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Li D, Zhang X, Lu Y, Jing L, Hu H, Song Y, Wu S, Zhu W. Post-sepsis psychiatric disorder: Pathophysiology, prevention, and treatment. Neurol Sci 2024; 45:3093-3105. [PMID: 38381393 PMCID: PMC11176234 DOI: 10.1007/s10072-024-07409-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 02/14/2024] [Indexed: 02/22/2024]
Abstract
Post-sepsis psychiatric disorder, encompassing anxiety, depression, post-traumatic stress disorder and delirium, is a highly prevalent complication secondary to sepsis, resulting in a marked increase in long-term mortality among affected patients. Regrettably, psychiatric impairment associated with sepsis is frequently disregarded by clinicians. This review aims to summarize recent advancements in the understanding of the pathophysiology, prevention, and treatment of post-sepsis mental disorder, including coronavirus disease 2019-related psychiatric impairment. The pathophysiology of post-sepsis psychiatric disorder is complex and is known to involve blood-brain barrier disruption, overactivation of the hypothalamic-pituitary-adrenal axis, neuroinflammation, oxidative stress, neurotransmitter dysfunction, programmed cell death, and impaired neuroplasticity. No unified diagnostic criteria for this disorder are currently available; however, screening scales are often applied in its assessment. Modifiable risk factors for psychiatric impairment post-sepsis include the number of experienced traumatic memories, the length of ICU stay, level of albumin, the use of vasopressors or inotropes, daily activity function after sepsis, and the cumulative dose of dobutamine. To contribute to the prevention of post-sepsis psychiatric disorder, it may be beneficial to implement targeted interventions for these modifiable risk factors. Specific therapies for this condition remain scarce. Nevertheless, non-pharmacological approaches, such as comprehensive nursing care, may provide a promising avenue for treating psychiatric disorder following sepsis. In addition, although several therapeutic drugs have shown preliminary efficacy in animal models, further confirmation of their potential is required through follow-up clinical studies.
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Affiliation(s)
- Dayong Li
- Department of Emergency Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Department of Intensive Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Ave, Wuhan, 430030, Hubei, China
| | - Xujie Zhang
- Department of Intensive Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Ave, Wuhan, 430030, Hubei, China
| | - Yuru Lu
- Department of Emergency Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Department of Intensive Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Ave, Wuhan, 430030, Hubei, China
| | - Liang Jing
- Department of Emergency Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Department of Intensive Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Ave, Wuhan, 430030, Hubei, China
| | - Hongjie Hu
- Department of Emergency Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Department of Intensive Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Ave, Wuhan, 430030, Hubei, China
| | - Yaqin Song
- Department of Emergency Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Department of Intensive Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Ave, Wuhan, 430030, Hubei, China
| | - Shuhui Wu
- Department of Emergency Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Department of Intensive Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Ave, Wuhan, 430030, Hubei, China
| | - Wei Zhu
- Department of Emergency Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
- Department of Intensive Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Ave, Wuhan, 430030, Hubei, China.
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Zhang F, Xu H, Liu Q, Sun Y, Yan W, Ouyang H, Liu W. Single session of interpretation bias modification helped to improve fear of COVID-19 and COVID-19-related post-traumatic stress symptoms. BMJ MENTAL HEALTH 2024; 27:e300871. [PMID: 38302409 PMCID: PMC10836354 DOI: 10.1136/bmjment-2023-300871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 12/14/2023] [Indexed: 02/03/2024]
Abstract
BACKGROUND Post-traumatic stress symptoms (PTSS) are frequently observed in those who have experienced trauma events like the COVID-19 outbreak. The cognitive model of PTSS highlights the relationship between PTSS and negative interpretation bias. OBJECTIVE The present study aimed to modify interpretation bias and to improve PTSS as well as PTSS-related fear. METHODS 59 participants with high PTSS levels were recruited and randomly allocated to either the interpretation modification programme (IMP) intervention group or the interpretation control condition (ICC) control group. PTSS, negative interpretation bias, fear of COVID-19, and depression and anxiety symptoms were assessed before and after training. FINDINGS Intention-to-treat analyses showed that compared with ICC, participants receiving IMP generated fewer negative interpretations for ambiguous scenarios, and the group-by-time interaction effect was significant. IMP also illustrated a more significant change in fear after training compared with ICC. Although no effects of training conditions were found on PTSS, the interaction of training conditions with fear reduction could predict PTSS improvement. CONCLUSIONS IMP could improve negative interpretations and fear related to COVID-19 and might help to ameliorate PTSS. CLINICAL IMPLICATIONS The role of PTSS-related emotion should be considered when exploring the effectiveness of IMP. IMP is a flexible approach that can be tailored to the specific characteristics of the traumatic event, which makes it suitable for a broader range of traumatised individuals.
