Effect of the COVID-19 pandemic on stress, anxiety, and depressive disorders in German primary care: A cross-sectional study

University Students' Financial Situation During COVID-19 and Anxiety and Depressive Symptoms: Results of the COVID-19 German Student Well-Being Study (C19 GSWS)

Background

The COVID-19 pandemic has had a major impact on students' financial situation as well as on their mental health.

Aim

To examine the reported change in the financial situation of German university students before and across two time points of the COVID-19 pandemic and to evaluate its associations with anxiety and depressive symptoms.

Methods

We used data from the cross-sectional COVID-19 German Student Well-being Study conducted at five German universities (N = 7203). Linear regression models were used to analyze associations between a reported change in financial situation and anxiety and depressive symptoms.

Results

Twenty-eight percent of the participants reported to have a worsened financial situation at the time of the survey compared to the time prior to the pandemic. A worsened financial situation at the time of the survey as compared to prior to the pandemic was associated with higher levels of anxiety and depressive symptoms reported in all three depression and anxiety scales [a 1.46 point increase on the CES-D 8 scale (95% confidence interval (CI): 1.19; 1.73), a 0.37-point increase in PHQ-2 (95% CI: 0.28; 0.46), and a 0.45-point increase in GAD-2 (95% CI: 0.35; 0.55)]. An improved financial situation, on the other hand, was associated with lower levels of anxiety and depressive symptoms. As for the second change, comparing the current financial situation with the situation during the first wave of the pandemic, the associations with anxiety and depressive symptoms were broadly similar.

Conclusion

Our findings suggest that students are a vulnerable population in need of mental and financial support during times of crisis. Future research is needed to obtain insights into potential long-term effects of the pandemic on students' mental health.

Trends in the Diagnostic Prevalence of Mental Disorders, 2012-2022

BACKGROUND

Evaluations by the statutory health insurance carriers in Germany have revealed a rising prevalence of diagnoses of mental disorders, at varying levels and to varying extents. For mental health surveillance purposes, we analyzed prevalence trends across health insurance carriers, before and during the COVID-19 pandemic and stratified by diagnosis group, sex and age.

METHODS

Nationwide outpatient claims data of all statutorily insured individuals for the years 2012-2022 (Nmin = 68.7 million people, Nmax = 73.7 million people) were used to determine the diagnostic prevalence of mental disorders (ICD-10 F00-F99 and five selected diagnosis groups), with stratification by sex and age. Changes over time in the spectrum of all documented mental disorders are described.

RESULTS

Over the period 2012-2022, the percentage of people with outpatient diagnoses of mental disorders rose from 33.4% to 37.9% (a relative increase of 13.4%). In the selected diagnosis groups, the trends ranged from -11.6% to +115.8% and were generally steady over time, though stronger or stagnating trends were seen in some groups from 2020 onward. Diagnostic prevalence rose to a greater extent in male (+18.3%) than in female individuals (+10.8%) over the period 2012-2022. The greatest increases (> +15%) were seen among 11- to 17-yearolds and in 60- to 84-year-olds. The composition of the diagnosis spectrum was more stable in adults than in children and adolescents.

CONCLUSION

Trends in diagnostic prevalence differ across mental disorders and population subgroups and have changed in some diagnosis groups since the COVID-19 pandemic. Contextualizing research is needed for a better understanding of these developments.

A Comparative Study of the Impact of the Covid-19 Pandemic on Mental Health, Healthcare Access, and Pain Levels of Patients with Chronic Pain from Spring 2020 to Spring 2021

Purpose

The short-term impact of the Covid-19 pandemic on patients with chronic pain has been under the microscope since the beginning of the pandemic. This time-lag design study aimed to track changes in pain levels, access to care, mental health, and well-being of Greek chronic pain patients within the first year of the Covid-19 pandemic.

Patients and Methods

101 and 100 chronic pain patients were contacted during the Spring of 2020 and 2021, respectively. A customized questionnaire was used to evaluate the perceived impact of the pandemic on pain levels and healthcare access. Psychological responses, personality characteristics, and overall well-being were evaluated using the Depression, Anxiety, and Stress Scale (DASS-42), the Ten-Item Personality Index (TIPI) and the Personal Wellbeing Index (PWI).

