The role of psychological inflexibility on post-traumatic stress symptoms among COVID-19 survivors

The COVID-19 outbreak spread rapidly around the world, causing a pandemic and negatively affecting the mental health of society. During this process, one of the most mentally affected groups has been patients who contracted COVID-19. Post-traumatic stress disorder (PTSD) is reported to be an important public health problem after pandemics. In this study, we aimed to investigate the relationship between psychological inflexibility, which is thought to underlie mental problems and PTSD symptoms in Covid-19 survivors. A total of 194 patients over 18 years old who were admitted to the Chest Diseases Outpatient Clinic with a previous COVID-19 infection and who agreed to participate were included in the study. Socio-demographic information form as well as questionnaire forms for Hospital Anxiety and Depression Scale (HADS), Acceptance and Action Questionnaire II (AAQ-II), Impact of Events Scale-Revised (IES-R) and Insomnia Severity Index (ISI) were conducted on the patients. Female gender, participants with lower education level, and those with additional chronic diseases had significantly higher IES-R values ( p = 0.014, p = 0.029 and p = 0.011, respectively). IES-R scores showed a significant positive correlation with HADS-Anxiety (A) ( p < 0.001), HADS-Depression (D) ( p < 0.001), AAQ-II ( p < 0.001) and ISI ( p < 0.001) scores. AAQ-II also scores significantly associated with HADS-A scores ( p = 0.0053), and similarly, the effect of HADS-A scores on IES-R scores was also significant ( p = 0.0009). The mediating role of HADS-A scores in the effect of AAQ-II scores on IES-R scores was significant (β = 0.0757, 95% CI = 0.0024 to 0.1785). AAQ-II scores had a significantly associated with ISI scores (β = 0.1263, p = 0.0033). Similarly, ISI scores had a significant association with IES-R scores (β = 1.3882, p < 0.001). In this model, ISI scores significantly mediated the relationship between AAQ-II scores and IES-R scores (β = 0.1753, 95% CI = 0.0640 to 0.3060). In our study, we found that female gender, low education level and additional chronic diseases were associated with PTSD symptoms in COVID-19 survivors. We also found that psychological inflexibility may be a common factor associated with PTSD, depression and anxiety symptoms and insomnia severity. Psychotherapeutic interventions to reduce psychological inflexibility, especially in patients who suffered an infection like COVID-19 during the pandemics, may prevent these patients from experiencing anxiety, depression, PTSD symptoms and sleep problems.