(5): R147. doi:
10.1186/cc5070.
9. Foa EB, Cashman L, Jaycox L, Perry K. The validation of a self-report measure of posttraumatic stress disorder: The posttraumatic diagnostic scale. Psychol Assess. 1997; 9(4): 445-51. doi: 10.1016/j.psychres.2007.09.005. Epub 2008 Aug 20.
10. Lei XY, Xiao LM, Liu YN, Li YM. Prevalence of Depression among Chinese University Students: A Meta-Analysis. PLoS One. 2016; 11(4):
e0153454. doi: 10.1371/journal.pone.0153454.
11. Liu N, Zhang F, Wei C, et al. Prevalence and predictors of PTSS during COVID-19 outbreak in China hardest-hit areas: Gender differences matter. Psychiatry Res. 2020; 287: 112921. doi: 10.1016/j.psychres.2020.112921. Epub 2020 Mar 16.
12. Neria Y, Nandi A, Galea S. Post-traumatic stress disorder following disasters: A systematic review. Psychol Med. 2008; 38(4): 467-80. doi: 10.1017/S0033291707001353. Epub 2007 Sep 6.
13. Galea S, Nandi A, Vlahov D. The epidemiology of post-traumatic stress disorder after disasters. Epidemiol Rev. 2005; 27: 78-91. doi: 10.1093/ epirev/mxi003.
14. Ibrahim H, Hassan CQ. Post-traumatic stress disorder symptoms resulting from torture and other traumatic events among Syrian Kurdish refugees in Kurdistan Region, Iraq. Front Psychol. 2017; 8: 241. doi: 10.3389/fpsyg.2017.00241.
15. Neria Y, DiGrande L, Adams BG. Posttraumatic Stress Disorder Following the September 11, 2001, Terrorist Attacks: A Review of the Literature Among Highly Exposed Populations. Am Psychol. 2011; 66(6): 429-46. doi: 10.1037/ a0024791.
16. Nania T, Dellafiore F, Caruso R, Barello S. Risk and protective factors for psychological distress among Italian university students during the COVID-19 pandemic: The beneficial role of health engagement. Int J Soc Psychiatry. 2020; 2076402094. doi: 10.1177/0020764020945729. Online ahead of print.
17. Schleyer TKL, Forrest JL. Methods for the design and administration of web-based surveys. J Am Med Informatics Assoc. 2000; 7(4): 416-25.
doi: 10.1136/jamia.2000.0070416.
18. Weiss DS. The Impact of Event Scale: Revised.
In: Wilson JP, Tang CS, Eds. Cross-Cultural Assessment of Psychological Trauma and PTSD. Boston: Springer, 2007: 219-38.
19. Pietrantonio F, De Gennaro L, Di Paolo MC, Solano L. The impact of event scale: Validation of an Italian version. J Psychosom Res. 2003; 55(4): 389-93. doi: 10.1016/s0022-3999(02)00638-4.
20. Graffigna G, Barello S, Bonanomi A, Lozza E. Measuring patient engagement: development and psychometric properties of the Patient Health Engagement (PHE) Scale. Front Psychol. 2015; 6: 274. doi: 10.3389/fpsyg.2015.00274.
21. Jollife IT, Cadima J. Principal component analysis: A review and recent developments. Philos Trans R Soc A Math Phys Eng Sci. 2016; A 374: 20150202. doi: 10.1098/rsta.2015.0202.
22. Dubey S, Biswas P, Ghosh R, et al. Psychosocial impact of COVID-19. Diabetes Metab Syndr Clin Res Rev. 2020; 14(5): 779-88. doi: 10.1016/j.dsx.2020.05.035. Epub 2020 May 27.
23. Sahu P. Closure of Universities Due to Coronavirus Disease 2019 (COVID-19): Impact on Education and Mental Health of Students and Academic Staff. Cureus. 2020; 12(4): e7541. doi: 10.7759/cureus.7541.
24. Liang L, Gao T, Ren H, et al. Post-traumatic stress disorder and psychological distress in Chinese youths following the COVID-19 emergency. J Health Psychol. 2020; 25(9): 1164-75. doi: 10.1177/1359105320937057. Epub 2020
Jul 6.
25. Wang J, Korczykowski M, Rao H, et al. Gender difference in neural response to psychological stress. Soc Cogn Affect Neurosci. 2007; 2(3): 227-39. doi: 10.1093/scan/nsm018.
