An anxiety disorder that’s normally associated with war veterans, PTSD can affect anyone exposed to a traumatic event. There is particular concern for frontline healthcare staff and some patients who were hospitalised with severe Covid symptoms.
The Royal College of Psychiatrists say estimates by the NHS Strategy Unit suggest there could be 230,000 new referrals for PTSD between 2020/21 and 2022/23 in England alone, according to official figures. Given this projection, there is no reason why rates of PTSD in Northern Ireland, as in other parts of the UK, and indeed globally, could potentially rise.
Covid-19 has obviously increased exposure to traumatic experience, which causes the condition, although outside of the pandemic context PTSD can be triggered, not only by military combat but also among those who experience road accidents, bereavement, divorce, and sexual or violent assault. But cases of severe illness can also be triggers, and Covid has sadly made this and the trauma of personal loss more prevalent.
The Royal College of Psychiatrists says the NHS is already facing the biggest backlog of those waiting for mental health help in its history.
Forecasts cited by the college from the NHS strategy unit, which carries out NHS analysis, show there could be a rise in PTSD referrals of about 77,000 cases a year.
The NHS strategy unit said it was not possible to directly compare the modelling of new cases to current figures since the NHS does not publish a total figure for all PTSD referrals. However, analysis suggests the number of new cases predicted would represent a significant increase.
The strategy unit said its forecast of the rise in cases was based on the effects of the pandemic on domestic abuse victims, children and young people, relatives of Covid survivors, health and care workers, and those who have lost friends and family to the disease.
Prof Neil Greenberg, expert editor of the Royal College of Psychiatrists’ new resource tool for patients with PTSD, said: “It’s a common misunderstanding that only people in the armed forces can develop PTSD – anyone exposed to a traumatic event is at risk.
“It’s vital that anyone exposed to traumatic events is properly supported at work and home. Early and effective support can reduce the likelihood of PTSD and those affected should be able to access evidence-based treatment in a timely manner. Especially our NHS staff who are at increased risk as a result of this unprecedented crisis.”
The college highlighted a poll of 709 ICU staff across six NHS hospitals in England during the first wave of the pandemic that found two in five reported symptoms of PTSD – more than twice the rate found in military veterans with recent combat experience.
It also pointed to research published in the journal BJPsych Open earlier this year, which found that 35% of Covid patients who were put on a ventilator go on to experience extensive symptoms of PTSD.
What symptoms result from PTSD according to experts?
Dr Alison McClymont, a psychologist specialising in mental health, says: “Symptoms will focus around avoiding connecting with the memory that was traumatic, this might present itself as hyper-vigilance (a feeling of being on edge), increased irritability, panic or, in extreme cases, dissociation (a feeling of being ‘outside of your body’).
“This might produce intrusive thoughts or images where the body is trying to force the brain to process the memory and place it in the long term memory store, rather than triggering the fight or flight mechanism where the body believes it ‘is still happening’.
While Dr Rhianna McClymont, GP at digital healthcare provider, Livi (livi.co.uk), adds: “Many people with PTSD push memories away, avoiding people and places connected to them and refusing to talk about what happened. This can make them feel emotionally numb and withdrawn. You’re likely to relive the experiences of the event through nightmares and flashbacks.
There are often physical symptoms too, she says, such as headaches, dizziness, chest pains and stomach aches. “Symptoms usually develop within a month, but sometimes can develop several months, or even years, later.”
Why is it happening as a result of the pandemic?
“A pandemic is a traumatic event,” says Alison. “It’s entirely logical and reasonable that it induces PTSD – someone’s entire sense of safety and reality has been threatened.”
Many people experienced (and are still experiencing) feeling a loss of control, social isolation and a significant financial impact, and all of these things can cause PTSD at their most extreme. If someone close to you has died as a result of Covid or you’ve been very ill and hospitalised yourself, your risk factor goes up further.
“If you have experienced a tragedy as a result of this – the trauma is compounded and it makes sense a person’s psychology would desperately attempt not to remember, or to avoid the situation happening again, so the pain is not re-experienced,” she adds.
What about frontline staff?
For many healthcare workers, the impact of the crisis has been monumental.
“Let’s be frank,” says Alison, “witnessing many people dying and being helpless due to lack of resources or support to help them, is one of the most traumatic things a person could experience.
“Feelings of helplessness in response to trauma have been shown by research to have a monumentally significant effect in whether or not PTSD will later develop. The emotional memory of being stuck and without control is one of the precursors to PTSD.”
A recent study by Oxford University found that PTSD in healthcare workers during the pandemic was often exacerbated by past trauma, too.
What help is available?
It’s important to recognise the symptoms early, says Niels Eék, psychologist and co-founder of mental wellbeing app Remente (remente.com).
“No matter how small or insignificant they may feel, I would always recommend the first steps to be to talk with a loved one or someone close, about what you are feeling or experiencing.
“Secondly, speak to your GP. Your GP is trained to recognise and treat mental health too. The good news is that PTSD is treatable, the earlier the prognosis, the better the outcome,” he says.
Left untreated, PTSD can cause depression, anxiety or phobias, says Rhianna. “It’s not unusual for people with PTSD to misuse drugs and alcohol, and to consider self-harming, or to have suicidal feelings.”
But there are effective, specialist treatments available. “Psychological therapies are an important part of treatment for PTSD, and options include counselling and CBT,” she says. It can often be helpful to talk about experiences in a group situation – lots of charities run local PTSD support groups. Therapy for PTSD can include trauma-focused cognitive behavioural therapy (TF-CBT), a specific form of CBT that helps treat PTSD by helping people confront traumatic memories and come to terms with the events that took place,” Rhianna adds.
“Another is eye movement desensitisation and reprocessing (EMDR) – a newer treatment that can reduce the symptoms of PTSD by changing the negative way people think about a traumatic event.
Occasionally, medication such as antidepressants or analgesics and other anti-anxiety medications can be used for PTSD symptoms.