Abstract
Objective: The COVID-19 pandemic had a profound impact on millions of people, affecting their biological, psychological, and social well-being. The biological effects of SARS-CoV-2 have reportedly been linked to cognitive, emotional, and behavioral symptoms. Traumatic experiences associated with the disease and treatment procedures are regarded as potential risk factors for the emergence of posttraumatic stress symptoms (PTSS); as a result, the severity of the disease and the experience of hospitalization can significantly influence the mental well-being of individuals who have contracted COVID-19. This study aims to assess the factors that influence the development of PTSS among individuals who have recovered from COVID-19.
Method: Sociodemographic features, hospitalization status, and physical symptoms of COVID-19 were assessed and PTSS, alexithymia, perceived social support, anxiety, and depression were examined with validated self-report questionnaires (Impacts of Events Scale-Revised, Toronto Alexithymia Scale-20, The Multidimensional Scale of Perceived Social Support, Hospital Anxiety and Depression Scale) in a sample with 105 inpatients and 107 outpatients.
Results: PTSS and depression scores of inpatients and outpatients were not significantly different (t(210)=1.246, p=0.214, and t(210)=-0.493, p=0.623, respectively), however, anxiety scores of outpatients were higher (t(209.880)=-2.938, p=0.004). Hospitalization did not significantly affect avoidance and hyperarousal symptoms but was associated with increased intrusion symptoms (t(210)=2.095, p=0.037).
In a hierarchical regression model, predictors of PTSS were identified; in step 3 sleep disturbance and initial loss of smell and taste were significant factors (β=0.282, p<0.010; β=0.163, p=0.019, respectively). In step 4, the effects of depression, anxiety, and alexithymia were superior to all other variables (β=0.211, β=0.318, β=0.261, respectively, p<0.010) and initial loss of smell and taste and sleep disturbance did not remain significant in the final model. The final results indicated that psychological assessments made a distinctive contribution to the overall variation in Impacts of Events Scale-Revised scores, extending beyond demographic characteristics, individual variations, and COVID-19 symptoms. Additionally, social support had an indirect impact on PTSS, which was mediated by anxiety, depression, and alexithymia (total bunstd=-0.446, S.E.boot=0.057, CIboot 95% (-0.563, -0.338)). The direct effect of social support on PTSS was non-significant (cunstd=-0.004, S.E.=0.072, CI 95% (-0.146, 0.137)).
Conclusion: This study contributes to the literature about the worldwide effects of COVID-19 on mental trauma by establishing the possible predictors for PTSS; and highlights the importance of reflecting on the COVID-19 history of patients and providing appropriate support.

Key words: Anxiety, Depression, Hospitalization, Mental Health, SARS-CoV-2