Onset and frequency of depression in post-COVID-19 syndrome: A systematic review

Extracellular vesicles in mood disorders: A systematic review of human studies

Extracellular vesicles (EVs) are small, membrane-bound particles that are naturally released by nearly all cell types in the body. They serve as molecular biosignatures, reflecting the state of their cells of origin and providing a non-invasive peripheral marker of central nervous system (CNS) activity under physiological and pathological conditions. We conducted a systematic review (ID: CRD42024528824) of studies investigating the use of EVs in mood disorders within clinical populations. We screened articles indexed in PubMed, EMBASE, Scopus, ISI Web of Science, and APA PsycInfo from January 2010 to October 2024. Available research has focused on four key areas: (1) EV cargo as mechanistic and diagnostic biomarkers; (2) EV cargo as predictive or tracking biomarkers for antidepressant response; (3) EV cargo and neuroimaging correlates; and (4) EV physical properties. Most studies examined major depressive disorder (MDD), with others addressing bipolar disorder (BD), adolescent depression, postpartum depression, and late-life depression. Notably, only 35,55 % of the studies utilized brain-derived EVs. Through analyses of EV-derived miRNA, proteins, mtDNA, and metabolites, these studies have explored neural mitochondrial function, brain insulin resistance, neurogenesis, neuroinflammation, and blood-brain barrier permeability in the context of mood disorders. Some EV-derived markers demonstrated diagnostic and predictive potential. This review discusses key findings, limitations of current research, and future directions for leveraging EVs in the study of mood disorders.

Long-term consequences of COVID-19 on sleep, mental health, fatigue, and cognition: a preliminary study

INTRODUCTION

Post-COVID-19 Syndrome (PCS) is defined as symptoms persisting beyond 12 weeks from the onset of symptoms. Notably, COVID-19 has been associated with long-term effects on the brain and mental health. This cross-sectional study aims to investigate depression, fatigue, sleep quality, and cognitive dysfunction, particularly working memory, in individuals with PCS compared to a healthy control group.

MATERIAL AND METHODS

Between April and December 2021, 45 COVID-19 individuals and 60 healthy individuals met the eligibility criteria. Demographic information and the Montreal Cognitive Assessment were collected. Two visual working memory tasks, Delayed Match-to-Sample (DMS) and n-back, were performed, along with self-report questionnaires: Beck Depression Inventory, Modified Fatigue Impact Scale, and Pittsburgh Sleep Quality Index.

RESULTS

A total of 105 participants were enrolled. Findings reveal that the PCS group exhibited notably higher levels of cognitive impairment (13.3% vs. 1.6%, p = 0.04), depression (53.9% vs. 25.9%, p = 0.03), and sleep disturbances (53.9% vs. 18.6%, p = 0.01) compared to the healthy control group. Sleep latency and sleep duration were particularly affected. No significant differences in working memory function were observed between the two groups (p = 0.90 for DMS and p = 0.98 for n-back).

CONCLUSION

The study highlights the higher prevalence of sleep disturbance, depression, and cognitive impairment in the PCS phase, with inflammation likely playing a significant role. Moreover, the study suggests that untreated depression and sleep disturbances may pose long-term risks for dementia. Understanding the underlying mechanisms is crucial for developing effective interventions and support for individuals recovering from the infection. Prospective longitudinal studies with larger and more diverse samples are warranted to confirm and expand upon these findings.

Predictors of COVID-Related stress in a community sample in Turkey: a cross-sectional study

The distinctive mental health features associated with COVID-19 have gained importance as the psychological effects of the pandemic on the community become more visible. This study aims to assess the COVID-related stress status and associated factors in the community sample of Turkey. The sample of this cross-sectional study is composed of 2.065 people between the ages of 18-90. Data were collected through an online survey prepared by Google.docs between October-December, 2020. Mild to moderate stress was found in the community with the most common symptoms of the fear of contamination and danger. Some variables, such as being female and the severity of COVID-19 illness, were associated with higher COVID-related stress. Vulnerable groups associated with high stress should be monitored during the pandemic. The findings of this study will guide the practices of professionals working in the field of public health, healthcare, or mental health in possible future pandemics.

The Impact of Long COVID on Employment and Well-Being: A Qualitative Study of Patient Perspectives

BACKGROUND

Exploring the experiences of Long COVID patients who face challenges with employment may inform improvements in how healthcare systems can provide holistic care for this patient population.

OBJECTIVE

Understand perspectives about the impact of Long COVID on employment and well-being among patients seeking healthcare for Long COVID.

DESIGN

Qualitative study involving one-on-one interviews.

PARTICIPANTS

Eligible participants were 18 years of age or older, spoke English, self-reported as doing well in daily life before having COVID-19, and reported that COVID-19 was still having a significant impact on their life three or more months following an acute infection.

APPROACH

Participants were recruited from a post-COVID recovery clinic at an academic medical center. Interviews were conducted from August to September 2022.

KEY RESULTS

Among all participants (N = 21), most described that they were not able to work at a capacity equivalent to their norm pre-COVID-19. For those who continued working after their COVID-19 infection, the effort and energy required for work left little capacity to participate in other life activities and made it difficult to attend recommended healthcare appointments. Participants reported financial impacts of changes in employment including loss of income and changes in insurance, which were compounded by high healthcare costs. Changes in employment resulted in emotional repercussions including feelings of loss of self-identity and fear of judgement at work. Participants discussed issues surrounding access to strategies to address challenges posed by the impact of Long COVID on employment, including strategies learned from healthcare providers to cope with Long COVID symptoms at work and efforts to seek disability benefits or workplace accommodations.