Results

The perceived effect of the pandemic and the Covid-related restrictions affected significantly access to healthcare, pain levels and quality of life. Differences were detected in the PWI sub-scales regarding Personal Safety, Sense of Community-Connectedness, Future Security, Spirituality-Religiousness, and General Life Satisfaction. Marital status, parenthood, education and place of residence were associated with differences in pain levels, emotional and psychological responses.

Conclusion

Changes in chronic pain levels, emotional responses, and overall well-being took place throughout the year. Also, an evident shift took place in the care delivery system. Both tendencies disclose an ongoing adaptation process of chronic pain patients and healthcare services that needs further monitoring.

Incidence of mental health diagnoses during the COVID-19 pandemic: a multinational network study

AIMS

Population-wide restrictions during the COVID-19 pandemic may create barriers to mental health diagnosis. This study aims to examine changes in the number of incident cases and the incidence rates of mental health diagnoses during the COVID-19 pandemic.

METHODS

By using electronic health records from France, Germany, Italy, South Korea and the UK and claims data from the US, this study conducted interrupted time-series analyses to compare the monthly incident cases and the incidence of depressive disorders, anxiety disorders, alcohol misuse or dependence, substance misuse or dependence, bipolar disorders, personality disorders and psychoses diagnoses before (January 2017 to February 2020) and after (April 2020 to the latest available date of each database [up to November 2021]) the introduction of COVID-related restrictions.

RESULTS

A total of 629,712,954 individuals were enrolled across nine databases. Following the introduction of restrictions, an immediate decline was observed in the number of incident cases of all mental health diagnoses in the US (rate ratios (RRs) ranged from 0.005 to 0.677) and in the incidence of all conditions in France, Germany, Italy and the US (RRs ranged from 0.002 to 0.422). In the UK, significant reductions were only observed in common mental illnesses. The number of incident cases and the incidence began to return to or exceed pre-pandemic levels in most countries from mid-2020 through 2021.

CONCLUSIONS

Healthcare providers should be prepared to deliver service adaptations to mitigate burdens directly or indirectly caused by delays in the diagnosis and treatment of mental health conditions.

Medical care services provision and stress experience in urologists during all waves of the COVID-19 pandemic in Germany

Purpose

Urologists' practices reported decreasing medical care provision and increasing stress experience in the first wave of the COVID-19 pandemic. However, long-term effects of the pandemic are unknown.

Methods

Medical record data of n = 127 urologists were used to assess changes in healthcare provision, comparing the pandemic with the pre-pandemic period. An online survey among n = 101 urologists was conducted to assess the physicians' perceptions of the identified healthcare provision and organizational changes and experiences of anxiety, stress, and support needs during the pandemic waves. Urologists consultations, specialists' referrals, hospital admissions, documented cancer diagnoses, urologists' perceptions of causes for these changes and experienced stress, anxiety and support needs. Results were demonstrated using descriptive statistics.

Results

Over the first two years of the pandemic, there was a slight decline in consultations (-0,94%), but more intensive reduction in hospital admissions (-13,6%) and identified cancer diagnoses (-6,2%). Although patients' behavior was seen as the main reason for the changes, 71 and 61% of consultations of high-risk patients or urgent surgeries were canceled. Telemedical approaches were implemented by 58% of urologists, and 88% stated that the reduced cancer detection rate would negatively affect patients' outcomes. Urologists reported higher anxiety, stress, and need for support during all waves of the pandemic than other disciplines, especially females.

Conclusion

The pandemic tremendously affects urologists' health care provision and stress experience, possibly causing long-term consequences for patients and physicians.

Efficacy and moderators of metacognitive training for depression in older adults (MCT-Silver): A randomized controlled trial

BACKGROUND

Up to 79 % of older adults with depression do not receive treatments commensurate with guideline recommendations. Metacognitive Training-Silver (MCT-Silver) is a low-intensity group training, which aims to reduce depressive symptoms by targeting (meta)cognitive beliefs.

METHODS

A randomized controlled trial comparing MCT-Silver (n = 41) to cognitive remediation (n = 39) was conducted with older adults with major depressive disorder and/or dysthymia. Clinician-rated depression (Hamilton Depression Rating Scale [HDRS, primary outcome]), self-reported depression (Beck Depression Inventory-II [BDI-II]), negative cognitive beliefs, positive metacognitive beliefs, rumination, health status, quality of life, and neurocognitive functioning were assessed at baseline, eight weeks (post) and three months (follow-up).

