{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T04:46:12Z","timestamp":1787028372029,"version":"build-2736575974"},"reference-count":48,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2024,11,6]],"date-time":"2024-11-06T00:00:00Z","timestamp":1730851200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Tuscany Region, Bando COVID-19"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Background: The present work aimed to estimate the economic impact of PTSD following COVID-19 in a population of patients affected by systemic autoimmune disease (SAD) using a cost-of-illness approach and accounting for the perspective of society. Methods: Considering data collected from SAD patients enrolled in a specialized outpatient clinic in the Tuscany region, Italy, generalized linear models and LASSO logistic regression were used to evaluate the impact of PTSD on costs and its relevance as a possible predictor of being a high-cost patient, respectively. Results: Considering 301 SAD patients, 161 (51.2%) of whom were diagnosed with PTSD, the overall costs were EUR 3670 [890; 40,529] per patient\/year among patients with PTSD and EUR 2736.7 [283; 21,078] per patient\/year among those without PTSD (p-value &lt; 0.001), with differences mainly attributable to significantly greater direct non-healthcare and indirect costs. PTSD was estimated to increase overall costs (\u03b2 = 0.296 (0.140), p-value = 0.035), direct non-healthcare (\u03b2 = 1.193 (0.392), p-value = 0.002), and indirect costs (\u03b2 = 3.741 (1.136), p-value = 0.001). PTSD diagnosis was also significantly associated with the likelihood of being a high-cost patient. Conclusions: Findings from the present study offer a novel perspective on the economic impact of COVID-19 and provide valuable data for policymakers to better understand the demand for healthcare services and associated costs.<\/jats:p>","DOI":"10.3390\/ijerph21111476","type":"journal-article","created":{"date-parts":[[2024,11,6]],"date-time":"2024-11-06T06:27:39Z","timestamp":1730874459000},"page":"1476","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["The Economic Impact of Post-Traumatic Stress Disorder Among Patients with Systemic Autoimmune Diseases During the COVID-19 Pandemic"],"prefix":"10.3390","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9948-0301","authenticated-orcid":false,"given":"Valentina","family":"Lorenzoni","sequence":"first","affiliation":[{"name":"Intitute of Management, Scuola Superiore Sant\u2019Anna, 56127 Pisa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1735-211X","authenticated-orcid":false,"given":"Gianni","family":"Andreozzi","sequence":"additional","affiliation":[{"name":"Intitute of Management, Scuola Superiore Sant\u2019Anna, 56127 Pisa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9420-4105","authenticated-orcid":false,"given":"Ilaria","family":"Palla","sequence":"additional","affiliation":[{"name":"Intitute of Management, Scuola Superiore Sant\u2019Anna, 56127 Pisa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chiara","family":"Tani","sequence":"additional","affiliation":[{"name":"Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claudia","family":"Carmassi","sequence":"additional","affiliation":[{"name":"Psychiatry Unit, Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0130-4412","authenticated-orcid":false,"given":"Giovanni","family":"Fulvio","sequence":"additional","affiliation":[{"name":"Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesca","family":"Trentin","sequence":"additional","affiliation":[{"name":"Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara","family":"Fantasia","sequence":"additional","affiliation":[{"name":"Psychiatry Unit, Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lorenzo","family":"Conti","sequence":"additional","affiliation":[{"name":"Psychiatry Unit, Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liliana","family":"Dell\u2019Osso","sequence":"additional","affiliation":[{"name":"Psychiatry Unit, Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marta","family":"Mosca","sequence":"additional","affiliation":[{"name":"Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1877-5459","authenticated-orcid":false,"given":"Giuseppe","family":"Turchetti","sequence":"additional","affiliation":[{"name":"Intitute of Management, Scuola Superiore Sant\u2019Anna, 56127 Pisa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,11,6]]},"reference":[{"key":"ref_1","unstructured":"(2023, March 02). World Health Organization: Coronavirus Disease (COVID-19). Available online: https:\/\/www.who.int\/emergencies\/diseases\/novel-coronavirus-2019."