The COVID-19 Pandemic as a Traumatic Stressor: Mental Health Responses of Older Adults with Chronic PTSD

Rutherford, Bret R; Choi, C. Jean; Chrisanthopolous, Marika; Salzman, Chloe; Zhu, Carlen; Montes-Garcia, Carolina; Liu, Ying; Brown, Patrick J.; Yehuda, Rachel; Flory, Janine; Neria, Yuval; Roose, Steven P.

OBJECTIVE: Individuals with Posttraumatic stress disorder (PTSD) who experience additional traumas or stressful life events may undergo symptomatic worsening, but no data exist on whether exposure to the COVID-19 pandemic in a high infection area worsens mental health among older adults with chronic PTSD. METHODS: Seventy-six older adults (N=46 with PTSD and N=30 trauma-exposed comparison subjects [TE]) for whom pre-pandemic data were available were interviewed between April 1 and May 8, 2020 to quantify depressive (Hamilton Rating Scale for Depression [HRSD]) and PTSD symptom (Posttraumatic Stress Disorder Checklist [PCL-5]) levels. Group differences in baseline characteristics as well as pre-post pandemic symptom levels were examined, and participant characteristics were assessed as moderators of symptom change. RESULTS: Compared to TEs, individuals with PTSD more often reported living alone and experiencing a physical illness (χ2=5.1, df=1, p=0.02). PCL-5 scores among individuals with PTSD decreased during the COVID-19 pandemic by 7.1 points (t(69)=-3.5, p=.0008), whereas the TE group did not change significantly. Overall no significant differences in HRSD was found between groups, but a race/ethnicity variable was found to moderate HRSD symptom change. Non-black/Hispanic individuals with PTSD experienced significantly increased HRSD scores during the pandemic compared to black/Hispanic PTSD participants. CONCLUSIONS: The findings are indicative of complexity in the responses of older individuals with PTSD to further stressful life events as well as possibly unique aspects to the COVID-19 pandemic as a stressor. Sources of resilience may exist based on experience with prior traumas as well as increasing age promoting more adaptive coping styles.