RESULTS

Both groups demonstrated moderate to large reductions in depression. No superior effects of MCT-Silver on clinician-rated depression (HDRS) were detected. MCT-Silver led to greater reductions in self-reported depression and rumination at post- and follow-up. Despite this, scores at post- and follow-up assessments were similar for both groups. MCT-Silver's effect on depressive symptoms was moderated by baseline rumination, positive metacognitive beliefs and previous treatment experience. MCT-Silver was evaluated as superior according to patient appraisals.

LIMITATIONS

Conclusions are limited by divergent findings on measures of depression and that the study was conducted during the COVID-19 pandemic.

CONCLUSIONS

Whereas no superior effect of MCT-Silver was found for the primary outcome, there was a significant effect of MCT-Silver for self-reported depression and rumination. Patients endorsing rumination and positive metacognitive beliefs as well as those without previous psychological treatment may benefit more from MCT-Silver.

Hair Transplantation in the United States: A Population-based Survey of Female and Male Pattern Baldness

Background

Androgenetic alopecia, the most common type of hair loss, can impair the patient's overall mental health. Although there are pharmaceutical and surgical treatments available, little is known about the public standpoint toward hair transplantation (HT).

Methods

A sample of individuals living in the United States (n = 1000; male and female participants were equally distributed) was asked to fill out the questionnaire. The online survey was conducted in June 2022.

Results

Most participants (42%; n = 416) were between 41 and 60 years of age. Study participants frequently reported that, with their hair loss progressing, they would not feel attractive anymore (n = 400; 40%), nor as confident as before (n = 330; 33%). Although women with minimal hair loss were willing to spend a median price of $4000 [interquartile range (IQ) IQR $1000-$5000], women with extensive hair loss were willing to spend significantly more (median = $5000; IQR $3600-$6375; P = 0.011). This was reproducible in men (P = 0.033). Although significantly fewer women considered undergoing HT (430 women versus 447 men; P < 0.001), female participants were willing to pay more for their HT compared with men (P = 0.039).

Conclusions

Individuals living in the United States consider hair loss to impair their attractiveness and regard HT as a valuable therapeutic option. More affordable and gender-specific HT should be subject to future research work.

Association between carpal tunnel syndrome and the five-year incidence of anxiety disorder and depression in adults followed in general practices in Germany

OBJECTIVE

Little is known about the longitudinal relationship between carpal tunnel syndrome (CTS) and mental health. Therefore, this retrospective cohort study investigated the association between CTS and the five-year incidence of anxiety disorder and depression in adults from Germany.

METHODS

Data from the Disease Analyzer database (IQVIA) were used for the present study. Patients aged ≥18 years diagnosed for the first time with CTS in one of 1284 general practices in Germany in 2005-2020 were included (index date). Individuals without CTS were matched to those with CTS using a propensity score based on age, sex, the mean number of consultations per year during the follow-up, and the index year. In people without CTS, the index date was a randomly selected consultation in 2005-2020.

RESULTS

There were 75,135 patients with and 75,135 patients without CTS included in the study (mean [SD] age 57.2 [16.5] years; 59.7% women). Within five years of the index date, the incidence of anxiety disorder was 3.9% and 3.6% in the group with and the group without CTS, respectively (log-rank p-value<0.001), while figures for depression were 14.8% and 11.5% (log-rank p-value<0.001). These findings were corroborated in the Cox regression analyses adjusted for multiple physical conditions, as CTS was associated with anxiety disorder (HR = 1.14, 95% CI = 1.08-1.21) and depression (HR = 1.29, 95% CI = 1.25-1.33) in the overall sample.

CONCLUSION

CTS was associated with an increased incidence of anxiety disorder and depression in Germany. Further research should identify the mediators involved in these relationships.