CONCLUSIONS

Patients with Long COVID may face significant challenges due to changes in their ability to work. Healthcare providers can support these patients by connecting them to financial assistance resources, facilitating appropriate mental health treatment, and expediting workplace accommodation requests.

Cyclodextrin-Based Drug Delivery Systems for Depression: Improving Antidepressant Bioavailability and Targeted Central Nervous System Delivery

Cyclodextrin (CD)-based drug delivery systems have emerged as a promising strategy to overcome limitations commonly encountered in antidepressant therapy, including low bioavailability, poor solubility, and suboptimal penetration of the blood-brain barrier. This review synthesizes current evidence demonstrating that complexing various classes of antidepressants-such as tricyclic antidepressants (TCAs), selective serotonin reuptake inhibitors (SSRIs), and atypical antidepressants-with β-CD or its derivatives significantly enhances drug solubility and stability. In addition, encapsulation with CDs can diminish systemic toxicity and improve pharmacokinetics, thereby helping to optimize dosage regimens and reduce adverse effects. Analysis of published in vitro and in vivo studies indicates that CD formulations not only boost therapeutic efficacy but also enable sustained or targeted release, which is critical for drugs requiring precise plasma and tissue concentrations. When compared to other carriers (e.g., liposomes, polymeric nanoparticles, dendrimers), CD-based systems often stand out for their ease of formulation, biocompatibility, and cost-effectiveness, although limited drug-loading capacity can be a drawback. We recommend expanding in vivo trials to substantiate the clinical benefits of CD-antidepressant complexes, particularly for treatment-resistant cases or specific subpopulations (e.g., elderly and pediatric patients). Additional investigations should also explore hybrid systems-combining CDs with advanced nano- or macroparticles-to amplify their advantages and address any limitations. Ultimately, integrating CDs into antidepressant regimens holds substantial potential to refine therapy outcomes, reduce adverse events, and pave the way for more personalized, effective interventions for depression.

The relationship between cognitive function and neuropsychiatric disorders with quantitative electroencephalogram (qEEG) on long COVID syndrome patients

Background

The COVID-19 pandemic has resulted in long-term consequences for a subset of affected individuals, known as long COVID syndrome. The neurological and psychiatric effects of this condition remain incompletely understood. This study aims to evaluate heightened common mental disorders in long COVID through assessing psychiatric, cognitive, neurophysiological aspects, and emphasizing lasting mental health impacts.

Methods

This cross-sectional study compared patients with long COVID to those who had recovered from COVID-19 without residual symptoms using quantitative electroencephalogram (qEEG) analysis. We conducted qEEG analyses, and Montreal Cognitive Assessment (MoCA) and Self-Rating Questionnaire (SRQ) tests on participants. Analyses included brain spectrum examination, hemispheric asymmetry, and inter-electrode connectivity.

Results

Analyses revealed lower MoCA scores in the memory domain were lower in the long COVID group (Mann Whitney Utest), indicating that individuals with long COVID experience more substantial cognitive deficits. There is no statistical difference for spectrum examination and hemispheric asymmetry observed in the qEEG data between the COVID and long COVID groups. Connectivity analysis showed statistically significant higher connectivity in temporal-occipital (T6-O2) in long COVID groups (Mann Whitney Utest).

Conclusion

Our findings underscore the persistent neuropsychiatric impact of COVID-19, particularly in long COVID patients. Notably, working memory deficits in MoCA scores were identified as one of the most frequent neuropsychological symptoms in these individuals. Decreased brain connectivity indicates cognitive-sensorimotor decline and is confirmed by the frequent brain fog symptoms in long COVID.

Predictors for Anxiety and Stress in Long COVID: A Study in the Brazilian Population

Anxiety and stress are major challenges for public health and represent significant symptoms in long COVID. Despite the repercussions on quality of life and mental health, their impacts have not been systematically consolidated in the Brazilian population. Our objective was to analyze the indicators and predictors of anxiety and perceived stress in people who have experienced long COVID in different regional contexts in Brazil. This cross-sectional survey was carried out in the five regions of Brazil and included 4239 adult individuals who had at least one diagnosis of COVID-19. Participants responded to questions on the Depression, Anxiety, and Stress Scale (DASS-21). The GAMLSS class of regression models estimated the predictors associated with the outcomes investigated. The results showed a predominance of participants with a single diagnosis of COVID-19 (65.4%), mild clinical conditions (89.5%), and high adherence to immunization strategies (98.4%). Overall, 48.5% of participants had residual symptoms that started between 4 and 12 weeks after the acute phase of COVID-19 infection. Positive screening for anxiety and perceived stress was associated with female gender, diagnosis of chronic diseases, presence of physical symptoms, moderate or severe clinical condition in the acute phase of the infection, and the need for hospitalization. Through this study, we confirmed that anxiety and stress, developed or exacerbated during the post-COVID-19 phase, represent significant challenges in the Brazilian population. Sociodemographic, clinical, and care conditions were predictors of the outcomes assessed. Knowing these repercussions can allow for personalizing mental health care and help structure evidence-based public policies.

Systolic Pulmonary Artery Pressure as Long-Term Mortality Predictor in Elderly Critically Ill with Severe COVID-19 Pneumonia

BACKGROUND

COVID-19 can cause acute pulmonary hypertension (PH), worsening outcomes in critically ill elderly patients. Point-of-care ultrasound (POCUS), assessing right ventricular hemodynamics, predicts short-term outcomes. This study examines the long-term impact of acute PH on mortality in elderly COVID-19 patients.