},{"key":"ref_2","unstructured":"World Health Organization (2023, March 02). Facing Mental Health Fallout from the Coronavirus Pandemic. Available online: https:\/\/www.who.int\/news-room\/feature-stories\/detail\/facing-mental-health-fallout-from-the-coronavirus-pandemic."},{"key":"ref_3","unstructured":"(2023, March 02). World Health Organization: The Impact of COVID-19 on Mental Health Cannot Be Made Light of. Available online: https:\/\/www.who.int\/news-room\/feature-stories\/detail\/the-impact-of-covid-19-on-mental-health-cannot-be-made-light-of."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Brivio, E., Oliveri, S., Guiddi, P., and Pravettoni, G. (2021). Incidence of PTSD and generalized anxiety symptoms during the first wave of COVID-19 outbreak: An exploratory study of a large sample of the Italian population. BMC Public Health, 21.","DOI":"10.1186\/s12889-021-11168-y"},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Forte, G., Favieri, F., Tambelli, R., and Casagrande, M. (2020). The Enemy Which Sealed the World: Effects of COVID-19 Diffusion on the Psychological State of the Italian Population. J. Clin. Med., 9.","DOI":"10.3390\/jcm9061802"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"797","DOI":"10.1080\/09540261.2022.2145184","article-title":"PTSD trajectories across different mental disorders in the second year of the COVID-19 pandemic in Italy: A naturalistic, longitudinal, multicenter study","volume":"34","author":"Carmassi","year":"2022","journal-title":"Int. Rev. Psychiatry"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"883","DOI":"10.1080\/07420528.2021.1895199","article-title":"Sleep quality mediates the effect of chronotype on resilience in the time of COVID-19","volume":"38","author":"Bazzani","year":"2021","journal-title":"Chronobiol. Int."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1016\/j.sleep.2022.01.002","article-title":"Poor sleep quality and unhealthy lifestyle during the lockdown: An Italian study","volume":"90","author":"Bruno","year":"2022","journal-title":"Sleep Med."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"105951","DOI":"10.1016\/j.appet.2022.105951","article-title":"Late chronotypes, late mealtimes. Chrononutrition and sleep habits during the COVID-19 lockdown in Italy","volume":"172","author":"Bazzani","year":"2022","journal-title":"Appetite"},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Wang, C., Pan, R., Wan, X., Tan, Y., Xu, L., Ho, C.S., and Ho, R.C. (2020). Immediate Psychological Responses and Associated Factors during the Initial Stage of the 2019 Coronavirus Disease (COVID-19) Epidemic among the General Population in China. Int. J. Environ. Res. Public Health, 17.","DOI":"10.3390\/ijerph17051729"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"859","DOI":"10.1136\/annrheumdis-2020-217871","article-title":"Characteristics associated with hospitalization for COVID-19 in people with rheumatic disease: Data from the COVID-19 Global Rheumatology Alliance physician-reported registry","volume":"79","author":"Gianfrancesco","year":"2020","journal-title":"Ann. Rheum. Dis."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"837","DOI":"10.1136\/annrheumdis-2020-217566","article-title":"Clinical course of coronavirus disease 2019 (COVID-19) in a series of 17 patients with systemic lupus erythematosus under long-term treatment with hydroxychloroquine","volume":"79","author":"Mathian","year":"2020","journal-title":"Ann. Rheum. Dis."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Picchianti Diamanti, A., Cattaruzza, M.S., Di Rosa, R., Del Porto, F., Salemi, S., Sorgi, M.L., Martin Martin, L.S., Rai, A., Iacono, D., and Sesti, G. (2020). Psychological Distress in Patients with Autoimmune Arthritis during the COVID-19 Induced Lockdown in Italy. Microorganisms, 8.","DOI":"10.3390\/microorganisms8111818"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"263","DOI":"10.1177\/09612033221145634","article-title":"Post-traumatic stress disorder in patients with systemic lupus erythematosus heavily affects quality of life. A cross-sectional web survey-based study","volume":"32","author":"Moroni","year":"2023","journal-title":"Lupus"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"e074224","DOI":"10.1136\/bmj-2022-074224","article-title":"Comparison of mental health symptoms before and during the COVID-19 pandemic: Evidence from a systematic review and meta-analysis of 134 cohorts","volume":"380","author":"Sun","year":"2023","journal-title":"BMJ"},{"key":"ref_16","first-page":"379","article-title":"Effect of COVID-19 confinement on the mental status of patients with systemic lupus erythematosus","volume":"156","year":"2021","journal-title":"Med. Cl\u00edn. (Engl. Ed.)"