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Affiliation(s)
- Fan Zhang
- Lab for Post-traumatic Stress Disorder, Faculty of Psychology, Naval Medical University, Shanghai, People's Republic of China
- The Emotion & Cognition Lab, Faculty of Psychology, Naval Medical University, Shanghai, People's Republic of China
| | - Huijing Xu
- Faculty of Psychology, Naval Medical University, Shanghai, People's Republic of China
| | - Qian Liu
- Faculty of Psychology, Naval Medical University, Shanghai, People's Republic of China
| | - Yingchao Sun
- Faculty of Psychology, Naval Medical University, Shanghai, People's Republic of China
| | - Wenjie Yan
- Lab for Post-traumatic Stress Disorder, Faculty of Psychology, Naval Medical University, Shanghai, People's Republic of China
- The Emotion & Cognition Lab, Faculty of Psychology, Naval Medical University, Shanghai, People's Republic of China
| | - Hui Ouyang
- Lab for Post-traumatic Stress Disorder, Faculty of Psychology, Naval Medical University, Shanghai, People's Republic of China
- The Emotion & Cognition Lab, Faculty of Psychology, Naval Medical University, Shanghai, People's Republic of China
| | - Weizhi Liu
- Lab for Post-traumatic Stress Disorder, Faculty of Psychology, Naval Medical University, Shanghai, People's Republic of China
- The Emotion & Cognition Lab, Faculty of Psychology, Naval Medical University, Shanghai, People's Republic of China
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Martínez-Borba V, Martínez-García L, Peris-Baquero Ó, Osma J, del Corral-Beamonte E. Guiding future research on psychological interventions in people with COVID-19 and post COVID syndrome and comorbid emotional disorders based on a systematic review. Front Public Health 2024; 11:1305463. [PMID: 38274511 PMCID: PMC10808326 DOI: 10.3389/fpubh.2023.1305463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Accepted: 12/26/2023] [Indexed: 01/27/2024] Open
Abstract
Objective The COVID-19 pandemic has been emotionally challenging for the entire population and especially for people who contracted the illness. This systematic review summarizes psychological interventions implemented in COVID-19 and long COVID-19 patients who presented comorbid emotional disorders. Methods and measures 3,839 articles were identified in 6 databases and 43 of them were included in this work. Two independent researchers selected the articles and assessed their quality. Results 2,359 adults were included in this review. Severity of COVID-19 symptoms ranged from asymptomatic to hospitalized patients; only 3 studies included long COVID-19 populations. Similar number of randomized controlled studies (n = 15) and case studies (n = 14) were found. Emotional disorders were anxiety and/or depressive symptoms (n = 39) and the psychological intervention most represented had a cognitive behavioral approach (n = 10). Length of psychological programs ranged from 1-5 sessions (n = 6) to 16 appointments (n = 2). Some programs were distributed on a daily (n = 4) or weekly basis (n = 2), but other proposed several sessions a week (n = 4). Short (5-10 min, n = 4) and long sessions (60-90 min, n = 3) are proposed. Most interventions were supported by the use of technologies (n = 18). Important risk of bias was present in several studies. Conclusion Promising results in the reduction of depressive, anxiety and related disorders have been found. However, important limitations in current psychological interventions were detected (i.e., duration, format, length, and efficacy of interventions were not consistently established across investigations). The results derived from our work may help to understand clinical practices in the context of pandemics and could guide future efforts to manage emotional suffering in COVID-19 patients. A stepped model of care could help to determine the dosage, length and format of delivery for each patient.Systematic review registration: PROSPERO 2022 CRD42022367227. Available from: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022367227.
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Affiliation(s)
- Verónica Martínez-Borba
- Institute for Health Research Aragón (IIS Aragón), Zaragoza, Spain
- Department of Psychology and Sociology, Universidad de Zaragoza, Zaragoza, Spain
| | - Laura Martínez-García
- Institute for Health Research Aragón (IIS Aragón), Zaragoza, Spain
- Department of Psychology and Sociology, Universidad de Zaragoza, Zaragoza, Spain
| | - Óscar Peris-Baquero
- Institute for Health Research Aragón (IIS Aragón), Zaragoza, Spain
- Department of Psychology and Sociology, Universidad de Zaragoza, Zaragoza, Spain
| | - Jorge Osma
- Institute for Health Research Aragón (IIS Aragón), Zaragoza, Spain
- Department of Psychology and Sociology, Universidad de Zaragoza, Zaragoza, Spain
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He J, Lin J, Sun W, Cheung T, Cao Y, Fu E, Chan SHW, Tsang HWH. The effects of psychosocial and behavioral interventions on depressive and anxiety symptoms during the COVID-19 pandemic: a systematic review and meta-analysis. Sci Rep 2023; 13:19094. [PMID: 37925535 PMCID: PMC10625531 DOI: 10.1038/s41598-023-45839-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 10/24/2023] [Indexed: 11/06/2023] Open
Abstract
Psychosocial and behavioral interventions have been shown to significantly reduce depressive and anxiety symptoms in different populations. Recent evidence suggests that the mental health of the general population has deteriorated significantly since the start of Coronavirus Disease 2019 (COVID-19) pandemic. We conducted a systematic review and meta-analysis of studies on the therapeutic effects of psychosocial and behavioral interventions on depression and anxiety during the COVID-19 pandemic. We systematically searched six electronic databases between December 2019 and February 2022 including PubMed, PsycINFO, Scopus, Web of Science, CNKI, and Wanfang Data. We included randomized clinical trials of psychosocial and behavioral interventions in individuals with depressive or anxiety symptoms during the COVID-19 outbreak compared to various control conditions. A total of 35 eligible studies with 5457 participants were included. The meta-analysis results showed that psychosocial and behavioral interventions had statistically significant moderate effects on depression [SMD = - 0.73, 95% CI (- 1.01, - 0.45), I2 = 90%] and large effects on anxiety [SMD = - 0.90, 95% CI (- 1.19, - 0.60), I2 = 92%], especially in the general population and COVID-19 survivors. Exercise and cognitive behavioral therapy were found to be the most effective treatments with moderate-to-large effect size for depression and anxiety during the outbreak of COVID-19. We also found the internet-based approach could also achieve almost equally significant effects on depression and anxiety compared with face-to-face traditional approach. Our findings suggest that cognitive behavioral therapy and physical exercise intervention are significantly effective for depression and anxiety related to the COVID-19 pandemic regardless of the delivery modes, and gender differences should be taken into consideration for better implementation of interventions in clinical and community practice.