26. Kitson A. Rising from the ashes: Affirming the spirit of courage, community resilience, compassion and caring. J Clin Nurs. 2020; 29: 2765-6. doi: 10.1111/jocn.15182.
27. Alegría M, Polo A, Gao S, et al. Evaluation of a patient activation and empowerment intervention in mental health care. Med Care. 2008; 46(3): 24756. doi: 10.1097/MLR.0b013e318158af52.
28. Green CA, Perrin NA, Polen MR, Leo MC, Hibbard JH, Tusler M. Development of the patient activation measure for mental health. Adm Policy Ment Health. 2010; 37(4): 327-33. doi: 10.1007/s10488-009-0239-6. Epub 2009 Aug 29.
29. Dellafiore F, Caruso R, Arrigoni C, et al. The development of a self-efficacy scale for nurses to assess the nutritional care of older adults: A multi-phase study. Clin Nutr. 2020; S0261-5614. doi: 10.1016/j.clnu.2020.08.008. Epub ahead of print.
30. Dellafiore F, Arrigoni C, Ghizzardi G, et al. Development and validation of the pressure ulcer management self-efficacy scale for nurses. J Clin Nurs. 2019; 28(17-18): 3177-88. doi: 10.1111/ jocn.14875. Epub 2019 Apr 21.
31. Dellafiore F, Pittella F, Arrigoni C, et al. A multi-phase study for the development of a selfefficacy measuring scale for ostomy care nursing management. J Adv Nurs. 2020; 76(1): 409-19.
doi: 10.1111/jan.14242. Epub 2019 Nov 3.
32. Arrigoni C, Caruso R, Campanella F, Berzolari FG, Miazza D, Pelissero G. Investigating burnout situations, nurses’ stress perception and effect of a post-graduate education program in health care organizations of northern Italy: a multicenter study. G Ital Med Lav Ergon. 2015; 37(1): 39-45.
33. Dellafiore F, Grugnetti AM, Caruso R, et al. “Nurses Professional Values Scale-Three”: A Validation Study Among Italian Nurses and Nursing Students. J Nurs Meas. 2020; 28(3): 1-16. doi: 10.1891/JNM-D-20-00030. Online ahead of print.
34. Arrigoni C, Grugnetti AM, Caruso R, et al. Describing the health behaviours of future nurses: A cross-sectional study among Italian nursing students. Acta Biomed. 2020; 91(3): e2020068. doi: 10.23750/abm.v91i3.8338.
35. Barello S, Nania T, Dellafiore F, Graffigna G, Caruso R. “Vaccine hesitancy” among university students in Italy during the COVID-19 pandemic. Eur J Epidemiol. 2020; 35(8): 781-3. doi: 10.1007/s10654-020-00670-z. Epub 2020 Aug 6.
36. Dellafiore F, Caruso R, Conte G, Grugnetti AM, Bellani S, Arrigoni C. Individual-level determinants of interprofessional team collaboration in healthcare. J Interprof Care. 2019; 33(6): 762-7. doi: 10.1080/13561820.2019.1594732. Epub 2019 Apr 21.
37. Rosa D, Terzoni S, Dellafiore F, Destrebecq A. Systematic review of shift work and nurses’ health. Occup Med (Lond). 2019; 69(4): 237-43. doi: 10.1093/occmed/kqz063.
38. Dellafiore F, Nania T, Bruscagin M, et al. Studio con metodo misto sequenziale sulle barriere che ostacolano l’implementazione di un nuovo modello organizzativo patient centred care: la prospettiva infermieristica. Prof Inferm. 2019; 72(3): 171-80. doi: 10.7429/pi.2019.72180.
39. Dellafiore F, Arrigoni C, Grugnetti AM, et al. Bedside nursing handover and organizational will to achieve personalization within an Italian Cardiac SurgeryUnit: the nurses’ viewpoint through a qualitative study. Prof Inferm. 2019; 72(1): 51-9. doi: 10.7429/pi.2019.721051.
40. Nania T, Barello S, Caruso R, et al. The state of the evidence about the Synergy Model for patient care. Int Nurs Rev. 2021 Mar; 68(1): 78-89. doi: 10.1111/inr.12629. Epub 2020 Sep 25.
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