METHODS

This retrospective long-term study analyzed data from patients over 70 years old with severe COVID-19 pneumonia admitted to a mixed 25-bed, level 3 intensive care unit (ICU). POCUS focused on systolic pulmonary artery pressure (sPAP) at admission. Mortality was evaluated 1000 days post-admission.

RESULTS

The study included 130 patients, comprising 30 long-term survivors and 100 non-survivors, with a cumulative long-term mortality rate of 77%. Non-survivors had significantly higher sPAP values (39.1 ± 12.8 vs. 30.4 ± 9.2, p = 0.04), which were associated with long-term mortality in survival analysis.

CONCLUSION

Acute pulmonary hypertension (PH), reflected by elevated systolic pulmonary artery pressure (sPAP), is strongly associated with long-term mortality in elderly critically ill COVID-19 patients. Early assessment of sPAP via POCUS may help identify high-risk patients and guide management strategies to improve outcomes.

Depressive symptomatology in Brazil: perspectives of statistical and psychometrics analyses of the PHQ-9 at four time-points (2020-2023) in the COVID-19 pandemic

The present research assessed the psychometric properties of the Patient Health Questionnaire-9 (PHQ-9) through an examination of its internal structure, invariance analysis, and standardization. Social distribution analyses of the measure were conducted using linear and binomial logistic regression. The sample consisted of 10,069 adults from all 27 states in Brazil. The data were obtained through four collections across different years of the COVID-19 pandemic (2020, 2021, 2022, and 2023), using independent samples. Confirmatory Factor Analysis (CFA) indicated that the measure is unidimensional with satisfactory fit indices. The model was invariant in relation to the variables investigated at four different levels (configural, metric, scalar, and strict). The standardization supported hypothetical cut scores indicating the severity of depressive symptoms, categorized as very low (0 to 6), low (7 to 13), moderate (14 to 19), high (20 to 23), and very high (≥ 24). We found that sex/gender, skin color/ethnicity, age, education level, and year of the pandemic were predictors of depressive symptoms in the adjusted linear regression analysis. The logistic regression showed variables with higher chances for a positive screening diagnosis of depression, with adjusted Odds Ratio as follows: years 2021 (ORadj = 1.275) and 2023 (ORadj = 1.409), women (ORadj = 1.900), Pardos individuals (ORadj = 1.252), education up to high school (ORadj = 1.272), being a northeast region resident (ORadj = 2.127), and younger people (ORadj = 1.716). The findings of this study indicate the suitability of the PHQ-9 for assessing depression in the population and recommend its use for monitoring depressive symptoms in the coming years in Brazil. Clinical implications include developing interventions to address the psychological impact of this and any future health crises.

Definitions and symptoms of the post-COVID syndrome: an updated systematic umbrella review

Post-COVID syndrome (PCS) describes a persistent complex of symptoms following a COVID-19 episode, lasting at least 4 to 12 weeks, depending on the specific criteria used for its definition. It is often associated with moderate to severe impairments of daily life and represents a major burden for many people worldwide. However, especially during the first two years of the COVID-19 pandemic, therapeutic and diagnostic uncertainties were prominent due to the novelty of the disease and non-specific definitions that overlooked functional deficits and lacked objective assessment. The present work comprehensively examines the status of PCS definitions as depicted in recent reviews and meta-analyses, alongside exploring associated symptoms and functional impairments. We searched the database Pubmed for reviews and meta-analysis evaluating PCS in the period between May 31, 2022, to December 31, 2023. Out of 95 studies, 33 were selected for inclusion in our analyses. Furthermore, we extended upon prior research by systematically recording the symptoms linked with PCS as identified in the studies. We found that fatigue, neurological complaints, and exercise intolerance were the most frequently reported symptoms. In conclusion, over the past eighteen months, there has been a notable increase in quantity and quality of research studies on PCS. However, there still remains a clear need for improvement, particularly with regard to the definition of the symptoms necessary for diagnosing this syndrome. Enhancing this aspect will render future research more comparable and precise, thereby advancing and understanding PCS.

Impact of underlying diseases and complications on COVID-19 mortality in South Korea: analysis of national health insurance service data

BACKGROUND

Comorbidities or complications significantly influence coronavirus disease-2019 (COVID-19) severity and mortality risk. Therefore, this study aimed to compare treatment outcomes of COVID-19 inpatients by underlying diseases or complications.

METHOD

Data on COVID-19 patients from the National Health Insurance Service customized research database were analyzed while focusing on eight underlying diseases and complications: diabetes, hypertension, heart disease, kidney disease, liver disease, dementia, depression, and respiratory disease.

RESULTS

Of the 377,812 COVID-19 patients in 2021, 51.47% were male and 48.53% were female, and post-diagnosis mortality was 2.04%; 68.7% (n = 259,560) of patients had at least one underlying condition, with the following frequency: respiratory disease (78.88%), heart disease (33.84%), hypertension (30.29%), liver disease (21.38%), depression (9.32%), kidney disease (4.89%), and dementia (3.87%). Among patients without any underlying diseases, 19.8% (n = 74,925) were treated for post-diagnosis complications, with the following frequency: respiratory disease (89.21%), liver disease (19.12%), heart disease (14.90%), diabetes (10.37%), hypertension (8.22%), depression (3.86%), kidney disease (2.04%), and dementia (0.64%). Except for liver disease, all underlying diseases were associated with mortality. COVID-19 patients with diabetes exhibited a 1.42-fold higher mortality risk (95% confidence interval [CI ]1.35-1.50). All complications were associated with death, with kidney-related complications conferring a 4.84-fold higher mortality risk (95% CI 3.62-6.48).