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Affiliation(s)
- Jiali He
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong
| | - Jingxia Lin
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong
- Mental Health Research Center, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong
| | - Wen Sun
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong
| | - Teris Cheung
- Mental Health Research Center, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong
| | - Yuan Cao
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong
- Mental Health Research Center, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong
| | - Eugene Fu
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong
| | - Sunny H W Chan
- School of Health and Social Wellbeing, University of the West of England, Bristol, UK
| | - Hector W H Tsang
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong.
- Mental Health Research Center, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong.
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Smaik N, Simmons LA, Abdulhaq B, Dardas LA. The feasibility and preliminary efficacy of narrative exposure therapy on post-traumatic stress disorder among Syrian refugees in Jordan. Int J Nurs Sci 2023; 10:518-526. [PMID: 38020837 PMCID: PMC10667293 DOI: 10.1016/j.ijnss.2023.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 09/01/2023] [Accepted: 09/16/2023] [Indexed: 12/01/2023] Open
Abstract
Objectives Post-traumatic stress disorder (PTSD), anxiety, and depression are common mental health disorders among refugees, and all require immediate mental health support to prevent short- and long-term detrimental health outcomes. The purpose of this study was to evaluate the feasibility and preliminary efficacy of narrative exposure therapy (NET) in reducing symptoms of PTSD, depression, and anxiety among Syrian refugees residing in Jordan. Methods A two-arm randomized control trial was utilized. A total of 40 Syrian refugees aged 18 to 64 diagnosed with PTSD were randomly allocated to either the NET intervention group (n = 20) or the waitlist control group (n = 20) using a computer-generated allocation list with 1:1 allocation. PTSD symptoms were evaluated using the Arabic rendition of the Harvard Trauma Questionnaire, while depression and anxiety symptoms were appraised using the Arabic adaptation of the Hopkins Symptoms Checklist-25. Descriptive statistics were employed to characterize the sample and survey data. Independent t-tests were conducted to assess mean score differences in PTSD, anxiety, and depression between the intervention and control groups. Results Post NET intervention, significant reductions in PTSD (t = -10.00, P < 0.001), anxiety (t = -9.46, P < 0.001), and depression (t = -6.00, P < 0.001) scores were observed in the intervention group compared to the control group. Effect sizes were moderate for the trauma (Cohen's d = 0.73) and depression (Cohen's d = 0.79) symptoms and notably large for anxiety symptoms (Cohen's d = 0.97). There were no adverse events related to study participation. The intervention achieved a 100% participant retention rate. Conclusions The results pertaining to retention rate, adherence to the study protocol, data completeness, cultural congruence, and participants' satisfaction provided strong support for the future implementation of the full-scale RCT. NET may be a feasible and helpful approach for refugees and other patients with PTSD, anxiety, and depression.
