PERITRAUMATIC TONIC IMMOBILITY RESPONSE IS ASSOCIATED WITH INCREASE

OF PTSD SYMPTOMS IN HEALTHCARE PROFESSIONALS AFTER SIX MONTHS: THE

LONGITUDINAL CONSEQUENCES OF THE COVID-19 PANDEMIC

Sérgio José de Souza Junior, Camila Monteiro Fabricio Gama, Thayssa Guerra, Leticia de Oliveira, Mirtes Garcia Pereira
Universidade Federal Fluminense-UFF

Introduction: Professionals who worked in combating the pandemic have been particularly Results
subject to dealing with traumatic events involving death or the risk of death, not only of
people close to them but also of patients and work colleagues. One possible mental health Probable Probable PTSD
consequence of exposure to traumatic events is the development of the Post Traumatic TI response PTSD diagnosis diagnosis by TI level
Stress Disorder (PTSD). One factor that can influence the development of this disorder is Extreme
the peritraumatic tonic immobility response. 17% With
77 % Extreme
With TI 29%
Objective: To investigate the long-term predictive factor of the tonic immobility response, 40%
resulting from traumatic events experienced during the COVID-19 pandemic, in the mental
health of professionals working in hospital environments during the pandemic. 46 % Significant
This project is part of the second wave of a longitudinal study called
PSICOVIDA. (CONEP 4.063.653). The study involves collaboration between the
Universities: UFF, UFRJ, UNIRIO, UERJ and UFOP. Significant 19 % Without
23%
Without Without
60% 71%
Methodology:
Waves: Statistical analyses
1ª - 12 /06/ 2020 - 19 /09/ 2020
Negative binomial regression - Hierarchical
The snowball sampling technique was used to collect data during the first wave (Gama et
PCL t2 IRR Std. Err. z 95 % CI p-value
al., 2022). Participants in the first wave were invited to leave their e-mail addresses to
participate in the second wave of the study.
2ª.- 26 /02/ 2021 – 17 /06/ 2021 TIS T1- Not adjusted 1.037 .003 7.82 (0,028-0,046) 0.000
After six months, e-mails were sent with the invitation and an individual link to the online
research platform (Google Forms). Adjusted for age and
gender 1.036 .005 8.05 (1.027-1.045) 0.000
Participants
N:233, mean age 40.33 years (SD = 10.5, 20-66 years), predominantly Rio de Janeiro Adjusted for age, gender
(66%) and mostly women (n = 192, 82.4%). Multivariate logistic regression
1.013 .005 2.94 (1.004-1.023)
and PCL t1 0.003
Instruments PCL t2 OR Std. Err. z 95 % CI p-value
We collected sociodemographic information, a questionnaire about traumatic events
related to the COVID-19 pandemic, and Psychometric scales translated and validated for
Brazilian people measuring PTSD symptoms and the tonic immobility response. Adjusted for age and
Psychometric scales Gender
1- Tonic Immobility Scale (TIS) (Fusé et al., 2007; Reichenheim et al., 2014) Significant TI 3.46 1.25 3.44 (1.70-7.02) 0.001
• 6 items, 7-point Likert scale, ranging from 0 to 6 Extreme TI 15.50 6.96 6.11 (6.43-37.37) 0,000
• Significant TI: above the midpoint and extreme TI above the upper third of the scale Adjusted for age, gender
range (Fusé et al., 2007; Heidt et al., 2005; Gama et al., 2022). and PCL t1
2- Posttraumatic Stress Disorder Scale (PTSD) Checklist 5 (PCL-5) (Weathers et al., Significant TI 2.24 0.91 1.99 (1.01-4.99) 0.047
2013; Lima et al., 2016) Extreme TI 7.47 3.75 4.01 (2.79-19.95) 0.000
• 20 items, 5-point Likert scale, ranging from 0 to 4 Discussion: Our findings indicate that having a significant TI response and an extreme TI
• Suggested cut-off point for a possible diagnosis of PTSD: 36 or more (Pereira-Lima et response increase the chances of having high PTSD scores 6–12 months later. The
al., 2019). increments in the chance of having a probable PTSD diagnosis were 2.24 and 7.47 times,
respectively. This result confirms the predictive role of this response for the
1001 development/severity of mental disorders in the long term. Other studies from our group have
health professionals in the first wave already reported an association between tonic immobility and PTSD severity and poor
prognosis (Fiszman et al., 2008; Kalaf et al., 2015; Portugal et al., 2012; Rocha-Rego et al.,
2009; Volchan et al., 2017; Gama et al., 2022). However, this is the first study to explore the
476 525 long-term effect of this peritraumatic response for traumas related to the COVID-19 pandemic.
did not volunteer second wave volunteered for the second wave

265
did not respond to the second wave
Exclusions due to filling errors (n=22) and no
traumatic events related to covid-19 in the second
wave (n=5)
References:
FISZMAN A et al. Peritraumatic Tonic Immobility Predicts A Poor Response To Pharmacological Treatment In Victims
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responded to the KALAF J., et al. Peritraumatic Tonic Immobility In A Large Representative Sample Of The General Population:
Association With Posttraumatic Stress Disorder And Female Gender. Compr Psychiatry. 60: 68–72, 2015.
second wave PORTUGAL, L. C. L., et al (2012). Peritraumatic tonic immobility is associated with posttraumatic stress symptoms in
undergraduate Brazilian students. Revista Brasileira de Psiquiatria, 34(1), 60–65.
ROCHA-REGO, V. et al. Is Tonic Immobility The Core Sign Among Conventional Peritraumatic Signs And Symptoms
Listed For Ptsd? Journal Of Affective Disorders, V. 115, P. 269-273, 2009
233 VOLCHAN E et al. Immobility Reactions Under Threat: A Contribution To Human Defensive Cascade And Ptsd.; 76:
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