[Pre-existing Mental Disorders and Depressiveness in the Second Wave of the SARS-CoV-2-Pandemic - The Role of Pandemic-Associated Stressors]

The second wave of the SARS-CoV-2 pandemic was characterized by drastic restrictions. From previous pandemics as well as from the first wave, it is known that especially individuals with a history of mental disorders may be highly vulnerable to develop poor mental health. Therefore, this paper examines the association of prior mental disorders (PMD) and depressiveness in the 2nd pandemic wave, considering general stress, perceived isolation, perception of political measures to curb the pandemic, fears regarding consequences of the pandemic and changes in the employment and income situation. A cross-sectional analysis was conducted with data of 812 participants of the health related beliefs and health care experiences in Germany study (HeReCa). The association between PMD and depressiveness was studied by means of weighted (for education and age) logistic regression, adjusted for the named variables as well as sociodemographic characteristics. Individuals with PMD displayed substantially more often higher depressiveness than individuals without PMD (OR: 25.1; 95% CI: 11.0-57.3). This association decreased partially by accounting for higher general stress and stress from isolation. Lack of partnership, low income, and male sex were associated with higher depressiveness, but only marginally changed the association of PMD and depressiveness. Overall, during the pandemic, persons with PMD were more likely to develop higher depressiveness than persons without. It is strongly advised to provide care for mental illness in pandemic times, which can be completed by E-Mental-Health or professional support for coping with stress.

Trajectories of Adjustment Disorder and Well-Being in Austria and Croatia during 20 Months of the COVID-19 Pandemic

The present study aimed to investigate the trajectories of adjustment disorder (AD) symptoms and well-being over 20 months of the COVID-19 pandemic in Austria and Croatia. Further objectives of this study were to examine whether sociodemographic characteristics and the symptoms of anxiety and depression could predict these trajectories. As part of the pan-European ESTSS ADJUST study, N = 1144 individuals were recruited using convenience sampling and assessed four times between June 2020 and January 2022 through an online survey. Latent growth curve modelling was applied to estimate the trajectories of AD symptoms and well-being. Over time, the prevalence of probable AD varied between 9.8% and 15.1%. The symptoms of AD tended to increase, whereas well-being tended to decrease. According to the majority of the models tested, women, participants from Austria and those with lower income had higher initial AD symptoms, whereas older participants and those from Croatia had higher initial well-being. In all models and at all timepoints, anxiety and depression significantly predicted AD and well-being scores. Overall, our study points to several predictors of AD and well-being and indicates high variability in people's reactions to the pandemic. Psychosocial support for the general population is needed during pandemics and similar crises, with a special focus on vulnerable groups.

Mental health and well-being in the first year of the COVID-19 pandemic among different population subgroups: evidence from representative longitudinal data in Germany

OBJECTIVES

To examine potential deteriorations in mental health and well-being in the first COVID-19 pandemic year compared with the previous decade focusing on the following vulnerable subgroups in Germany: women with minor children in the household, those living without a partner, younger and older adults, those in a precarious labour market situation, immigrants and refugees, and those with pre-existing physical or mental health risks.

DESIGN

Analyses of secondary longitudinal survey data using cluster-robust pooled ordinary least squares models.

PARTICIPANTS

More than 20 000 individuals (aged 16+ years) in Germany.

PRIMARY AND SECONDARY OUTCOME MEASURES

Mental Component Summary Scale (MCS) of the 12-item Short-Form Health Survey measuring mental health-related quality of life, single item on life satisfaction (LS).

RESULTS

We find a decline in the average MCS in the 2020 survey that is not particularly striking in the overall time course, still resulting in a mean score below those of all preceding waves since 2010. We find no change in LS from 2019 to 2020 against the background of a general upward trend. Regarding vulnerability factors, only the results on age and parenthood are partially in line with our expectations. In 2020, LS declined among the youngest adults; MCS declined among mothers (and women and men without children) but not fathers. Unlike respective comparison groups, refugees, those unemployed before the pandemic and those with pre-existing mental health risks experienced no MCS declines in 2020, whereas persons living without a partner, the eldest, and those with pre-existing health risks exhibited continued increases in LS.

CONCLUSIONS

There is no evidence for substantial breakdowns in mental health or subjective well-being in the first pandemic year in the German population or its subgroups, particularly when considering developments of the previous decade. Since the majority of hypothesised vulnerable groups to pandemic stressors showed more stable MCS and LS, our results warrant further study.

