Trauma-spectrum symptoms among the Italian general population in the time of the COVID-19 outbreak

Figures & data

Table 1. Sample characteristics

	No./Median (%/IQR)
Age	38 (23)
Gender
Women	14,448 (79.61)
Men	3699 (20.38)
Education
≤Undergraduate	8682 (47.84)
≥Graduate	7795 (42.95)
Lower education	1670 (9.20)
Occupation
Housemaker	1155 (6.36)
Unemployed	2127 (11.72)
Employed	10,984 (60.53)
Retired	293 (1.61)
Student	3588 (19.77)
Region
North	7991 (44.03)
Centre	4695 (25.87)
South	5175 (28.52)
Missing	286 (1.58)
Lockdown/quarantine
Lockdown	17,486 (96.36)
Quarantine	148 (0.8)
Missing	513 (2.83)
Working activity change
As usual	2349 (12.94)
^aSmart-working	6804 (37.49)
Discontinued	7601 (41.89)
More than usual	672 (3.7)
Missing	721 (3.97)
Loved one’s status
Not infected, deceased or Hospitalized	16,576 (91.34%)
Infected	801 (4.41)
Deceased	254 (1.4)
Hospitalized	428 (2.36)
Missing	88 (0.48)
GPS-Risk/Protective Items
Other stressful life events	9325 (51.39)
Poor Social Support	6949 (38.29)
Early adverse life events	8637 (47.59)
History of mental illness	5114 (28.18)
Poor Resilience	3761 (20.73)

^asmart working refers to working online from home.

Figure 1. Percentage of endorsement of GPS-Sym items

Table 2. Exploratory factor analysis

Factor	Eigenvalue	Difference	Proportion	Cumulative
Factor1	5.401	3.582	0.443	0.443
Factor2	1.818	1.166	0.149	0.592
Factor3	0.652	−0.201	0.054	0.646
Factor4	0.853	−0.083	0.070	0.716
Factor5	0.936	0.280	0.077	0.792
Factor6	0.656	−0.042	0.054	0.846
Factor7	0.698	0.030	0.057	0.903
Factor8	0.668	0.367	0.055	0.958
Factor9	0.302	0.095	0.025	0.983
Factor10	0.207	.	0.017	1.000

Table 3. Factor loadings, promax rotated

Variable		Factor 1	Factor 2	Uniqueness
GPS02	Avoidance	0.8233		0.4604
GPS01	Re-experiencing	0.8038		0.4487
GPS08	Anxiety	0.7333		0.2411
GPS03	Hyperarousal	0.6805		0.6319
GPS09	Worry	0.6058		0.3579
GPS10	Depressed mood	0.5095		0.2957
GPS12	Insomnia	0.484		0.6271
GPS05	Guilt	0.3281		0.7296
GPS13	Self-harm		0.8866	0.3456
GPS04	Numbing		0.6019	0.7183
GPS11	Anhedonia		0.5425	0.5347
GPS06	Worthlessness		0.5212	0.5822
GPS15	Depersonalization		0.4825	0.7098
GPS16	Other problems		0.4666	0.6073
GPS18	Substance Abuse		0.4523	0.7098
GPS07	Anger		0.4415	0.5636
GPS14	Derealization		0.3379	0.7644
Cronbach’s Alpha		0.76	0.66
Avg. Interitem Corr		0.06	0.03

Table 4. Confirmatory factor analysis fit indices

Fit statistic	1-factor model	two-factor model	three-factor model
χ^2	χ^2(119) = 2537.5	χ^2(118) = 2343.91	χ^2(116) = 1725.5
RMSEA [90%CI]	0.048 [0.046, 0.049]	0.046 [0.044, 0.048]	0.040 [0.038, 0.041]
CFI	0.769	0.788	0.847
TLI	0.736	0.755	0.820
SRMR	0.082	0.075	0.070
CD	0.857	0.893	0.944

χ²difference test, model 1 vs model 2: χ²₍₁₎ = 193.6, p < 0.001.

χ²difference test, model 1 vs model 3: χ²₍₃₎ = 812, p < 0.001.

χ²difference test, model 2 vs model 3: χ²₍₂₎ = 618.4 p < 0.001.

Table 5. Pairwise correlations

	three-factor model
	PTSS	Negative Affect	Dissociation	GPS-Sym
PHQ-9	0.39	0.77	0.39	0.76
GAD-7	0.50	0.76	0.38	0.78
ISI	0.37	0.58	0.27	0.59
PSS	0.46	0.74	0.33	0.74

PTSS: Post-Traumatic symptoms; Global Psychotrauma Scale – total symptom score; PHQ-9: Patient Health Questionnaire; GAD-7: Generalized Anxiety Disorder Questionnaire; ISI: Insomnia Severity Index; PSS: Perceived Stress Scale.