CONCLUSION

Underlying diseases and complications in COVID-19 patients were associated with death. Even with the same disease, the timing of onset, before or after COVID-19 diagnosis, induced a difference in the mortality risk. Both underlying diseases and complications should be considered for more proactive medical interventions.

Sparse Bernoulli mixture modeling with negative-unlabeled data: an approach to identify and characterize long COVID

SARS-CoV-2-infected individuals have reported a diverse collection of persistent and often debilitating symptoms commonly referred to as long COVID or post-acute sequelae of SARS-CoV-2 (PASC). Identifying PASC and its subphenotypes is challenging because available data are "negative-unlabeled" as uninfected individuals must be PASC negative, but those with prior infection have unknown PASC status. Moreover, feature selection among many potentially informative characteristics can facilitate reaching a concise and easily interpretable PASC definition. Therefore, to characterize PASC and the spectrum of PASC subphenotypes while identifying a minimal set of features, we propose a Bernoulli mixture model with novel parameterization to accommodate negative-unlabeled data and Bayesian priors to induce sparsity. We present an efficient expectation-maximization algorithm for estimation, and a grid search procedure to select the number of clusters and level of sparsity. We evaluate the proposed method with a simulation study and an analysis of data on self-reported symptoms from the ongoing Researching COVID to Enhance Recovery-Adult Cohort study.

Neuropsychological outcome of indoor rehabilitation in post-COVID-19 condition-results of the PoCoRe study

Background

Post COVID-19 condition (PCC) is increasingly recognized as a debilitating condition characterized by persistent symptoms following SARS-CoV-2 infection. Neuropsychological deficits, including cognitive impairments and fatigue, are prevalent in individuals with PCC. The PoCoRe study aimed to evaluate the burden of neuropsychological deficits in PCC patients undergoing multidisciplinary indoor rehabilitation and to describe possible changes in this symptomatology.

Methods

The PoCoRe study, a prospective, non-randomized, controlled longitudinal study, recruited PCC patients from six German indoor rehabilitation centers. Eligible participants underwent comprehensive neuropsychological assessments at admission and discharge. Various measures were employed, including the fatigue scale for motor functioning and cognition (FSMC), the Test Battery for Attention (TAP) and the Montreal Cognitive Assessment (MoCA).

Results

Out of the 1,086 recruited participants, a total of N = 701 participants were included in the main data analysis. The prevalence of fatigue on admission was high (84.6%) and decreased significantly by discharge (77.4%), with a mild effect size. Reaction times on the alertness subtest were abnormal in 70% of patients on admission and 50% on discharge. Sustained attention was abnormal in 55% of patients on admission, decreasing to 43% on discharge. These differences were significant with mild effect sizes. Furthermore, of the 27% of participants with pathological MoCA scores at admission, 63% improved to normative levels during rehabilitation, indicating a significant treatment effect (p ≤ 0.001). However, the MoCA demonstrated limited sensitivity in detecting attention deficits.

Conclusion

The PoCoRe study highlights the high prevalence of neuropsychological deficits and fatigue in PCC patients, with notable improvements observed following multidisciplinary rehabilitation. Challenges remain in accurately identifying and addressing these deficits, underscoring the importance of comprehensive neuropsychological assessment and tailored rehabilitation interventions. Further research is warranted to optimize screening tools and enhance neuropsychological care for PCC patients in both rehabilitation and outpatient settings.

Could probiotics be used as a novel therapeutic approach to alleviate the reproductive and neurobehavioral side effects of sertraline? A study in male mice

There are still few studies that have investigated the impact of sertraline (SE) on fertility, as well as adjuvant treatments that alleviate its side effects. Thus, the present study aimed to investigate the impact of SE on reproductive and neurobehavior parameters and verify whether the probiotic Lactobacillus rhamnosus alleviates the side effects of SE. After carrying out a dose-response study with SE, experiment II was conducted. Thus, male mice were distributed into four experimental groups (n=8-9/group): control (CO)-received filtered water (vehicle); sertraline group (S)-received 20 mg/kg of SE, diluted in the vehicle; probiotic (P)-received the probiotic Lactobacillus rhamnosus (1×109 CFU) diluted in the vehicle; and SP group that received both probiotic and SE. The treatment occurred/lasted for 30 days. At the end of treatment, behavioral aspects were analyzed. After euthanasia, the organs were weighed, the histology of the testis and epididymis were analyzed, and the sperm quality and also natural fertility were verified. Complementarily, in vitro assays were carried out to verify whether sertraline could affect sperm capacitation and embryonic development. The results showed that the SP group, compared to S, did not reduce body weight and seminal gland weight and presented a lower number of resorptions. Notably, the rate of resorption in both the SP and S groups was similar to that of the control group. It was also observed that the S group was less exploratory and more anxious than the SP group. Thus, the present study demonstrated that SE has an impact on the reproductive system and neurobehavior. Therefore, for the first time, we demonstrate that the probiotic can alleviate the side effects of SE.

Main Predictors of Decreasing in Quality of Life in Patients With Post-COVID-19: A Cross-Sectional Study

OBJECTIVE

We aimed to assess physical and psychosomatic manifestations of patients with long COVID and their association with a decreased patient's quality of life (QOL) or different times elapsed since the COVID-19 diagnosis.