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Affiliation(s)
- Nadeen Smaik
- School of Nursing, The University of Jordan, Amman, Jordan
| | - Leigh Ann Simmons
- The Betty Irene Moore School of Nursing, UC Davis, Sacramento, CA, USA
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Raeder R, Clayton NS, Boeckle M. Narrative-based autobiographical memory interventions for PTSD: a meta-analysis of randomized controlled trials. Front Psychol 2023; 14:1215225. [PMID: 37829075 PMCID: PMC10565228 DOI: 10.3389/fpsyg.2023.1215225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 08/25/2023] [Indexed: 10/14/2023] Open
Abstract
Introduction The aim of this systematic review and meta-analysis is to evaluate the efficacy of narrative-based interventions (NBIs) for individuals with post-traumatic stress disorder (PTSD). Investigating the efficacy of NBIs should yield insight on autobiographical memory (AM) phenomena implicated in PTSD onset and recovery, leading to improved intervention protocols. Furthermore, by analyzing how NBIs influence maladaptive AM distortions, we hope to shed light on the theorized narrative architecture of AM more generally. Methods A systematic literature search was conducted according to PRISMA and Cochrane guidelines in MEDLINE, EMBASE, PsychINFO, and PubMed. Additional studies were then also identified from the reference lists of other relevant literature and considered for inclusion. Studies were then evaluated for adherence to the inclusion/exclusion criteria and assessed for risk of bias. Various meta-analyses were performed on included studies to understand how NBIs may or may not influence the overall effect size of treatment. Results The results of the meta-analysis of 35 studies, involving 2,596 participants, suggest that NBIs are a viable and effective treatment option for PTSD, yielding a statistically significant within-group effect size and decrease in PTSD symptomatology at both post-treatment [g = 1.73, 95% CI (1.23-2.22)] and 3-9 month follow-up assessments [g = 2.33, 95% CI (1.41-3.26)]. Furthermore, the difference in effect sizes between NBIs compared to active and waitlist controls was statistically significant, suggesting that NBIs are superior. Sub-analyses showed that NET provided a stronger effect size than FORNET, which may be due to the nature of the traumatic event itself and not the treatment protocol. While evidence of small study and publication bias was present, a weight-function model and trim-and-fill method suggested it was not influencing the overall results. Discussion This meta-analysis presents strong evidence supporting the use of NBIs in the treatment of PTSD. Clear similarities can be identified between NBIs included in this analysis that make them distinct from non-NBI interventions, which are reviewed in the discussion. Controlled comparisons between NBIs and non-NBIs would help to further understand AM mechanisms of action implicated in recovery and how various interventions facilitate them. Future research should also aim to elucidate the full range of AM impairment in individuals with PTSD to gain insight on how other memory capabilities, such as the ability to mentally simulate the future, are implicated in the pathogenesis of PTSD.
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Affiliation(s)
- Robert Raeder
- Department of Psychology, University of Cambridge, Cambridge, United Kingdom
| | - Nicola S. Clayton
- Department of Psychology, University of Cambridge, Cambridge, United Kingdom
| | - Markus Boeckle
- Scientific Working Group, Karl Landsteiner University of Health Sciences, Krems, Austria
- Department of Transitory Psychiatry, University Hospital Tulln, Tulln, Austria
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Rafiei M, Mohammadi Z, Mohamadirizi S. The effect of "Narrative writing reflection" method on the hope of patient with COVID-19: A health promotion intervention. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2023; 12:298. [PMID: 37849879 PMCID: PMC10578558 DOI: 10.4103/jehp.jehp_1590_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Accepted: 03/16/2023] [Indexed: 10/19/2023]
Abstract
BACKGROUND Corona virus disease disease as a life-threatening respiratory disease causes psychological problems including hopelessness in patients. So the aim of this study was to determine the effect of Narrative writing reflection on hope of patient with COVID-19. MATERIALS AND METHODS The study was experimental with a pre-test-post-test and with the control group design. The subjects were randomly divided into the intervention (n = 30) and control (n = 30) groups. The intervention group received Narrative writing reflection. The control group was receiving routine care. Before and after the intervention, the patients were asked to complete the 12-item Herth Hope Index. Data were analyzed with by using spss software and paired t test and independent t-test with a significance level of P < 0.05. RESULTS Independent t-test showed that the hope scores before intervention in both intervention and control groups were not statistically significant (P > 0.05), whereas there was a significant difference between two groups after the intervention (P < 0.05). CONCLUSION The results of this study showed that the use of mindfulness methods such as narrative writing in hospitalized and quarantined patients who are unable to communicate with the outside environment could increase the hope in patient.
