Traumatic Distress and Protective Factors Among COVID-19 Survivors in Wuhan, China: An Exploration through Social Workers' Accounts

Background and Purpose: One year after the clearance of new infection cases in Wuhan, the first epicenter of the COVID-19 epidemic, 46, 471 COVID-19 survivors still live in the shadow of the pandemic. While previous literature has provided timely evidence on the existence and prevalence of traumatic distress among COVID-19 survivors, there is a lack of in-depth qualitative exploration on the nature and typology of traumatic distress, as well as a need for research focusing on the protective factors that could help COVID-19 survivors make life adjustments and overcome the aftermath of COVID-19. This study attempts to fill the gap in research through the accounts of social work service providers, making COVID-19 survivors’ voices and stories heard. Further, these accounts may strengthen our knowledge and ability to develop evidence-based and trauma-informed care for COVID-19-affected communities worldwide.

Methods: Fourteen social work service providers (age 23 to 38) who directly served COVID-19 survivors in Wuhan were recruited using the purposive sampling method to participate in semi-structured interviews. Most participants were female (n = 11; 78.6%) and in their 20s (n = 9; 64.2%). On average, participants had more than 3 years of working experience as social workers (M = 3.2, SD = 1.8) and more than half-year experience serving COVID-19 survivors (M = 6.3, SD = 2.6). The interview outline consisted of three sections of open-ended items probing into different aspects of participants’ observations and experiences during their services to COVID-19 survivors: survivors’ experiences and support systems, participants’ subjective experiences, and participants’ reflection on the service system. Interview transcripts were transcribed verbatim and collaboratively coded by team members with an inductive thematic analysis approach. Based on the codebook generated from the coding process, the team sorted three major themes and seven sub-themes.

Results: Firstly, participants commonly observed and mentioned COVID-19 survivors’ physical and psychological traumatic distress directly associated with the infection incident. For example, physical sequelae and its consequent medical and financial distress leading to an alternation of their life attitudes and choices of life; some behavioral and emotional features of the survivors were psychologically rooted, such as over-protection behaviors implied the fear of reinfection. Secondly, post-recovery traumatic experiences posed as adverse ecological (e.g., family-level and community-level) stressors holding COVID-19 survivors back from returning to normal life. For example, some survivors developed a sense of self-inferiority due to consistent exposure to micro-aggressive or discriminative actions. Thirdly, personal characteristics (e.g., age, personality, life history) and external factors (e.g., time, social support) served as protective factors for COVID-19 survivors to combat traumatic distress.

Conclusions and Implications: Findings unfold substantial demands for post-traumatic social work services to COVID-19 survivors, calling for social workers’ attention on strengthening the community-level system of trauma-informed practice for COVID-19-affected communities around the world. This study also enlightens the necessity of conducting follow-up research to focus on the challenges social workers have experienced, such as secondary traumatic stress.