Published online Oct 19, 2023. doi: 10.5498/wjp.v13.i10.803
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
The debate regarding diagnostic classification systems in psychiatry (categorial vs dimensional systems) has essential implications for the diagnosis, prevention and treatment of stress reactions.
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.
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).
Media-supported study using the Qualtrics platform.
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.
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.
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.