METHODS

This is a cross-sectional study. We retrospectively collected the clinical characteristics of adult patients who had tested positive for SARS-CoV-2 and had symptoms at least as early as 4 weeks after COVID-19 in México City between April 2020 and February 2021. A total of 179 were included. They answered questions to define chronic symptoms. The Sniffin' Sticks Screening 12 test olfactory evaluation was performed. The diminish of QOL was defined by ≥10 points in the EuroQol visual analog scale between pre- and post-COVID-19, and each dimension of EQ-5D-5L test was evaluated. Chi-square test, Fisher's exact test, Student t test, Wilcoxon rank-sum, and signed-rank test were used as required. A backward stepwise logistic regression analysis determined the factors associated with a decrease in QOL. All analyses were performed using R software version 3.6.3 (R Foundation).

RESULTS

In the multivariable analysis, post-COVID-19 pain/discomfort (adjusted odds ratio [aOR] 2.5 [1.66-9.68]; P = .01), anxiety/depression (aOR 13 [1.44-17.23]; P = .03), and persistence of ≥3 symptoms (aOR 2.6 [0.96-7.47]; P = .05) remained statistically significant associated with decreased QOL.

CONCLUSIONS

Patients with long COVID-19 have decreased QOL mainly associated with pain/discomfort, anxiety/depression, and ≥3 persistent symptoms. Our findings enhanced the notion of a strong psychosomatic factors involved with long COVID-19. Therefore, these patients might benefit from neuropsychological rehabilitation, although the effect of such interventions should be evaluated.

Long COVID: A risk factor for anxiety, depression, and suicidality?

In many COVID-19 survivors, symptoms continue for a long time. This study aims to examine the relationship between the long-term effects of COVID-19, levels of anxiety and depression, and suicidal ideation with sociodemographic factors and symptoms. A cross-sectional study was conducted on patients who came for control at least 3 months after having COVID-19 disease, in the stable period, and still have symptoms after COVID-19. Demographic characteristics, symptoms, The Beck Depression Scale (BDS), The Beck Anxiety Scale (BAS), and suicidal ideation were assessed with face-to-face questionnaires. A total of 490 patients participated in the study. Thirty percent of patients scored positive on the BDS and 46% scored high on the BAS. Female sex was found to be a risk factor. Anxiety and depression were found to be significantly associated with long COVID symptoms. Both BAS and BDS scores were significantly higher in people with suicidality compared to others, and long-term symptoms were found to be statistically associated with this situation. Depression and anxiety are common in cases of long COVID. It is important for healthcare professionals to be aware of these potential mental health consequences, especially suicidality, and to provide appropriate support and interventions for individuals with long COVID.

The short-term impacts of COVID-2019 on depressive symptoms and cognitive decline: A community-based cohort study

Background

Neurological and psychological sequelae may persist after the infection of coronavirus disease 2019 (COVID-19). Depression and cognitive decline could increase the risk of Alzheimer's disease.

Objective

To estimate the impacts of COVID-19 on depressive symptoms and cognitive decline.

Methods

The data was from Beijing Research on Ageing and Vessel (BRAVE), which included all residents in the Xishan community. The first wave survey was performed from October to November 2019 (baseline) before the COVID-19 pandemic. The second wave survey was interrupted into two periods due to the introduction of the Ten New Measures, from October to November 2022 (no participants were infected) and from March to April 2023 (most participants were infected), providing an excellent opportunity to investigate the short-term impacts of COVID-19 on depressive symptoms and cognitive function with linear mixed models.

Results

Among a total of 1012 participants, the median (interquartile range, IQR) age at baseline was 60.00 (56.00, 65.00) years, with 374 (36.96%) men and 479 participants COVID-19 infected. Compared with uninfected participants, the infected did not suffer pronounced depressive symptoms (β = -0.047; 95% CI -0.204 to 0.110) and accelerated declines in global cognition (β = 0.116; 95% CI -0.001 to 0.234) from wave 1 to wave 2. Sensitive analyses shared generally consistent findings.

Conclusions

The impacts of COVID-19 infection on depressive symptoms and cognitive decline were not significant among participants in the BRAVE cohort. Further research is needed to investigate the long-term impacts on neurological and psychiatric symptoms.

The Mental Health Paradox of COVID-19 Prevention: Adherence, Fatigue, and Depression in a Longitudinal Perspective

OBJECTIVES

The COVID-19 pandemic presented significant challenges, particularly the psychological impact of prolonged preventive measures. This study aimed to explore the longitudinal relationships among adherence, anti-pandemic fatigue, and depression, focusing on how these dynamics evolved.

METHODS

A prospective longitudinal survey was conducted among 627 adults in Hong Kong during the pandemic across 3 waves. Repeated measures ANOVA, cross-lagged path modeling, and mediation model were employed to assess temporal relationships among adherence, anti-pandemic fatigue, and depression.

RESULTS

Adherence at T3 significantly predicted T4's anti-pandemic fatigue (B = 0.196, SE = 0.055) and depression (B = 1.690, SE = 0.247), and anti-pandemic fatigue significantly predicted T4's depression (B = 0.684, SE = 0.260). These effects diminished at later waves, reflecting psychological relief as restrictions eased. Notably, adherence was found to increase anti-pandemic fatigue, which in turn exacerbated depressive symptoms.

CONCLUSION

While relationships varied over the 3 time points, the longitudinal design has clarified the causal inference. The study highlights the mental toll of prolonged restrictions and emphasizes the importance of designing integrative strategies that support adherence while addressing fatigue and depression. These findings offer actionable insights for primary care and community health programs in managing future public health emergencies.

Mood disorders after COVID-19 infection: a single-center experience

Objectives

The present study aimed to examine mood disorders in patients discharged from the hospital due to Coronavirus Disease-19 (COVID-19).

