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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
Processing time: 154 Days and 16.6 Hours
BACKGROUND
The Coronavirus disease 19 (COVID-19)-related psychiatric burden partly results from prolonged social stress world-wide. Studies have examined the psychiatric impact of COVID-19 on Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM 5) and International Classification of Diseases 11th Revision (ICD-11) categories, implicating multiple diagnoses, complicating clinical management.
AIM
To verify whether COVID-19-related psychopathology spans multiple DSM-5 and ICD-11 diagnoses, but not in a random pattern. Consequently, empirical analysis of the multiple associated symptoms will better describe COVID-19-related psychopathology.
METHODS
We conducted a bi-national study during the first surge of the pandemic: an Italian sample (n = 21217, studied March-April 2020); and three representative longitudinal samples from Israel (n = 1276, 1189, and 1432 respectively, studied May-July 2020). Data in Italy were collected by a national internet-based survey with an initially approached sample of about one million persons and in Israel by the Israeli Central Bureau of Statistics using probability-based national representative sampling. Data analysis focused on the frequency and patterns of reported multiple mental health symptoms.
RESULTS
Combinations with all symptoms were more prevalent than combinations with fewer symptoms, with no majorities-minorities differences in both countries, demonstrating the generalizability of the transdiagnostic pattern of mental health issues in both nations. A history of previous mental disorder (Italian study) and an increase in symptom prevalence over time (Israel study) were associated with an increased number of symptoms. Conclusions: Based on finding correlated symptom diversity spanning conventional diagnostic categories, we suggest that the pattern of mental health issues associated with the COVID-19 pandemic is transdiagnostic.
CONCLUSION
The findings have implications for improving prevention and treatment of COVID-19 related psychopathology and for post-pandemic times in conditions resulting from multiplicity of stressors with mixed symptomatology in the clinical picture.
Core Tip: The unique clinical picture that characterizes the reaction to the pandemic as shown in our findings may raise broader thoughts on diagnostic considerations regarding a new category beyond pandemic mental health symptomatology. This suggested category as outlined in our recently published review in the World Journal of Psychiatry may involve transdiagnostic criteria resulting from multiplicity of stressors. This type of condition may be apparent in the post-coronavirus disease (COVID) era although not recognized to date. Our findings showing this type of complex transdiagnostic symptomatology in two countries indicate a need for a new understanding of the COVID-19 pandemic’s psychopathological consequences in the post-COVID era.