Relationship between COVID-19 Pandemic Confinement and Worsening or Onset of Depressive Disorders

Several studies indicate that the pandemic and associated confinement measures may have had an impact on mental health, producing the onset or persistence of symptoms such as stress, anxiety, depression, and fear. This systematic review aims to identify the factors influencing the onset or worsening of depressive symptoms during COVID-19-related confinement. Our systematic search produced 451 articles from selected databases, 398 of which were excluded based on established criteria, while 53 were selected for review. Most studies have reported an increase in the prevalence of depressive symptoms in the general population during the first weeks of confinement. The predominant risk factors associated with the appearance of depressive symptoms included female sex, low educational level, young age, economic difficulties, comorbidities, and a history of previous depressive episodes. People with a pre-existing diagnosis of depressive disorder generally experienced a worsening of their symptoms during confinement in most of the reviewed studies. Moreover, symptomatology persisted at higher levels post-confinement, without significant improvement despite relief in confinement measures. Therefore, ongoing evaluations of post-pandemic depressive symptoms are necessary to advance the knowledge of the relationship between pandemics and depression, allowing accurate conclusions and associations to be made.

Time trends in mental health indicators in Germany's adult population before and during the COVID-19 pandemic

Background

Times of crisis such as the COVID-19 pandemic are expected to compromise mental health. Despite a large number of studies, evidence on the development of mental health in general populations during the pandemic is inconclusive. One reason may be that representative data spanning the whole pandemic and allowing for comparisons to pre-pandemic data are scarce.

Methods

We analyzed representative data from telephone surveys of Germany's adults. Three mental health indicators were observed in ~1,000 and later up to 3,000 randomly sampled participants monthly until June 2022: symptoms of depression (observed since April 2019, PHQ-2), symptoms of anxiety (GAD-2), and self-rated mental health (latter two observed since March 2021). We produced time series graphs including estimated three-month moving means and proportions of positive screens (PHQ/GAD-2 score ≥ 3) and reports of very good/excellent mental health, as well as smoothing curves. We also compared time periods between years. Analyses were stratified by sex, age, and level of education.

Results

While mean depressive symptom scores declined from the first wave of the pandemic to summer 2020, they increased from October 2020 and remained consistently elevated throughout 2021 with another increase between 2021 and 2022. Correspondingly, the proportion of positive screens first decreased from 11.1% in spring/summer 2019 to 9.3% in the same period in 2020 and then rose to 13.1% in 2021 and to 16.9% in 2022. While depressive symptoms increased in all subgroups at different times, developments among women (earlier increase), the youngest (notable increase in 2021) and eldest adults, as well as the high level of education group (both latter groups: early, continuous increases) stand out. However, the social gradient in symptom levels between education groups remained unchanged. Symptoms of anxiety also increased while self-rated mental health decreased between 2021 and 2022.

Conclusion

Elevated symptom levels and reduced self-rated mental health at the end of our observation period in June 2022 call for further continuous mental health surveillance. Mental healthcare needs of the population should be monitored closely. Findings should serve to inform policymakers and clinicians of ongoing dynamics to guide health promotion, prevention, and care.

Anxious and Angry: Early Emotional Adaptation of Medical Students in a Situational Crisis on the Example of the COVID-19 Pandemic

BACKGROUND

The COVID-19 pandemic is an example of a situational crisis resulting in emotional destabilization. The aim of the study was to analyze changes in the level of anxiety and anger in medical students during the early adaptation to the situational crisis, and to estimate the risk factors for fear and anger in this group.

METHODS

Participants were 949 medical students (M = 22.88, SD = 4.10) in the first stage on March 2020, and 748 (M = 22.57, SD = 3.79) in the second stage on June 2020. The STAI, STAXI-2, and our own questionnaire were used.

RESULTS

First vs the second stage: anxiety state (p < 0.001), anger state (p = 0.326), and feeling angry (p < 0.05). The regression model (F(14.1681) = 79.01, p < 0.001) for the level of anxiety state explains 39% of the dependent variable variance (r² = 0.39). The model for the anger-state level (F(6.1689) = 68.04, p < 0.001)-19% (r² = 0.19).

CONCLUSIONS

During the early adaptation to the situational crisis, the general level of anxiety decreased, but anger was at the same level. The anxiety was explained by contact with potentially or objective infected persons, and the level of anger was based on the need for greater social support.