Methods

The study included patients who were admitted to Akdeniz University with the diagnosis of COVID-19. Post-Traumatic Stress Disorder (PTSD) Checklist - Civilian Version (PCL-5), and Beck Anxiety and Depression Inventories were administered to the patients at least 30 days after discharge.

Results

A total of 215 patients were included. The median age was 56 years, and 60.9%(131) were male. There was no statistically significant difference in mood disorders scale scores between male and female. However, there was a weak negative correlation between age and PCL-5 scores (rho: -0.157, p: 0.021). The depression scores (p < 0.001), anxiety scores (p < 0.001) and PCL-5 (p = 0.001) scores were statistically significantly higher in patients with respiratory symptoms at the time of enrollment (after a mean duration of 87.9 days following discharge). Married individuals had statistically significantly lower anxiety, depression, and PCL-5 scores. Beck anxiety scores were statistically significantly higher in patients receiving systemic steroid.

Conclusion

A substantial portion of patients with COVID-19 suffer from mood disorders after hospital discharge. Those patients with residual symptoms who live alone and receive corticosteroid represent a vulnerable population.

Photobiomodulation: shining a light on depression

Depression is a prevalent public health issue, characterized by persistent low mood, impaired concentration, and diminished motivation. Photobiomodulation (PBM), which involves the application of red or near-infrared light, modulates physiological processes by enhancing cerebral blood flow, reducing inflammation, inhibiting apoptosis, and promoting neurogenesis. PBM can be administered transcranially or through systemic approaches, offering a potentially effective intervention for depression. This review discusses the characteristics of PBM, its underlying neurobiological mechanisms, and relevant physical parameters. Recent progress in both animal and clinical research underscores PBM's therapeutic potential for depression and emphasizes the need for further studies to establish a robust theoretical basis for standardized treatment protocols.

Persistent post COVID-19: Implications for women's health research and policy from members of the Women's Health Expert Panel of the American Academy of Nursing

BACKGROUND

Despite that globally the percent of women and men who tested positive for COVID-19 appears equal and that men with COVID-19 were 60% more likely than women to be severely ill and to die from complications (Rozenberg et al., 2020), studies of sex differences show that women compared with men are more likely to manifest persistent post-COVID-19 syndrome (PPCS).

PURPOSE

In this paper, we address some of the extant evidence for impact of the PPCS on women's health and well-being to underpin our suggestions for research and policy considerations.

METHODS

We assessed key papers in the extant literature to formulate views on needed health-related research and policies.

DISCUSSION

We discuss how key PPCS manifestations vary by sex, resemble sequelae uncovered for other chronically fatiguing or serious postinfectious trauma conditions, influence women's reproductive health (e.g., menstrual cycle, fertility, pregnancy, and menopause transition), impair women's social function and economic productivity, and challenge what is required for influential treatment and prevention.

CONCLUSION

To inform effective diagnosis, management and prevention of the significantly prevalent and debilitating PPCS, high on research and policy agendas should be uncovering multidimensional evidence of the impact on women, especially on their overall and reproductive health, well-being, social function and economic productivity.

Cognition, function, and mood post-COVID-19: Comparative analysis using the health and retirement study

Millions of Americans endure post-COVID conditions (PCC), yet research often lacks pre-illness measurements, relying primarily on follow-up assessments for analysis. The study aims to examine the prevalence of PCC, including cognitive impairment, functional limitation, and depressive symptoms, along with relevant risk factors, while controlling for individuals' pre-illness status measured in 2018. A cross-sectional retrospective study utilized the 2018 and 2020 Health and Retirement Study surveys. Sample included individuals with COVID-19 (n = 409; average age 64) and individuals without COVID-19 (n = 8689; average age 59). COVID-19 positive: Individuals with positive tests, physician diagnoses, emergency room visits, or hospitalizations for COVID-19 between 2019-2020. Cognition was assessed using immediate and delayed word-recall tests, serial seven subtractions, and backward counting. Functional status was measured using limitations in activities of daily living (ADLs) and instrumental ADLs. Depressive symptoms were measured using the modified Center for Epidemiology Studies Depression scale. Participants' perception of experiencing PCC was collected. Logistic regression and propensity score matching were employed for these analyses. Among 409 COVID-19-positive respondents (14% hospitalized), 24% exhibited new impairments after COVID-19 infection. Noteworthy increases in functional limitation (OR [95% CI]: 2.18 [0.95, 0.97], p < 0.001) and a marginal rise in cognitive impairment (1.79 [0.99, 3.32], p = 0.053) following COVID-19 infection were observed in comparison to their pre-COVID-19 baseline. Compared to 8689 non-COVID-19 cases, the 409 COVID-19 positives showed increased functional decline (1.78 [1.26, 2.51], p = 0.001) and depressive symptoms (1.41 [1.04, 1.91], p = 0.03). Factors associated with PCC included pre-existing impairments, lower education, female gender, prior hospitalization, higher comorbidity, lower wealth, and mild COVID-19. A notable number of respondents, especially older individuals with fewer pre-existing health conditions, experienced PCC without awareness. Compared to an individual's pre-illness baseline and uninfected individuals, being positive for COVID-19 raised the risk of functional limitation, depressive symptoms, and cognitive impairment. Additionally, addressing PCC through both subjective and objective approaches is essential to alleviate individual and societal burdens.

Anxiety and depression among individuals with long COVID: Associations with social vulnerabilities

BACKGROUND

We examined the association between symptoms of anxiety and depression among individuals with long COVID and five social vulnerabilities (expenses, employment, food insufficiency, housing, and insurance).

