Events in our lives can determine our health. Trauma or stressful experiences such as the ones covid-19 is dealing with not only affect us psychologically but can also trigger autoimmune diseases.

Why were US war veterans diagnosed with more autoimmune diseases than other population groups? The direct link between post-traumatic stress disorder and these types of pathologies has been known for years. However, more in-depth studies have determined that the traumatic event may be less extreme but emotionally impactful everyday life experiences and these can increase the likelihood of suffering from a traumatic event by up to 50 percent. autoimmune disease.

In this sense, we as a society are experiencing painful and unexpected developments because of covid-19. The distance from sick or deceased family members, the difficulty of mourning or the threat of contagion itself are not only traumatic situations but they are confronting us with the unknown and represent a cultural change that we are not used to. We do not yet know what side effects the pandemic may have and we will see over the years, but this link between stress and trauma and autoimmune diseases has to be taken into account.

In 2018, the Journal of the American Association published a study conducted in Austria among a population of more than 100,000 people in which family factors were taken into account. The aim of this study was to to assess the relationship between different stress-related disorders and the subsequent onset of autoimmune diseases.

Our immune system responds to the body's signals of distress. Although its function is to maintain our integrity in the face of external aggression or aggression caused to one of our systems, it fails to a greater extent when a person has been subjected to stress levels. Specifically, 41 autoimmune diseases have been identified that are more likely to occur, such as rheumatoid arthritis or coeliac disease.

But what is the relationship between psychic phenomena and physical illness? It has been shown that a psychological disturbance can lead to the inflammatory cytokine production and the development of autoimmune diseases. By controlling inflammation and B-cell activating factor (BAFF), we can prevent the development of autoimmune disease.

On the other hand, stress can also reduce the immune response and reduce the response of lymphocytes or natural killer cells, cause a decrease in IgM and a decrease in the humoral response to immunisation.

The expression of emotions is also a factor that can protect us. There is a statistical link between alexithymia - the inability to express what is happening to us - and diseases such as systemic lupus erythematosus.

How can we break the link between a stressor and autoimmune disease?

One of the most effective preventative measures is the psychiatric treatment following the stressful event. If antidepressants, selective serotonin reuptake inhibitors, are prescribed in the first year after diagnosis, the risk of autoimmune disease is reduced and even lower than in the non-autoimmune population.

At Biosalud Day Hospital, we always carry out a multifactorial diagnosis of autoimmune diseases and we do not forget the psychosomatic approach, which is so important. This orientation helps us to take into account the psychological factor when taking a medical history, as our patients often only associate events that may constitute trauma or stress when we ask the right questions in the consultation.

Lifestyle habits and the support of psychology professionals are also factors in prevention. If we can get a person to maintain emotional stability with support, physical activity and an adequate diet, we can help to prevent the disease.e can prevent diseases or improve the quality of life of patients, reducing inflammatory effects or preventing symptomatological outbreaks.

How does acute stress affect us during a pandemic?

The people who may have suffered the most, or are suffering the most are acute stress, are those who work in health care. The organisation of human and material resources in the work environment or the human factor - the relationship with patients and relatives - or the obligation to make critical decisions quickly are stressors that can evolve from acute stress to post-traumatic stress disorder (PTSD) and other pathologies.

However, this is not the only population at risk. All people who work in close contact with other people and who were in their workplaces even during confinement and therefore more exposed, experience these situations with greater fear.

For the whole population, stressors can range from changes in habits, delays in the end of quarantine, contradictory information, loss of work...

The symptoms of acute stress are divided into different categories:

• The state of mindThe patients are unable to experience pleasurable and positive feelings and emotions and are plunged into a "black cloud" from which there is no way out.
• Intrusion and avoidanceIt is paradoxical, but on the one hand there are intrusive memories of stressful events that cannot be controlled, and on the other hand, we voluntarily want to avoid thinking about or coming into contact with the places and people with whom we have experienced those events.
• Alert: acute stress puts us in a state of alertness that leads to sleep disturbances, hypervigilance, concentration problems or irritability.
• Dissociation: A person with this disorder may even have an altered sense of reality and not remember or recognise aspects of themselves or the event they have experienced.

The differences between acute stress disorder and post-traumatic stress disorder are that, in the first case, the concurrence of all the symptoms is not necessary for its diagnosis and it can appear between the third day and the month after the event. Moreover, there is no single cause that triggers the events. Risk factors for both disorders include:

• The additional stress we suffer for other reasons, something that has happened as a result of the pandemic (e.g., being at work and bereavement in conditions of confinement).
• The duration of the event, as has been the case for health workers on a day-to-day basis.
• Preconditions such as childhood trauma or gender - women are more likely to develop these pathologies.
• Social, emotional or professional support after the experience of the event, which is essential to place ourselves in the "here and now" in a healthy way.

As mentioned above, it is important to act early at the psychiatric and psychological level to prevent these symptoms from having consequences for the body and, in particular, for autoimmune diseases in the future.