Exploring the Implications of New-Onset Diabetes in COVID-19: A Narrative Review

Post-viral new-onset diabetes has been an important feature of the COVID-19 pandemic. It is not always clear if new-onset diabetes is the unmasking of a previously undiagnosed condition, the acceleration of prediabetes, or new-onset diabetes that would not have otherwise occurred. Even asymptomatic cases of COVID-19 have been associated with new-onset diabetes. Diabetes that emerges during acute COVID-19 infection tends to have an atypical presentation, characterized by hyperglycemia and potentially life-threatening diabetic ketoacidosis. It is not always clear if new-onset diabetes is type 1 or type 2 diabetes mellitus. Many cases of COVID-associated diabetes appear to be type 1 diabetes, which is actually an autoimmune disorder. The clinical course varies temporally and with respect to outcomes; in some cases, diabetes resolves completely or improves incrementally after recovery from COVID-19. Disruptions in macrophagy caused by COVID-19 infection along with an exaggerated inflammatory response that can occur in COVID-19 also play a role. Those who survive COVID-19 remain at a 40% elevated risk for diabetes in the first year, even if their case of COVID-19 was not particularly severe. A subsequent post-pandemic wave of new diabetes patients may be expected.

1.5 years pandemic - Psychological burden over the course of the COVID-19 pandemic in Germany: A nine-wave longitudinal community study

BACKGROUND

The dynamic COVID-19 pandemic has been associated with mental strain. However, most studies focused primarily on the beginning of the pandemic and rarely took into account the long-term course. The aim of this prospective-longitudinal study was to investigate levels and changes of pandemic-related fears, unspecific anxiety, depressive symptoms, and psychosocial-behavioral factors over the first 1.5 years of the pandemic.

METHODS

We conducted a nine-wave longitudinal online-survey from March 2020 to October 2021 with a total of 8148 participants of the adult general population in Germany. Descriptive examination and multilevel analysis were carried out to assess psychological burden, risk-bearing and protective psychosocial-behavioral factors, and associations with sociodemographics and the pandemic's duration and severity over the course of the pandemic.

RESULTS

Symptoms of mental strain fluctuated across the pandemic and displayed a relative maximum at the pandemic's early beginning and during the second and third COVID-19 waves. Most participants (approximately 67.4 %-82.1 %) reported mild and transient symptoms, but a substantial portion (approximately 17.9 %-32.6 %) experienced pronounced mental health problems during the pandemic. Symptom severity was negatively associated with the duration of the pandemic and positively associated with the rate of new infections.

LIMITATIONS

The observational study design, non-probability-sampling methods, and online self-report assessments limit the generalizability of our results.

CONCLUSIONS

The fluctuating course of psychological burden during the pandemic emphasizes the relevance of continuous monitoring during this challenging time. Particularly individuals with pronounced subclinical symptoms or manifesting mental disorders should be targeted with adequate prevention and early intervention programs.

Depressive symptoms in the general population before and in the first year of the COVID-19 pandemic: Results of the GEDA 2019/2020 study

Background

Study results on the impact of the COVID-19 pandemic on mental health in the first year of the pandemic are contradictory. The GEDA 2019/2020 study makes it possible to examine changes in depressive symptoms in the population.

Methods

A standardised telephone interview was used to survey a random sample of the population in Germany aged 15 and older. To exclude seasonal effects, 10,220 interviewees from the period April 2019 to January 2020 were compared with 11,900 from the period April 2020 to January 2021. Depressive symptoms were assessed with the internationally established 8-item Patient Health Questionnaire (PHQ-8).

Results

The prevalence of depressive symptoms decreased from 9.2% to 7.6% in the first year of the pandemic. Changes differ between women and men as well as between age and education groups. The analysis of individual symptoms suggests that it is not about a reduction of mental disorders of the depressive type in the narrower sense, but rather a decrease in stress-associated individual symptoms.

Conclusions

The decrease in stress-associated depressive symptoms in parts of the population can be interpreted as an indication that pandemic-related changes in everyday life and the working environment may have had a positive effect on individual areas of mental health in certain groups, at least temporarily in the first year of the pandemic. The continuing strong social inequality in depressive symptoms to the disadvantage of low education groups confirms that the need for social situation-related health promotion and prevention with regard to the living and working conditions of socially disadvantaged people must not be lost sight of in times of pandemic. For groups in the population that partly showed a worsening of symptoms in this phase of the pandemic, e.g. the diminished ability to concentrate of very old men, targeted support options should be created in the future.