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"917","DOI":"10.1007\/s10198-020-01184-x","article-title":"How expensive are post-traumatic stress disorders? Estimating incremental health care and economic costs on anonymised claims data","volume":"21","author":"Bothe","year":"2020","journal-title":"Eur. J. Health Econ."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1016\/j.pulmoe.2020.03.002","article-title":"The COVID-19 outbreak: From \u201cblack swan\u201d to global challenges and opportunities","volume":"26","author":"Mazzoleni","year":"2020","journal-title":"Pulmonology"},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Lu, X., and Lin, Z. (2021). COVID-19, Economic Impact, Mental Health, and Coping Behaviors: A Conceptual Framework and Future Research Directions. Front. Psychol., 12.","DOI":"10.3389\/fpsyg.2021.759974"},{"key":"ref_20","unstructured":"Drummond, M.F., Schulpher, M.J., Claxton, K., Stoddart, G.L., and Torrance, G.W. (2015). Methods for the Economic Evaluation of Health Care Programmes, Oxford University Press."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"143","DOI":"10.2165\/00019053-199814020-00001","article-title":"Cost-of-Illness Studies","volume":"14","author":"Koopmanschap","year":"1998","journal-title":"Pharmacoeconomics"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"S109","DOI":"10.1097\/MLR.0b013e31819c94a1","article-title":"Issues for the Next Generation of Health Care Cost Analyses","volume":"47","author":"Basu","year":"2009","journal-title":"Med. Care"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"485","DOI":"10.1016\/j.comppsych.2008.11.006","article-title":"A multidimensional spectrum approach to post-traumatic stress disorder: Comparison between the Structured Clinical Interview for Trauma and Loss Spectrum (SCI-TALS) and the Self-Report instrument (TALS-SR)","volume":"50","author":"Carmassi","year":"2009","journal-title":"Compr. Psychiatry"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1186\/1745-0179-4-2","article-title":"Validity and reliability of the Structured Clinical Interview for the Trauma and Loss Spectrum (SCI-TALS)","volume":"4","author":"Shear","year":"2008","journal-title":"Clin. Pract. Epidemiol. Ment. Health"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"267","DOI":"10.1016\/j.jad.2019.10.044","article-title":"Post-traumatic stress burden in a sample of hospitalized patients with Bipolar Disorder: Which impact on clinical correlates and suicidal risk?","volume":"262","author":"Carmassi","year":"2020","journal-title":"J. Affect. Disord."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1016\/j.jpsychires.2014.09.006","article-title":"Frequency of trauma exposure and Post-Traumatic Stress Disorder in Italy: Analysis from the World Mental Health Survey Initiative","volume":"59","author":"Carmassi","year":"2014","journal-title":"J. Psychiatr. Res."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1186\/s12991-018-0184-4","article-title":"Exploring PTSD in emergency operators of a major University Hospital in Italy: A preliminary report on the role of gender, age, and education","volume":"17","author":"Carmassi","year":"2018","journal-title":"Ann. Gen. Psychiatry"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"375","DOI":"10.1016\/j.biopsych.2014.03.028","article-title":"Subthreshold Post-traumatic Stress Disorder in the World Health Organization World Mental Health Surveys","volume":"77","author":"McLaughlin","year":"2015","journal-title":"Biol. Psychiatry"},{"key":"ref_29","unstructured":"(2023, March 02). Italian Ministry of Health: Remunerazione Prestazioni di Assistenza Ospedaliera per Acuti, Assistenza Ospedaliera di Riabilitazione e di Lungodegenza Post Acuzie e di Assistenza Specialistica Ambulatoriale, Available online: https:\/\/www.salute.gov.it\/portale\/temi\/p2_6.jsp?id=3662&area=programmazioneSanitariaLea&menu=vuoto."},{"key":"ref_30","unstructured":"Agenzia Italiana del Farmaco (2024). Elenchi Farmaci di Classe A e H."},{"key":"ref_31","unstructured":"(2023, March 02). Eurostat: Statistics. Available online: https:\/\/ec.europa.eu\/eurostat\/databrowser\/view\/earn_nt_net\/default\/table?lang=en%5D.]."