METHODS

Data from the Census Bureau's Household Pulse Survey (HPS) detailing COVID incidence, duration, and symptoms between June 1st and November 14th, 2022 contained versions of the Generalized Anxiety Disorder (GAD-2) and the Patient Health Questionnaire (PHQ-2) questionnaires. Associations between anxiety, depression, and the five social vulnerabilities among respondents from different racial and ethnic groups experiencing long COVID were evaluated using generalized binomial logistic regression. Structural equation models tested whether social vulnerabilities mediated the pathway between race/ethnicity and anxiety/depression.

RESULTS

Blacks, Asians/others, and Hispanics with long COVID were significantly more likely to report anxiety and depression and various social vulnerabilities than Whites. Anxiety among Blacks was significantly associated with difficulty with expenses [Odds Ratio (OR) = 1.743, 95 % Confidence Interval (CI) = 1.739, 1.747], employment (OR = 1.519, 95 % CI = 1.516, 1.523), and housing (OR = 1.192, 95 % CI = 1.19, 1.194). Anxiety among Hispanics was significantly associated with food insufficiency (OR = 1.048, 95 % CI = 1.044, 1.052). Depression among Blacks was significantly associated with trouble with expenses (OR = 1.201, 95 % CI = 1.198, 1.205) and employment (OR = 1.129, 95 % CI = 1.127, 1.132). Mediation analysis showed that the number of social vulnerabilities partially mediated the association between race and anxiety.

LIMITATIONS

This retrospective study utilized secondary, observational, self-reported data from the HPS. Therefore, results may not be generalizable outside of the context in which they were collected.

CONCLUSIONS

The development of tailored programs for population health should address the differential associations of anxiety and depression with social difficulties among racial and ethnic groups.

Pharmacotherapy and psychotherapy in depression - complementarity or exclusion?

Purpose

This article attempts to outline the dilemma regarding the use of pharmacotherapy and psychotherapy in the treatment of mental disorders with particular emphasis on depression. Depressive disorder is one of the most common mental disorders suffered by society; it affects from 5% to over 12% of the population [1]. It is also a growing problem as the number of diagnoses has increased over the last decades.

Views

The numerous organisations working to improve mental health have constructed guidelines focused on shaping preventive intervention and therapeutic procedures. However, the method of selecting a procedure remains unclear, with the choice between pharmacotherapy and psychotherapy being particularly troublesome. This begs the question of whether these forms of interaction are complementary or exclusive. The article provides an overview of the current discussion on the legitimacy of using multiple forms of interactions when treating depression. Currently, the treatment of depression is based primarily on pharmacotherapy using antidepressants and psychotherapy as well as combined treatment.

Conclusions

Although a diverse range of psychotherapeutic approaches are used to treat depression, research indicates that all leading approaches are similarly effective. Pharmacotherapy and psychotherapy offer comparable effectiveness in reducing depressive symptoms and demonstrate similar effects on neuronal activity. Combined treatment may offer optimal effectiveness, especially with moderate and severe symptoms of depression.

Post-Coronavirus Disease 2019 Effects in an Active University Population: A Within-Campus Cross-Sectional Study at a Major Educational Institution

Objective

To evaluate the associations among post-coronavirus disease 2019 (COVID-19) prevalence; risk factors and comorbidities have not been firmly established within a university outpatient population.

Patients and Methods

Records from 881 COVID-19 outpatient patients (504 females [57.9%] and 366 males [42.07%]), most of whom were between 30 and 40 years of age (mean=37.3 years old; 95% CI, 36.5-38.2), with initial infection data from February 2020 to August 2022 were reviewed once, whereas the survey took place during 2 different moments during the pandemic. The first period (April 20, 2021, to June 21, 2021) yielded 279 responses, whereas in the second period (June 23, 2021, to October 4, 2021), 602 responses were recorded. The instrument used contained 20 questions across 3 main domains: general information, data related to infection and adverse effects, and service satisfaction experience.

Results

All the patients were positive for immunoglobulin G antibodies against nucleocapsid by the third week. Post-COVID-19 symptoms arose at least 2 weeks after recovery from the initial illness; 654 individuals reported at least one symptom after the acute COVID-19 period, for a post-COVID-19 prevalence of 74.96%. The most frequent symptoms were fatigue (84%), headache (71%), and difficulty concentrating (71%). More than 60% of participants reported at least one comorbidity, among which the most common ones were obesity (35.9%), smoking (17.5%), and hypertension (12.2%).

Conclusion

In this study, we assessed post-COVID-19 prevalence among outpatients and found that comorbidities were strongly related to consequences impacting quality of life and mental health burden.

Comparing personality traits of healthcare workers with and without long COVID: Cross-sectional study

Aim

Pathological mechanisms of "long COVID" after recovery from the main symptoms of COVID-19 are unclear. We compared psychological differences between individuals with and without long COVID symptoms after initial COVID-19 infections.

Methods

This study includes medical workers with and without history of COVID-19. We assessed the degree of depression, health-related quality of life (HRQOL), the degree of anxiety and fear of COVID-19, and we used an original questionnaire. In the COVID-19 group, we also assessed personality traits and anxiety. The COVID-19 group was subclassified into those with and without long COVID to examine differences in circumstantial and psychological examinations.