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Affiliation(s)
- Malihe Rafiei
- Nursing and Midwifery Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Zakyieh Mohammadi
- Nursing and Midwifery Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Shahla Mohamadirizi
- Nursing and Midwifery Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
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Dillen H, Bekkering G, Gijsbers S, Vande Weygaerde Y, Van Herck M, Haesevoets S, Bos DAG, Li A, Janssens W, Gosselink R, Troosters T, Verbakel JY. Clinical effectiveness of rehabilitation in ambulatory care for patients with persisting symptoms after COVID-19: a systematic review. BMC Infect Dis 2023; 23:419. [PMID: 37344767 DOI: 10.1186/s12879-023-08374-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 06/05/2023] [Indexed: 06/23/2023] Open
Abstract
BACKGROUND Lingering symptoms after acute COVID-19 present a major challenge to ambulatory care services. Since there are reservations regarding their optimal management, we aimed to collate all available evidence on the effects of rehabilitation treatments applicable in ambulatory care for these patients. METHODS On 9 May 2022, we systematically searched articles in COVID-19 collections, Embase, MEDLINE, Cochrane Library, Web of Science, CINAHL, PsycArticles, PEDro, and EuropePMC. References were eligible if they reported on the clinical effectiveness of a rehabilitation therapy applicable in ambulatory care for adult patients with persisting symptoms continuing 4 weeks after the onset of COVID-19. The quality of the studies was evaluated using the CASP cohort study checklist and the Cochrane Risk of Bias Assessment Tool. Summary of Findings tables were constructed and the certainty of evidence was assessed using the GRADE framework. RESULTS We included 38 studies comprising 2,790 participants. Physical training and breathing exercises may reduce fatigue, dyspnoea, and chest pain and may improve physical capacity and quality of life, but the evidence is very weak (based on 6 RCTs and 12 cohort studies). The evidence underpinning the effect of nutritional supplements on fatigue, dyspnoea, muscle pain, sensory function, psychological well-being, quality of life, and functional capacity is very poor (based on 4 RCTs). Also, the evidence-base is very weak about the effect of olfactory training on sensory function and quality of life (based on 4 RCTs and 3 cohort studies). Multidisciplinary treatment may have beneficial effects on fatigue, dyspnoea, physical capacity, pulmonary function, quality of life, return to daily life activities, and functional capacity, but the evidence is very weak (based on 5 cohort studies). The certainty of evidence is very low due to study limitations, inconsistency, indirectness, and imprecision. CONCLUSIONS Physical training, breathing exercises, olfactory training and multidisciplinary treatment can be effective rehabilitation therapies for patients with persisting symptoms after COVID-19, still with high uncertainty regarding these effects. These findings can guide ambulatory care practitioners to treat these patients and should be incorporated in clinical practice guidelines. High-quality studies are needed to confirm our hypotheses and should report on adverse events.
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Affiliation(s)
- Hannelore Dillen
- EPI-Centre, Department of Public Health and Primary Care, KU Leuven, 7 Kapucijnenvoer, 3000, Leuven, Belgium.
- Academic Centre for General Practice, Department of Public Health and Primary Care, KU Leuven, 7 Kapucijnenvoer, 3000, Leuven, Belgium.
| | - Geertruida Bekkering
- Academic Centre for General Practice, Department of Public Health and Primary Care, KU Leuven, 7 Kapucijnenvoer, 3000, Leuven, Belgium
- Centre for Evidence-Based Medicine, 7 Kapucijnenvoer, 3000, Leuven, Belgium
- Cochrane Belgium, 7 Kapucijnenvoer, 3000, Leuven, Belgium
| | | | - Yannick Vande Weygaerde
- Department of Respiratory Medicine, Ghent University Hospital, 10 Corneel Heymanslaan, 9000, Ghent, Belgium
| | - Maarten Van Herck
- REVAL-Rehabilitation Research Center, Biomedical Research Institute (BIOMED), Faculty of Rehabilitation Sciences, Hasselt University, Agoralaan Building A, 3590, Diepenbeek, Belgium
- Department of Research and Development, Ciro, 1 Hornerheide, Horn, 6085 NM, The Netherlands
- Department of Respiratory Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, 25 P. Debyelaan, Maastricht, 6229 HX, The Netherlands
| | - Sarah Haesevoets
- REVAL-Rehabilitation Research Center, Biomedical Research Institute (BIOMED), Faculty of Rehabilitation Sciences, Hasselt University, Agoralaan Building A, 3590, Diepenbeek, Belgium
| | - David A G Bos
- EPI-Centre, Department of Public Health and Primary Care, KU Leuven, 7 Kapucijnenvoer, 3000, Leuven, Belgium
- Academic Centre for General Practice, Department of Public Health and Primary Care, KU Leuven, 7 Kapucijnenvoer, 3000, Leuven, Belgium
| | - Ann Li
- , post-COVID community, Belgium
| | - Wim Janssens
- Department of Respiratory Diseases, KU Leuven University Hospitals Leuven, 49 Herestraat, 3000, Leuven, Belgium
| | - Rik Gosselink
- Department of Rehabilitation Sciences, Research Group for Rehabilitation in Internal Disorders, KU Leuven, 101 Tervuursevest, 3001, Leuven, Belgium
| | - Thierry Troosters
- Department of Rehabilitation Sciences, Research Group for Rehabilitation in Internal Disorders, KU Leuven, 101 Tervuursevest, 3001, Leuven, Belgium
| | - Jan Y Verbakel
- EPI-Centre, Department of Public Health and Primary Care, KU Leuven, 7 Kapucijnenvoer, 3000, Leuven, Belgium
- Academic Centre for General Practice, Department of Public Health and Primary Care, KU Leuven, 7 Kapucijnenvoer, 3000, Leuven, Belgium
- NIHR Community Healthcare Medtech and IVD Cooperative, Nuffield Department of Primary Care Health Sciences, University of Oxford, Woodstock Road, Oxford, OX2 6GG, UK
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Gloeckl R, Leitl D, Schneeberger T, Jarosch I, Koczulla AR. Rehabilitative interventions in patients with persistent post COVID-19 symptoms-a review of recent advances and future perspectives. Eur Arch Psychiatry Clin Neurosci 2023:10.1007/s00406-023-01631-9. [PMID: 37326700 DOI: 10.1007/s00406-023-01631-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 05/29/2023] [Indexed: 06/17/2023]
Abstract
The SARS-CoV-2 pandemic has not only caused millions of deaths but left also millions of people with persistent symptoms behind. These long-term COVID-19 sequelae cause a considerable burden on individuals´ health, healthcare systems, and economies worldwide given the high rate of SARS-CoV-2 infections. Therefore, rehabilitative interventions and strategies are needed to counteract the post COVID-19 sequelae. The importance of rehabilitation for patients with persistent COVID-19 symptoms has been recently also highlighted in a Call for Action by the World Health Organisation. Based on previously published research, but also in line with clinical experience, COVID-19 is not one specific disease but rather presents in different phenotypes that vary in their pathophysiological mechanisms, symptomatic manifestations, and potential interventional approaches. This review provides a proposal for differentiating post COVID-19 patients in non-organ-specific phenotypes that may help clinicians to evaluate patients and to plan therapeutic options. Furthermore, we present current unmet needs and suggest a potential pathway for a specific rehabilitation approach in people with persistent post-COVID symptoms.