},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"McCullagh, P., and Nelder, J. (1989). Generalized Linear Models, Chapman & Hall\/CRC.","DOI":"10.1007\/978-1-4899-3242-6"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1186\/s13561-015-0045-7","article-title":"Statistical models for the analysis of skewed healthcare cost data: A simulation study","volume":"5","author":"Malehi","year":"2015","journal-title":"Health Econ Rev."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"267","DOI":"10.1111\/j.2517-6161.1996.tb02080.x","article-title":"Regression Shrinkage and Selection Via the Lasso","volume":"58","author":"Tibshirani","year":"1996","journal-title":"J. R. Stat. Soc. Ser. B (Methodol.)"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"171","DOI":"10.1111\/j.1755-5949.2008.00049.x","article-title":"Post-Traumatic Stress Disorder in Canada","volume":"14","author":"Mancini","year":"2008","journal-title":"CNS Neurosci. Ther."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"739","DOI":"10.1002\/da.20574","article-title":"Subsyndromal post-traumatic stress disorder is associated with health and psychosocial difficulties in veterans of Operations Enduring Freedom and Iraqi Freedom","volume":"26","author":"Pietrzak","year":"2009","journal-title":"Depress. Anxiety"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1186\/s13561-020-00281-0","article-title":"Hospital costs associated with post-traumatic stress disorder in somatic patients: A retrospective study","volume":"10","author":"Hehn","year":"2020","journal-title":"Health Econ Rev."},{"key":"ref_38","doi-asserted-by":"crossref","unstructured":"Pak, A., Adegboye, O.A., Adekunle, A.I., Rahman, K.M., McBryde, E.S., and Eisen, D.P. (2020). Economic Consequences of the COVID-19 Outbreak: The Need for Epidemic Preparedness. Front. Public Health, 8.","DOI":"10.3389\/fpubh.2020.00241"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"101734","DOI":"10.1016\/j.seps.2023.101734","article-title":"Should I have closed? A multiplex network approach for the short-term economic effect of COVID-19 containment measures in the EU","volume":"90","author":"Ceriotti","year":"2023","journal-title":"Socioecon. Plann Sci."},{"key":"ref_40","doi-asserted-by":"crossref","unstructured":"Wa\u0144kowicz, P., Szyli\u0144ska, A., and Rotter, I. (2020). Evaluation of Mental Health Factors among People with Systemic Lupus Erythematosus during the SARS-CoV-2 Pandemic. J. Clin. Med., 9.","DOI":"10.3390\/jcm9092872"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"191","DOI":"10.1002\/jts.22008","article-title":"The Economic Burden of PTSD in Northern Ireland","volume":"28","author":"Ferry","year":"2015","journal-title":"J. Trauma. Stress."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"21m14116","DOI":"10.4088\/JCP.21m14116","article-title":"The Economic Burden of Post-traumatic Stress Disorder in the United States from a Societal Perspective","volume":"83","author":"Davis","year":"2022","journal-title":"J. Clin. Psychiatry"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"rkaa072","DOI":"10.1093\/rap\/rkaa072","article-title":"The impact of the COVID-19 pandemic on the medical care and health-care behaviour of patients with lupus and other systemic autoimmune diseases: A mixed methods longitudinal study","volume":"5","author":"Sloan","year":"2021","journal-title":"Rheumatol. Adv. Pract."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"S463","DOI":"10.1192\/j.eurpsy.2023.993","article-title":"Social stigma of people with mental disorders and attitude to psychiatric treatment in Polish society","volume":"66","author":"Burdzik","year":"2023","journal-title":"Eur. Psychiatry"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"356","DOI":"10.1177\/1524838020946800","article-title":"Social Functioning in Individuals With Post-Traumatic Stress Disorder: A Systematic Review","volume":"23","author":"Scoglio","year":"2022","journal-title":"Trauma Violence Abuse"},{"key":"ref_46","first-page":"275","article-title":"Analysis of the Challenges Faced by the Families of Veterans with Post-Traumatic Stress Disorder: A Qualitative Study","volume":"5","author":"GoliGarmkhani","year":"2024","journal-title":"Appl. Fam. Ther. J."},{"key":"ref_47","first-page":"35","article-title":"Health Behavior Change in Post-Traumatic Stress Disorder: Patient Perspectives","volume":"2","author":"Shen","year":"2024","journal-title":"J. Pers. Psychosom. Res. (JPPR)"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"1041","DOI":"10.1089\/jwh.2023.0078","article-title":"Psychosocial and Economic Impacts of the COVID-19 Pandemic on the Mental Health of Veteran Men and Women","volume":"32","author":"Fox","year":"2023","journal-title":"J. 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