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©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
Transdiagnostic considerations of mental health for the post-COVID era: Lessons from the first surge of the pandemic
Sari Goldstein Ferber, Gal Shoval, Rodolfo Rossi, Viviana Trezza, Giorgio Di Lorenzo, Gil Zalsman, Aron Weller, J John Mann
Sari Goldstein Ferber, Aron Weller, Department of Psychology, Bar Ilan University, Ramat Gan 5290002, Israel
Gal Shoval, Department of Neuroscience, Princeton University, Princeton NJ 08544, United States
Gal Shoval, Gil Zalsman, Geha Mental Health Center, Petah Tiqva, Israel and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 77096, Israel
Rodolfo Rossi, Department of Systems Medicine, University of Rome Tor Vergata, Rome 00133, Italy
Viviana Trezza, Department of Science, Rome Tre University, Rome 00154, Italy
Giorgio Di Lorenzo, Department of Psychiatry, Rome University Tor Vergata, Rome 00179, Italy and IRCCS—Fondazione Santa Lucia, Rome 00179, Italy
Gil Zalsman, J John Mann, Division of Molecular Imaging and Neuropathology, Department of Psychiatry, Columbia University, NY, 10032, United States
Author contributions: Goldstein Ferber S and Mann JJ contributed to conceptualization; Di Lorenzo G, Rossi R and Trezza V verified the Italian data; Weller A and Goldstein Ferber S verified the Israeli data; Weller A, Goldstein Ferber Trezza V, Di Lorenzo G and Rossi R contributed to data curation; Weller A, Goldstein Ferber Trezza V, Di Lorenzo G and Rossi R contributed to formal analysis; Zalsman G and Shoval G contributed to investigation; Trezza V, Di Lorenzo G, Rossi R, Goldstein Ferber S and Mann JJ contributed tomethodology; Weller A, Goldstein Ferber S, Di Lorenzo G, and Rossi R contributed to project administration; Zalsman G, Shoval G, Mann JJ, Weller A, Goldstein Ferber S, Trezza V, Rossi R, and Di Lorenzo G contributed to validation; Goldstein Ferber S contributed to writing - original draft; Mann JJ, Trezza V, Rossi R, Di Lorenzo G, Zalsman G, Shoval G, Weller A and Goldstein Ferber S contributed to writing, review & editing; All authors contributed substantially to the final version of the manuscript.
Institutional review board statement: The Israeli representative samples were obtained according to the Israel Law of Statistics. The Italian study was reviewed and approved by the University of L’Aquila Institutional Review Board.
Informed consent statement: Informed consent was obtained in Israel verbally by a telephone call, and in Italy by an online click for virtual recruitment to this internet-based study.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Sari Goldstein Ferber, PhD, Additional Professor, Department of Psychology, Bar Ilan University, Geha St, Ramat Gan 5290002, Israel. sari.goldstein@biu.ac.il
Received: September 4, 2022
Peer-review started: September 4, 2022
First decision: October 30, 2022
Revised: November 28, 2022
Accepted: January 16, 2023
Article in press: January 16, 2023
Published online: February 6, 2023
ARTICLE HIGHLIGHTS
Research background
From early stages of the COVID-19 pandemic up to the current post-COVID era there are accumulating reports of a mix clinical picture of the related mental health symptomatology.
Research motivation
We hypothesized that the clinical picture of the COVID-19 related mental health symptomology span several conventional diagnostic categories and therefore there is a growing risk for misdiagnosing suffering individuals thus reducing the option of developing more accurate research -based programs for prevention and treatment.
Research objectives
To show that the association between 3 or more symptoms from different conventional diagnostic categories are more prevalent.
Research methods
Three consecutive representative samples in Israel has been compared to a very large sample in Italy for 3 or more associated symptoms from different conventional categories using proportion analyses.
Research results
The most frequent 4-symptom combination was Anxiety, post-traumatic stress symptoms (PTSS), Depression, and Post-Traumatic Stress Disorder-Negative Affect (PTSD-NA) (3.2%), compared to the other 4-symptom combinations. The prevalence of the 5-symptom combination, Anxiety, Perceived stress, PTSS, Depression, and PTSD-NA (9.0%, 95%CI: 8.5-9.3) was greater than that of the most prevalent 3- (95%CI: 3.0-3.5) and 4-symptom combinations (95%CI: 2.9-3.4, P < 0.001) In Italy.
The prevalence of the four-symptom combination (95%CI: 21.8-26.3) was greater than that of the most prevalent 3-symptom combination (Phobia, Anxiety and Depression, 7.32%, 95%CI: 6.0-8.7, P < 0.001) in Israel with an increase over time.
Research conclusions
We report evidence from studies in two different countries, on the presentation of complex symptomatology that crosses diagnostic boundaries, during the first surge of the COVID-19 pandemic. The complex of symptoms that we found correlated in severity. This suggests a common relationship or a single overarching disorder that we termed previously Complex Stress Reaction Syndrome. This offers an alternative and perhaps more complete characterization of psychopathology compared with employing multiple diagnoses for the same patient. Moreover, this pattern is observed within each of the two countries studied, despite different survey methods, and is found within ethnic subpopulations of both countries, attesting to the generalizability of the pattern.
Research perspectives
Further international studies are essential. Accordingly, we are currently conducting a multi-national study, based on the present empirical paper’s findings. This understanding needs to be extended to encompass psychopathology more comprehensively including neuropsychiatric effects. Without a more complete diagnosis, the treatment plan and organizational modifications cannot be complete.
