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

We performed linear regression analysis to identify associated factors with high IES-R-K score ( Table 2) . Shorter isolation period was associated with high IES-R-K score (standardized β coefficient − 0.272, P = 0.026). We compared the total IES-R-K and subscale scores according to isolation duration in Table 3 . The total scores did not differ significantly between male and female subjects (8.46 ± 9.59 vs. 12.38 ± 12.09, P = 0.158). However, the sleep disturbance subscale score was higher among female, compared to male subjects (1.57 ± 2.79 vs. 0.46 ± 1.17, P = 0.024). We divided the participants by median isolation duration. Participants isolated for less than 16 days showed a higher total score than those isolated for more than 16 days (13.47 ± 12.69 vs. 6.23 ± 6.45, P = 0.004). At a subscale level, avoidance (4.94 ± 5.94 vs. 2.34 ± 3.12, P = 0.027) and sleep disturbance, emotional numbing, and dissociation (4.75 ± 3.25 vs. 2.09 ± 2.28, P < 0.001) subscale scores were higher in participants who had been isolated for less than 16 days. With regard to the sleep disturbance, emotional numbing, and dissociation subscale scores, emotional numbing (2.22 ± 1.50 vs. 1.0 ± 1.16, P < 0.001) and dissociation (1.50 ± 1.59 vs. 0.49 ± 0.92, P = 0.002) scores were higher in that group. Before the outbreak of MERS, 5.9% of the participants (n = 4) had scores exceeding the cutoff point of the IES-R-K. We did not have pre-MERS IES-R-K scores for 23 respondents. Therefore, a paired-samples t-test was conducted to compare pre-and post-MERS IES-R-K scores in only 44 respondents (Table 4 ). Participants' post-traumatic stress symptoms increased at 1 year after the MERS outbreak. There was a significant difference in the total scores on the IES-R-K pre-and post-MERS (3.16 ± 9.02 vs. 9.69 ± 10.50, P < 0.001). At the subscale level, sleep disturbance, emotional numbing, and dissociation at post-MERS (2.52 ± 2.61) was significantly higher than that at pre-MERS (0.82 ± 2.40, P < 0.001). However, there was no significant difference in avoidance, intrusion, and hyperarousal at pre-MERS and post-MERS. When the fourth factor, which consists of three different symptoms, is broken down, there was a significant difference in emotional numbing (0.27 ± 0.85 vs. 1.16 ± 1.18, P < 0.001) and dissociation (0.20 ± 0.67 vs. 0.55 ± 0.93, P = 0.01) at pre-and post-MERS. However, sleep disturbance showed no significant difference (0.34 ± 1.36 vs. 0.82 ± 7.80, P = 0.07).