Table 6. Raw and averaged scores of the GPS factors

	Raw scores			Averaged Scores
Variable	Mean	SD	Range	Mean	SD	Range
Negative Affect	5.15	2.83	0–12	0.43	0.23	0–1
PTSS	1.47	1.13	0–3	0.49	0.37	0–1
Dissociation	0.57	0.66	0–2	0.28	0.33	0–1
GPS-sym	7.19	3.83	0–17	0.42	0.22	0–1
GPS-Tot	9.06	4.5	0–22	0.41	0.20	0–1

Table 7. Demographic and risk/protective factors as predictors of GPS scores (N = 17,231)

Variable	PTSS^a b [95% CI]	Negative affect^a b [95% CI]	Dissociation^a b [95% CI]	GPS-Sym^b b [95% CI]
Any Stressful Event Due To COVID-19	0.13*** [0.10,0.16]	0.22*** [0.19,0.24]	0.12*** [0.09,0.15]	0.85*** [0.74,0.95]
Working Activity change due to COVID-19
As Usual	ref
Smart Working ^c	0.06* [0.01,0.11]	0.08*** [0.03,0.12]	0.05 [−0.01,0.10]	0.28*** [0.12,0.44]
Discontinued	0.08*** [0.03,0.13]	0.10*** [0.06,0.14]	−0.01 [−0.05,0.04]	0.33*** [0.17,0.48]
More Than Usual	0.21*** [0.12,0.30]	0.11* [0.02,0.19]	0.09 [−0.01,0.18]	0.55*** [0.23,0.86]
Loved One Involved w/COVID-19
Not infected/deceased/hospitalize	ref
Infected	0.08* [0.01,0.15]	0.03 [−0.03,0.10]	0.05 [−0.03,0.12]	0.24 [−0.01,0.48]
Deceased	0.25*** [0.13,0.38]	0.16** [0.05,0.27]	0.08 [−0.05,0.21]	0.82*** [0.40,1.24]
Hospitalized	0.16** [0.06,0.26]	0.02 [−0.07,0.10]	−0.01 [−0.10,0.09]	0.22 [−0.11,0.55]
Lockdown Status
Lockdown	ref
Quarantine	0.20* [0.04,0.37]	0.26*** [0.11,0.41]	−0.06 [−0.23,0.11]	0.91** [0.35,1.48]
Hospitalized	−0.31 [−1.24,0.63]	0.17 [−0.67,1.00]	0.39 [−0.56,1.34]	0.48 [−2.42,3.38]
Age (Reversed)	0.04*** [0.02,0.06]	0.22*** [0.20,0.23]	0.05*** [0.03,0.07]	0.69*** [0.63,0.76]
Female	0.39*** [0.36,0.43]	0.26*** [0.23,0.29]	0.20*** [0.17,0.24]	1.33*** [1.20,1.45]
Region
North	ref
Centre	−0.02 [−0.06,0.01]	−0.03 [−0.06,0.01]	−0.03 [−0.07,0.00]	−0.11 [−0.24,0.01]
South	0.17*** [0.14,0.21]	0.07*** [0.04,0.10]	0.05** [0.02,0.09]	0.42*** [0.30,0.54]
Education
≥Graduate	ref
Undergraduate	0.05** [0.02,0.08]	0.05** [0.02,0.07]	0.11*** [0.08,0.15]	0.27*** [0.16,0.38]
Lower Education	0.06* [0.00,0.11]	0.07** [0.02,0.12]	0.17*** [0.11,0.23]	0.43*** [0.24,0.62]
In A Relationship	0.11*** [0.08,0.14]	0 [−0.03,0.03]	−0.04* [−0.08,-0.01]	0.11 [−0.00,0.22]
Occupation
Employed	ref
Housemaker	0.15*** [0.08,0.21]	0.10*** [0.04,0.16]	−0.03 [−0.10,0.04]	0.46*** [0.24,0.69]
Unemployed	0 [−0.05,0.05]	0.07** [0.03,0.12]	0.02 [−0.03,0.07]	0.24** [0.07,0.41]
Retired	−0.09 [−0.23,0.05]	0.06 [−0.07,0.18]	−0.08 [−0.21,0.06]	0.01 [−0.41,0.44]
Student	−0.15*** [−0.20,-0.10]	0.04* [0.00,0.09]	−0.05 [−0.10,0.00]	−0.07 [−0.24,0.09]
GPS-RP	0.14*** [0.13,0.15]	0.30*** [0.29,0.31]	0.15*** [0.13,0.16]	1.10*** [1.06,1.14]

^aseemingly unrelated regression, the three dependent variables are jointly modelled; ^b multiple linear regression model. PTSS: Post-Traumatic Stress Symptoms; GPS-Sym: Global Psychotrauma Scale – total symptom score. * p < 0.05; **p < 0.01; ***p < 0.001. c: smart working refers to working online from home.

Data availability statement

The data that support the findings of this study are available on request from the corresponding author, GDL. The data are not publicly available due to privacy restrictions, as they contain information that could compromise the privacy of research participants.