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Affiliation(s)
- Rainer Gloeckl
- Institute for Pulmonary Rehabilitation Research, Schoen Klinik Berchtesgadener Land, Malterhoeh 1, 83471, Schoenau Am Koenigssee, Germany.
- Department of Pulmonary Rehabilitation, Member of the German Center for Lung Research (DZL), University Medical Center Giessen and Marburg, Philipps-University Marburg (UGMLC), Marburg, Germany.
| | - Daniela Leitl
- Institute for Pulmonary Rehabilitation Research, Schoen Klinik Berchtesgadener Land, Malterhoeh 1, 83471, Schoenau Am Koenigssee, Germany
- Department of Pulmonary Rehabilitation, Member of the German Center for Lung Research (DZL), University Medical Center Giessen and Marburg, Philipps-University Marburg (UGMLC), Marburg, Germany
| | - Tessa Schneeberger
- Institute for Pulmonary Rehabilitation Research, Schoen Klinik Berchtesgadener Land, Malterhoeh 1, 83471, Schoenau Am Koenigssee, Germany
- Department of Pulmonary Rehabilitation, Member of the German Center for Lung Research (DZL), University Medical Center Giessen and Marburg, Philipps-University Marburg (UGMLC), Marburg, Germany
| | - Inga Jarosch
- Institute for Pulmonary Rehabilitation Research, Schoen Klinik Berchtesgadener Land, Malterhoeh 1, 83471, Schoenau Am Koenigssee, Germany
- Department of Pulmonary Rehabilitation, Member of the German Center for Lung Research (DZL), University Medical Center Giessen and Marburg, Philipps-University Marburg (UGMLC), Marburg, Germany
| | - Andreas Rembert Koczulla
- Institute for Pulmonary Rehabilitation Research, Schoen Klinik Berchtesgadener Land, Malterhoeh 1, 83471, Schoenau Am Koenigssee, Germany
- Department of Pulmonary Rehabilitation, Member of the German Center for Lung Research (DZL), University Medical Center Giessen and Marburg, Philipps-University Marburg (UGMLC), Marburg, Germany
- Teaching Hospital, Paracelsus Medical University Salzburg, Salzburg, Austria
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10
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Vagnini D, Lamperti N, Molgora S, Barile F, Facchin F, Mazza U, Saita E. Mental Health Issues as a Consequence of the Pandemic: Group Psycho-Educational Intervention to Support Patients Recovered from COVID-19 Infection. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6105. [PMID: 37372692 DOI: 10.3390/ijerph20126105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 06/01/2023] [Accepted: 06/06/2023] [Indexed: 06/29/2023]
Abstract
Common psycho-physical symptoms have emerged in patients who were previously recovered for COVID-19 infection, including traumatic experience and enduring emotional disturbances. A group psycho-educational intervention of seven weekly sessions and a follow-up after three months was proposed to all Italian-speaking patients formally discharged from a public hospital in northern Italy and physically recovered from infection. Eighteen patients were recruited and divided into four age-homogenous groups, each led by two facilitators (psychologists and psychotherapists). The group sessions followed a structured format with thematic modules, including main topics, tasks, and homework assignments. Data were collected through recordings and verbatim transcripts. The objectives of the study were twofold: (1) to analyze the emerging themes and gain insight into the significant aspects of the participants' lived experience of COVID-19, and (2) to examine changes in how participants approached these themes throughout the intervention process. Semantic-pragmatic text analyses, specifically thematic analysis of elementary context and correspondence analysis, were conducted using T-LAB software. Linguistic analysis revealed a congruence between the intervention's objectives and the participants' experiences. The study highlighted an evolution in the narratives, as participants transitioned from a passive and concrete perspective on the disease to a more comprehensive cognitive and emotional elaboration of their personal illness stories. These findings hold potential relevance for healthcare services and professionals working in this field.