Mild Cognitive Disorder in Post-COVID-19 Syndrome: A Retrospective Cohort Study of 67,000 Primary Care Post-COVID Patients

Background:

Little is known about the impact of COVID-19 on mild cognitive disorder.

Objective:

The aim of this retrospective cohort study was to investigate whether COVID-19 diagnosis is associated with subsequent mild cognitive disorder (MCD) compared to acute upper respiratory infections (AURI).

Methods:

This retrospective cohort study used data from the Disease Analyzer database (IQVIA) and included 67,046 patients with first-time symptomatic or asymptomatic COVID-19 diagnoses in 1,172 general practices in Germany between March 2020 and September 2021. Diagnoses were based on ICD-10 codes. Patients diagnosed with AURI were matched to 67,046 patients with COVID-19 using propensity scores based on sex, age, index month, and comorbidities. The index date was the diagnosis date for either COVID-19 or AURI. Associations between the COVID-19 and MCD were studied using conditional Poisson regression models.

Results:

The incidence of MCD was 7.6 cases per 1,000 person-years in the COVID-19 group and 5.1 cases per 1,000 person-years in the AURI group (IRR = 1.49, 95% CI = 1.22–1.82). The incidence rate ratio decreased strongly with increasing age from 10.08 (95% CI = 4.00–24.42) in the age group≤50 to 1.03 (95% CI = 0.81–1.31) in the age group > 70. In addition, the association between COVID-19 and MCD was significant in women (IRR: 1.70, 95% CI: 1.34–2.16) but not in men (IRR: 1.08, 95% CI: 0.75–1.56).

Conclusion

The incidence of MCD was low but significantly higher in COVID-19 than in AURI patients, especially among younger patients. If a cognitive disorder is suspected, referral to a specialist is recommended.

Factors Associated with Non-Severe Adverse Reactions after Vaccination against SARS-CoV-2: A Cohort Study of 908,869 Outpatient Vaccinations in Germany

BACKGROUND

Vaccination against SARS-CoV-2 significantly reduces the transmissibility of the virus and the likelihood of a severe course of COVID-19, and is thus a critical component in overcoming the current pandemic. The factors associated with adverse reactions after vaccination against SARS-CoV-2 have not yet been sufficiently evaluated.

METHODS

We used the Disease Analyzer database (IQVIA) to identify 531,468 individuals who received a total of 908,869 SARS-CoV-2 vaccinations in 827 general practices in Germany between April and September 2021. Cox regression models were used to analyze the frequency of vaccination-related side effects reported within 14 days after SARS-CoV-2 vaccination, as well as subjects' demographic characteristics and comorbidities.

RESULTS

The total number of side effects documented was 28,287 (3.1% of all vaccinations). Pain in the limb (24.3%), fatigue (21.0%), dizziness (17.9%), joint pain (15.7%), fever (9.5%), nausea (7.5%), and myalgia (6.4%) were the most common side effects documented among the 12,575 vaccinations with definite side effects. In the multivariate regression analysis, young age was associated with much higher odds of reported side effects (OR18-30 years: 4.45, OR31-40 years: 3.50, OR41-50 years: 2.89). In addition, pre-existing comorbidities such as dementia (OR: 1.54), somatoform disorder (OR: 1.53), anxiety disorder (OR: 1.43), depression (OR: 1.37), chronic respiratory tract disease (OR: 1.27), hypertension (OR: 1.20), and obesity (1.14) significantly increased the odds of side effects. Finally, the male sex was associated with increased odds of reported side effects (OR: 1.17).

CONCLUSION

Our study, based on a large outpatient database from Germany, identified young age, male sex, and pre-existing comorbidities such as dementia, somatoform disorders, anxiety disorders, and depression as factors associated with vaccine-related adverse events diagnosed in GP practices. These data could help to identify subgroups needing particular advice and care in the context of SARS-CoV-2 vaccinations.

