Observational Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Psychiatry. Oct 19, 2023; 13(10): 803-815
Published online Oct 19, 2023. doi: 10.5498/wjp.v13.i10.803
International study of the Complex Stress Reaction Syndrome: Implications for transdiagnostic clinical practice
Sari Goldstein Ferber, Aron Weller, Adele M Hayes, Tracy D Vannorsdall, Yaroup Ajlouni, Mo'nes Qudah, Gil Zalsman, Gal Shoval, Tommaso Benedetto Jannini, Racquel Fiedler, Lily X Chen, Danielle R Shayani, Elin Kachuki Dory, Dana Stolowicz-Melman, Connor Evans, Megan Trow, Giorgio Di Lorenzo, Rodolfo Rossi
Sari Goldstein Ferber, Adele M Hayes, Danielle R Shayani, Department of Psychological and Brain Sciences, University of Delaware, Newark, DE 19716, United States
Sari Goldstein Ferber, Department of Psychology, Bar Ilan University, Ramat Gan 5290002, Israel
Aron Weller, Racquel Fiedler, Elin Kachuki Dory, Dana Stolowicz-Melman, Department of Psychology and The Gonda Brain Research Center, Bar Ilan University, Ramat Gan 5290002, Israel
Tracy D Vannorsdall, Department of Psychiatry and Behavioral Sciences, Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD 21287, United States
Yaroup Ajlouni, Mo'nes Qudah, Jordan Health Aid-International, Amman 1234, Jordan
Gil Zalsman, Gal Shoval, Geha Mental Health Center, Petah Tiqva, Israel and Faculty of Medicine, Tel Aviv University, Ramat Aviv 6997801, Israel
Gil Zalsman, Division of Molecular Imaging and Neuropathology, Department of Psychiatry, Columbia University, New York, NY 10032, United States
Gal Shoval, Department of Neuroscience, Princeton University, Princeton, NJ 08544, United States
Tommaso Benedetto Jannini, Rodolfo Rossi, Department of Systems Medicine, Tor Vergata University of Rome, Rome 00133, Italy
Lily X Chen, UNSW School of Psychology, UNSW Sydney, Sydney 2052, Australia
Connor Evans, Department of Biology, Pacific University, Forest Grove, OR 97116, United States
Megan Trow, Oregon Chapter of Fulbright Association, Oregon, OR 97045, United States
Giorgio Di Lorenzo, Department of Systems Medicine, Tor Vergata University of Rome, Rome 00179, Italy
Giorgio Di Lorenzo, IRCCS, Fondazione Santa Lucia, Rome 00179, Italy
Author contributions: Goldstein Ferber S developed the CSRS conceptualization and was the leading author; Rossi R supervised the statistical analyses and data collection; All the other authors contributed to the study and the last version of this paper.
Institutional review board statement: IRB approvals for this international study were provided by The Johns Hopkins University, Baltimore, Maryland, USA, and by Bar Ilan University, Ramat-Gan, Israel. The study survey used the Qualtrics platform (Qualtrics, Provo, Utah, USA) for data collection.
Informed consent statement: All study participants provided online informed consent prior to study enrollment.
Conflict-of-interest statement: The authors declare no conflict of interest.
Data sharing statement: The study data are available upon request.
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, Affiliate Associate Professor, Department of Psychological and Brain Sciences, University of Delaware, 108 Wolf Hall, Newark, DE 19716, United States. sgf@udel.edu
Received: July 11, 2023
Peer-review started: July 11, 2023
First decision: August 16, 2023
Revised: August 25, 2023
Accepted: September 11, 2023
Article in press: September 11, 2023
Published online: October 19, 2023
Processing time: 92 Days and 18.9 Hours
ARTICLE HIGHLIGHTS
Research background

The debate regarding diagnostic classification systems in psychiatry (categorial vs dimensional systems) has essential implications for the diagnosis, prevention and treatment of stress reactions.

Research motivation

We previously found a unique pattern of stress reaction in a study executed during the coronavirus disease 2019 pandemic using large representative samples in two countries, and termed it the Complex Stress Reaction Syndrome (CSRS). In the current international study, in four continents, using six languages we aimed to investigate the generalization of the CSRS and its sensitivity to populations at risk.

Research objectives

We aimed to investigate CSRS, Type A [psychiatric symptoms, spanning anxiety, depression, stress symptoms, and post-traumatic stress disorder (PTSD)], with or without long-COVID residuals (CSRS, Type B, neuropsychiatric symptoms spanning cognitive deficits and fatigue, excluding systemic symptoms). Our two-tailed hypothesis was that CSRS is a condition related to an unrecognized type of stress reaction in daily life in the general population (Type A) or that it is related to the severe acute respiratory syndrome coronavirus 2 infection and its long-COVID residuals (Type B).

Research methods

Media-supported study using the Qualtrics platform.

Research results

The results of the Proportion Analyses showed that the prevalence of 4 symptoms spanning anxiety, depression, stress symptoms, and PTSD was significantly higher than the most prevalent combinations of fewer symptoms across 4 continents, age groups, and gender (CSRS, Type A). Further analyses identified two populations at risk: (1) Individuals that self-identified as non-binary gender; and (2) Women at young ages (< 40 years old) in North America.

Research conclusions

These results show a combined mental health risk factor related to stress reactivity, suggesting that the CSRS is sensitive to populations at risk and may be applied to future identification of other vulnerable sub-populations. It also supports the transdiagnostic approach for more accurate prevention and treatment. Time will tell if such transdiagnostic syndromes will be part of the discussions on the next revisions of the traditional classification systems or whether the crisis in psychiatry further evolves.

Research perspectives

A follow-up international study to investigate whether the condition of multiplicity of stressors is the etiological source for developing the CSRS, Type A clinical status, is warranted.