Nosocomial PTSD common with affective disorder diagnoses after psychiatric discharge
People with affective disorders had the highest rates of nosocomial PTSD 3 months after discharge from psychiatric hospitalization, according to a study in Psychiatry Research.
“This research was initially carried out in order to evaluate the traumatic effects of involuntary hospitalization and coercive measures in patients with mental disorders,” Panagiotis Kostaras, MD, PhD, of the Psychodynamic Centre of Psychotherapies and Research in Athens, Greece, told Healio Psychiatry. “It was based on the common belief that coercive measures are highly traumatic in psychiatric inpatients, although relevant literature was rather inconclusive and relatively old.”
Kostaras, lead author Sofia Martinaki, MSc, PhD, head of social workers at the University of Athens Medical School, Greece, and colleagues recruited 98 patients (53.1% men) hospitalized at the 1st Psychiatric Clinic of National and Kapodistrian University of Athens – Eginition Hospital between May 2019 and April 2020. Forty-nine (50%) were admitted involuntarily and 26 (26.5%) had their first psychotic episode.
Upon discharge, researchers collected demographic and previous hospitalization information. Participants completed questionnaires about adverse events during hospitalization (AEH), PTSD symptoms and insight. Main diagnoses from medical records were categorized as a psychotic spectrum disorder (53.1%), affective disorder (41.8%) or other mental disorder (8.2%). After 3 months, researchers reevaluated PTSD symptoms.
“We showed that exposure to violence during stay and the presence of affective disorders are the most significant risk factors for PTSD in relation to recent psychiatric hospitalization,” Kostaras said. “We introduced the term ‘nosocomial PTSD’ to describe this phenomenon. In fact, three out of four patients with affective disorders suffered from nosocomial PTSD 3 months after hospital discharge. Clinicians should thus be aware of the potentially traumatizing effects of hospitalization in patients with affective disorders, especially in women who are unemployed and not married (gender, marital and employment status were additional risk factors at discharge).”
There were no past or current PTSD diagnoses, but questionnaires at discharge showed PTSD and nosocomial PTSD (NPTSD) were prevalent in 8.2% and 41.8% of participants, respectively.
The most common AEH complaints were locked doors (83.7%) and noise levels (81.6%). Seeing someone restrained or brought in by police (30.6%) was the AEH most frequently rated the worst, though mechanical restraint or seclusion was most likely to be rated worst when reported (nine out of 11 reports, 81.8%). However, the only AEH that was a risk factor for NPTSD was exposure to violence; NPTSD was noted in 80% of exposure to violence reports (eight out of 10 reports).
Involuntary medication was a protective factor against PTSD symptoms (B = –0.22; 95% CI, –16.71 to 1.14), as were being married and employed. Restraint or seclusion had no significant effect on PTSD prevalence.
Limitations included improper evaluation for preexisting PTSD and previous trauma, short follow-up and small sample size. Based on their findings, Martinaki and colleagues made several clinical suggestions.
“Hospital admission, especially in women with affective disorders who are not employed and not married, should be initiated carefully, as they are more vulnerable to NPTSD,” they wrote. “In any event, psychiatric inpatients should be monitored for PTSD symptoms during and after hospitalization, especially if they have been in close proximity with aggressive patients.”