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Affiliation(s)
- Denise Vagnini
- Department of Psychology, Università Cattolica del Sacro Cuore, 20123 Milan, Italy
| | - Nicolò Lamperti
- Clinical Psychology Unit, Department of Mental Health and Addiction Services, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy
| | - Sara Molgora
- Department of Psychology, Università Cattolica del Sacro Cuore, 20123 Milan, Italy
| | - Francesca Barile
- Clinical Psychology Unit, Department of Mental Health and Addiction Services, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy
| | - Federica Facchin
- Department of Psychology, Università Cattolica del Sacro Cuore, 20123 Milan, Italy
| | - Umberto Mazza
- Clinical Psychology Unit, Department of Mental Health and Addiction Services, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy
| | - Emanuela Saita
- Department of Psychology, Università Cattolica del Sacro Cuore, 20123 Milan, Italy
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11
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Teixido L, Andreeva E, Gartmann J, Lemhöfer C, Sturm C, Gutenbrunner C. [Outpatient rehabilitative care for patients with Long-COVID - a guideline-based clinical practice guideline]. Laryngorhinootologie 2023. [PMID: 37130538 DOI: 10.1055/a-1985-0450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
BACKGROUND Even after weeks and months, persisting and also newly occurring symptoms after SARS-CoV-2 infection are common and lead in many cases to a broad spectrum of impairments and participation restrictions in all areas of daily life. Scientific evidence on therapeutic options still is limited. The aim of this work is therefore to provide pragmatic treatment recommendations analogous to the current therapeutic appliances guideline. METHOD In addition to a search in six electronic databases, the experiences from the treatment of more than hundred affected persons from the post-COVID outpatient rehabilitation service were used. Additionally, experiences with patients with similar symptoms from other diseases were included. All authors worked together to develop the pragmatic recommendations for the treatment of the main symptoms within the framework of outpatient therapy measures. A list of recommended diagnostics and functional assessments prior to therapy was also developed. RESULTS For the main symptoms fatigue, dyspnoea and cognitive impairment, the catalog of therapeutic products offers a wide range of therapeutic options under the diagnosis U09.9. The therapy packages should be composed individually and adapted to the patient's performance level that regularly should be (re-)assessed. Informing the patient about possible relapses and deteriorations and how to deal with them should be also part of the treatment regimen. DISCUSSION Physical modalities and rehabilitation interventions should be used in out-patient rehabilitation setting for the treatment of Long-COVID. In this regard, it is also important to take into account and treat serious complications after the disease, such as post-intensive care syndrome. Due to the rapid evolution of the knowledge a frequent review of scientific papers and recommendations should be conducted. High-quality intervention studies are necessary to achieve greater evidence in this field.
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Affiliation(s)
- Lidia Teixido
- Klinik für Rehabilitationsmedizin, Medizinische Hochschule Hannover, Hannover, Germany
| | - Elena Andreeva
- Klinik für Rehabilitationsmedizin, Medizinische Hochschule Hannover, Hannover, Germany
| | - Judith Gartmann
- Klinik für Rehabilitationsmedizin, Medizinische Hochschule Hannover, Hannover, Germany
| | | | - Christian Sturm
- Klinik für Rehabilitationsmedizin, Medizinische Hochschule Hannover, Hannover, Germany
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12
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Ye Z, Li W, Zhu R. Online psychosocial interventions for improving mental health in people during the COVID-19 pandemic: A systematic review and meta-analysis. J Affect Disord 2022; 316:120-131. [PMID: 35970325 PMCID: PMC9373538 DOI: 10.1016/j.jad.2022.08.023] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 07/05/2022] [Accepted: 08/10/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND During the COVID-19 pandemic, interventions for public mental health were mostly delivered through online modalities. Although many studies have explored the effectiveness of online psychosocial interventions through randomized controlled trials, there is a lack of quantitative synthesis of the effectiveness of online psychosocial interventions and an examination of their overall application. OBJECTIVE To understand the commonly used psychosocial interventions during the COVID-19 pandemic and the effectiveness of the interventions. METHODS Risk bias was assessed in the included studies according to the Cochrane Collaboration criteria, and data from post-test and follow-up were combined for standardized mean differences using Stata 16.0 software, and sources of heterogeneity were explored by subgroup analysis, and risk bias was assessed in the included studies using Review Manager 5.4 software. The study was written in strict accordance with PRISMA specifications, and registration was completed on the PROSPERO platform (CRD42022302917). RESULTS The online psychosocial intervention had an ameliorating effect on anxiety (SMD = -0.78), depression (SMD = -0.80), and insomnia (SMD = -0.19) in the public during the COVID-19 pandemic, was ineffective for the intervention on stress, and the effectiveness of the intervention on depression continued at follow-up. Subgroup analyses showed that the type of intervention, intervention form, Duration of intervention, and setting of the control group influenced the trial results to some extent, with cognitive behavioral therapy being the most effective intervention for anxiety and depressive symptoms, self-help interventions being more effective than interventions with therapist interventions, and 1-4 week interventions being more effective than 5-8 week interventions. Due to the limited number of studies included in the analysis and variability in quality, more randomized controlled trials are needed to test the findings. CONCLUSION Online psychosocial interventions can be effective in improving symptoms of anxiety, depression, stress, and insomnia in the public during the COVID-19 pandemic. However, additional randomized controlled trial studies are needed to determine which types of interventions are more appropriate for which populations and how they can be implemented to achieve better intervention outcomes.
