Post-traumatic stress symptoms in hemodialysis patients with MERS-CoV exposure

Cho, A Jin; Lee, Hong-Seock; Lee, Young-Ki; Jeon, Hee Jung; Park, Hayne Cho; Jeong, Da-Wun; Kim, Yang-Gyun; Lee, Sang-Ho; Lee, Chang-Hee; Yoo, Kyung Don; Wong, Ae Kyeong

The results of this study revealed that isolation duration is negatively associated with IES-R-K score. This result is contrary to those of previous studies that showed a positive correlation between quarantine duration and post-traumatic stress symptoms [13, 14] . However, isolation duration does not mean duration only, but also represents participants' cooperativeness with the mandatory quarantine request. When HD patients who were exposed to MERS-CoV were asked to undergo mandatory quarantine, some were cooperative, such that they were admitted immediately following instructions by medical staff. Others resisted the isolation, dragging on until, finally, they were forcibly hospitalized at a later stage. Since all participants were later released from quarantine on the same day, the isolation duration indicated their cooperativeness with the mandatory quarantine and their trust in the prevention system of epidemics. Therefore, the results of this study indicated that participants who cooperated with the isolation request and received longer support reported fewer posttraumatic stress symptoms. At the subscale level, patients quarantined for less than 16 days showed higher avoidance, emotional numbing, and dissociation, compared to those quarantined for more than 16 days. Psychological trauma causes not only post-traumatic stress symptoms such as intrusion, avoidance, and hyperarousal, but also many other somatic and psychiatric symptoms due to its complexity and the diversity of symptoms, showing high levels of comorbidity with other problems [15] . Based on Lee [16] suggestion regarding posttraumatic growth, trauma-related symptoms occur in sequential order, as follows: catatonia, emotional numbing, dissociation, fear, intrusion, paranoid ideation, avoidance, obsession, hyperarousal, anxiety, depression, existential emptiness, searching for meaning, and posttraumatic growth. The results of the current study, indicating that participants showed emotional numbing and dissociation more often, compared to intrusion, avoidance, and hyperarousal, in turn indicated that participants did not process the trauma and the isolation experience, so that their symptoms remained at the very early stage of processing trauma. This indicates that participants can experience subsequent symptoms of hyperarousal. Thus, psychological intervention and follow-up are needed.