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Using Metaphors to Understand Suffering in COVID-19 Survivors: A Two Time-Point Observational Follow-Up Study.

  • Palese, Alvisa1
  • Visintini, Erica1
  • Bressan, Valentina1
  • Fonda, Federico1
  • Chiappinotto, Stefania1
  • Grassetti, Luca2
  • Peghin, Maddalena3
  • Tascini, Carlo4
  • Balestrieri, Matteo5
  • Colizzi, Marco5, 6
  • 1 School of Nursing, Department of Medicine (DAME), University of Udine, 33100 Udine, Italy. , (Italy)
  • 2 Department of Economics and Statistics (DIES), University of Udine, 33100 Udine, Italy. , (Italy)
  • 3 Infectious and Tropical Diseases Unit, Department of Medicine and Surgery, University of Insubria-ASST-Sette Laghi, 33100 Varese, Italy. , (Italy)
  • 4 Infectious Diseases Division, Department of Medicine (DAME), University of Udine, 33100 Udine, Italy. , (Italy)
  • 5 Unit of Psychiatry, Department of Medicine (DAME), University of Udine, 33100 Udine, Italy. , (Italy)
  • 6 Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London SE5 8AF, UK.
Published Article
International Journal of Environmental Research and Public Health
Publication Date
Jan 12, 2023
DOI: 10.3390/ijerph20021390
PMID: 36674143


Accumulating evidence indicates that the COVID-19 pandemic carries risks to psychological health and represents a collective traumatic experience with consequences at the social, economic, and health levels. The primary aim of this study was to collect ongoing COVID-19 survivors’ pandemic-related experiences as expressed through the use of metaphors; the secondary aim was to explore socio-demographic variables associated with the metaphor orientation as negative, positive or neutral. An observational follow-up survey was conducted and reported according to the STROBE guidelines. Patients ≥ 18 years, who were treated for COVID-19 during the first wave (March/April 2020) and who were willing to participate in a telephone interview were involved and asked to summarize their COVID-19 experience as lived up to 6 and 12 months in a metaphor. A total of 339 patients participated in the first (6 months) and second (12 months) data collection. Patients were mainly female (51.9%), with an average age of 52.9 years (confidence interval, CI 95% 51.2−54.6). At 6 months, most participants (214; 63.1%) used a negative-oriented metaphor, further increasing at 12 months (266; 78.5%), when they used fewer neutral-/positive-oriented metaphors (p < 0.001). At the 6-month follow-up, only three individual variables (female gender, education, and experiencing symptoms at the COVID-19 onset) were significantly different across the possible metaphor orientation; at 12 months, no individual variables were significantly associated. This study suggests increasingly negative lived experiences over time and the need for personalized healthcare pathways to face the long-term traumatic consequences of COVID-19.

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