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Affiliation(s)
- Zhiyu Ye
- School of Education Research, China University of Geosciences, Wuhan, China; Research Center for Psychological and Health Sciences, China University of Geosciences, Wuhan, China
| | - Wentian Li
- School of Education Research, China University of Geosciences, Wuhan, China; Wuhan Mental Health Centre, Wuhan, China.
| | - Ruizi Zhu
- Queen's University, Kingston, Canada
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13
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International PRISMA scoping review to understand mental health interventions for depression in COVID-19 patients. Psychiatry Res 2022; 316:114748. [PMID: 35944370 PMCID: PMC9313534 DOI: 10.1016/j.psychres.2022.114748] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 07/22/2022] [Accepted: 07/24/2022] [Indexed: 01/19/2023]
Abstract
Preliminary research indicates that the COVID-19 illness affects the mental well-being of patients. This scoping review, thus, aims to examine the current state of research into mental health treatments for depression symptoms in COVID-19 patients. Select databases were searched on 7/1/2021. Full-text articles involved (1) mental health treatment (2) suicide and/or depression outcomes, (3) a quasi-experimental research trial, and (4) a primary analysis. 11 articles were included in this review. The studies spanned 5 countries, and demonstrated immediate positive effects of mental health treatments and tele-health as a treatment modality for depression in COVID-19 patients. 6 studies were randomized controlled trials. Various treatments were administered, including cognitive behavior therapy, mindfulness, and muscle relaxation. Most interventions were conducted in in-patient units and focused on acute symptoms. There were limitations in the design and description of methodology in many studies, which affects the generalizability and replicability of positive findings. Only two studies included a post-intervention follow-up and one study assessed suicide risk. Thus, this review found there is a pressing need for more research in the area, with greater rigor in study methodology, and for treatments targeting long-term symptoms and suicidality, and outpatient services.
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14
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Rehabilitation bei Post-COVID-19-Patienten - individuell und zielgerichtet*. INFO HÄMATOLOGIE + ONKOLOGIE 2022. [PMCID: PMC9090453 DOI: 10.1007/s15004-022-9030-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
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15
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Rehabilitation bei Post-COVID-19-Patienten - individuell und zielgerichtet. PNEUMO NEWS 2022; 14:30-39. [PMID: 35194469 PMCID: PMC8853292 DOI: 10.1007/s15033-022-2806-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Vus V, Nakanishi Y, da Silva GTB. MAPPING MENTAL HEALTH INTERVENTIONS DURING THE COVID-19 PANDEMIC. A COMPARISON REVIEW OF CHINA AND WESTERN EUROPE. WIADOMOSCI LEKARSKIE (WARSAW, POLAND : 1960) 2022; 75:1819-1826. [PMID: 36089863 DOI: 10.36740/wlek202208102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVE The aim: To map and compare mental health interventions during the Covid-19 pandemic in China and Western-Europe. The focus was specifically on the availability, duration, target group, content, setting, and outcomes of the interventions. PATIENTS AND METHODS Materials and methods: A scoping review was conducted by utilising several scientific databases. A total of 479 articles were found after removing the duplicate records. After screening, 36 articles were included in the study. Relevant intervention characteristics were systematically mapped, and compared within and among countries. CONCLUSION Conclusions: All interventions had shared aims to improve the psychological resilience and to reduce psychological distress. In particular, anxiety- and depression-related symptoms were commonly addressed. On average, interventions in China were larger scaled, had longer durations, and often used combinations of strategies such as therapies and exercises both in-person and remotely. Interventions in Western-Europe tend to be locally implemented on a smaller scale, and often used a single strategy. Most Chinese interventions targeted adolescents, while all interventions in Western-Europe were meant for adults. Most interventions were assessed using quantitative methods using various mental health scales, showing statistically significant effects in improving mental health.
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Affiliation(s)
- Viktor Vus
- INTERNATIONAL PLATFORM ON MENTAL HEALTH, INSTITUTE FOR SOCIAL AND POLITICAL PSYCHOLOGY NAES OF UKRAINE, KYIV, UKRAINE
| | - Yol Nakanishi
- ATHENA INSTITUTE, VRIJE UNIVERSITEIT, AMSTERDAM, THE NETHERLANDS
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