Anxiety Linked to COVID-19: A Systematic Review Comparing Anxiety Rates in Different Populations

The COVID-19 pandemic has incited a rise in anxiety, with uncertainty regarding the specific impacts and risk factors across multiple populations. A qualitative systematic review was conducted to investigate the prevalence and associations of anxiety in different sample populations in relation to the COVID-19 pandemic. Four databases were utilised in the search (Medline, EMBASE, CINAHL, and PsycINFO). The review period commenced in April 2021 and was finalised on 5 July 2021. A total of 3537 studies were identified of which 87 were included in the review (sample size: 755,180). Healthcare workers had the highest prevalence of anxiety (36%), followed by university students (34.7%), the general population (34%), teachers (27.2%), parents (23.3%), pregnant women (19.5%), and police (8.79%). Risk factors such as being female, having pre-existing mental conditions, lower socioeconomic status, increased exposure to infection, and being younger all contributed to worsened anxiety. The review included studies published before July 2021; due to the ongoing nature of the COVID-19 pandemic, this may have excluded relevant papers. Restriction to only English papers and a sample size > 1000 may have also limited the range of papers included. These findings identify groups who are most vulnerable to developing anxiety in a pandemic and what specific risk factors are most common across multiple populations.

Differential impact of the COVID-19 pandemic on primary care utilization related to common mental disorders in four European countries: A retrospective observational study

BACKGROUND

The COVID-19 pandemic is commonly believed to have increased common mental disorders (CMD, i.e., depression and anxiety), either directly due to COVID-19 contractions (death of near ones or residual conditions), or indirectly by increasing stress, economic uncertainty, and disruptions in daily life resulting from containment measure. Whereas studies reporting on initial changes in self-reported data frequently have reported increases in CMD, pandemic related changes in CMD related to primary care utilization are less well known. Analyzing time series of routinely and continuously sampled primary healthcare data from Sweden, Norway, Netherlands, and Latvia, we aimed to characterize the impact of the pandemic on CMD recorded prevalence in primary care. Furthermore, by relating these changes to country specific time-trajectories of two classes of containment measures, we evaluated the differential impact of containment strategies on CMD rates. Specifically, we wanted to test whether school restrictions would preferentially affect age groups corresponding to those of school children or their parents.

METHODS

For the four investigated countries, we collected time-series of monthly counts of unique CMD patients in primary healthcare from the year 2015 (or 2017) until 2021. Using pre-pandemic timepoints to train seasonal Auto Regressive Integrated Moving Average (ARIMA) models, we predicted healthcare utilization during the pandemic. Discrepancies between observed and expected time series were quantified to infer pandemic related changes. To evaluate the effects of COVID-19 measures on CMD related primary care utilization, the predicted time series were related to country specific time series of levels of social distancing and school restrictions.

RESULTS

In all countries except Latvia there was an initial (April 2020) decrease in CMD care prevalence, where largest drops were found in Sweden (Prevalence Ratio, PR = 0.85; 95% CI 0.81-0.90), followed by Netherlands (0.86; 95% CI 0.76-1.02) and Norway (0.90; 95% CI 0.83-0.98). Latvia on the other hand experienced increased rates (1.25; 95% CI 1.08-1.49). Whereas PRs in Norway and Netherlands normalized during the latter half of 2020, PRs stayed low in Sweden and elevated in Latvia. The overall changes in PR during the pandemic year 2020 was significantly changed only for Sweden (0.91; 95% CI 0.90-0.93) and Latvia (1.20; 95% CI 1.14-1.26). Overall, the relationship between containment measures and CMD care prevalence were weak and non-significant. In particular, we could not observe any relationship of school restriction to CMD care prevalence for the age groups best corresponding to school children or their parents.

CONCLUSION

Common mental disorders prevalence in primary care decreased during the initial phase of the COVID-19 pandemic in all countries except from Latvia, but normalized in Norway and Netherlands by the latter half of 2020. The onset of the pandemic and the containment strategies were highly correlated within each country, limiting strong conclusions on whether restriction policy had any effects on mental health. Specifically, we found no evidence of associations between school restrictions and CMD care prevalence. Overall, current results lend no support to the common belief that the pandemic severely impacted the mental health of the general population as indicated by healthcare utilization, apart from in Latvia. However, since healthcare utilization is affected by multiple factors in addition to actual need, future studies should combine complementary types of data to better understand the mental health impacts of the pandemic.