Results

Of 310 participants (141 men, 169 women, median age: 40 years), 167 had history of COVID-19 (83/84, 37 years) and 143 did not (58 men/85 women, 46 years). In the COVID-19 group, 26 had long COVID (12/14, 32 years) and 141 did not (58/85, 46 years). Fewer participants in the COVID-19 group had had COVID-19 vaccinations. The long COVID group had higher number of symptoms at the time of illness and higher NEO Five Factor Inventory Neuroticism scores than the non-long COVID group. They also had poorer mental health according to HRQOL than those without.

Conclusion

Risk factors for long COVID may include the number of symptoms at the time of illness and neurotic tendency on NEO Five Factor Inventory. Participants with long COVID had poorer mental health according to HRQOL. People with long COVID might be especially sensitive to and pessimistic about the symptoms that interfere with their daily lives, resulting in certain cognitive and behavioral patterns. They may benefit from early psychiatric intervention.

Statistical considerations for cardiovascular clinical trials straddling the continuum of pandemic phases

In 2020, the NIH and FDA issued guidance documents that laid the foundation for human subject research during an unprecedented pandemic. To bridge these general considerations to actual applications in cardiovascular interventional device trials, the PAndemic Impact on INTErventional device ReSearch (PAIINTERS) Working Group was formed in early 2021 under the Predictable And Sustainable Implementation Of National CardioVascular Registries (PASSION CV Registries). The PAIINTER's Part I report, published by Rymer et al. [5], provided a comprehensive overview of the operational impact on interventional studies during the first year of the Pandemic. PAIINTERS Part II focused on potential statistical issues related to bias, variability, missing data, and study power when interventional studies may start and end in different pandemic phases. Importantly, the paper also offers practical mitigation strategies to adjust or minimize the impact for both SATs and RCTs, providing a valuable resource for researchers and professionals involved in cardiovascular clinical trials.

A novel antidepressant homogeneous polysaccharide YLP-1 from Millettia pulchra ameliorates tryptophan metabolism and SCFAs through modulating gut microbiota

The root of Millettia pulchra (YLS) has been traditionally used as a folk medicine for the treatment of depression and insomnia in the Zhuang nationality of China, and its polysaccharides have potential antidepressant effect. In this study, a novel homogeneous polysaccharide (YLP-1) was purified from the crude polysaccharides of YLS, and it is mainly composed of glucose, arabinose and mannose with molar ratio of 87.25%, 10.77%, and 1.98%, respectively. YLP-1 is a novel α-glucan with the backbone of 1,4-Glcp and branched at C6 of 1,4,6-Glcp to combine 1,4-Manp and 1,5-Araf. The microstructure of YLP-1 displayed a uniform ellipsoidal-like chain morphology and dispersed uniformly in solution. YLP-1 effectively ameliorated depression-like ethological behaviors and restored the decreased catecholamine levels in chronic variable stress (CVS)-induced depression rats. Additionally, it significantly improved the disturbance of gut microbiota induced by CVS stimuli, particularly affecting bacteria that produce short-chain fatty acids (SCFAs), such as bacteria species Lactobacillus spp.. In vitro fermentation study further confirmed that YLP-1 intake could promote SCFAs production by Lactobacillus spp. YLP-1 also mitigated the disruption of tryptophan metabolites in urine and serum. These findings provide evidences for the further development of YLP-1 as a macromolecular antidepressant drug.

Structural and functional brain markers of cognitive impairment in healthcare workers following mild SARS-CoV-2 infection during the original stream

Severe acute respiratory syndrome coronavirus 2 infection often involves the nervous system, leading to cognitive dysfunctions, fatigue and many other neurological signs that are becoming increasingly recognized. Despite mild forms of the disease accounting for most cases worldwide, research on the pathophysiology driving mild coronavirus disease 2019 (COVID-19) has received little attention. In this respect, recent evidence has pointed out that around 30-40% of non-critical, mild-to-moderate severity COVID-19 survivors may display cognitive disturbances several months post-illness. Hence, the impact of COVID-19 on the brain structure and function, through potential neuropathological mechanisms underpinning cognitive alterations in post-mild COVID-19 infections, remains largely unexplored. This retrospective multicentre observational cohort study, entirely based on a healthcare worker sample (n = 65; 55% females, aged 21-61), investigated the cognitive status and the structural and functional brain integrity among non-hospitalized individuals who developed mild COVID-19 symptoms during the occurrence of severe acute respiratory syndrome coronavirus 2 variants Alpha to Delta, compared with healthy controls tested before the pandemic onset. All evaluations were performed at an average of 9-month follow-up post-infection period. Participants completed a comprehensive neuropsychological assessment and structural and functional MRI exams. Radiological inspection sought to detect the presence of white matter hyperintensities on axial fluid-attenuated inversion recovery images. Global and regional grey matter integrity assessment, analysing changes in grey matter volumes and cortical thinning, and functional connectivity alterations of resting-state brain networks were also conducted. Regression analyses tested the relationships between the presence of specific cognitive impairments and potential structural and functional brain findings. Our results revealed that clinical, cognitive screening and neuropsychological examinations were average between both groups, except for specific impairments related to executive functions in the mild COVID-19. Compared to healthy controls, mild COVID-19 subjects exhibited increased juxtacortical white matter hyperintensities, thalamic and occipital volume loss and diminished resting-state functional connectivity involving the left precuneus and cuneus in default-mode network and affecting the right angular gyrus and left precuneus in the dorsal attentional network. Reduced thalamic volume was the only variable selected in the final model explaining the observed executive function impairment in mild COVID-19. The presence of cognitive, structural and functional brain abnormalities over time suggests that the action of widespread neurovascular and inflammatory phenomena on the nervous system might also occur in mild forms following COVID-19 infection rather than permanent brain damage linked to the direct or indirect action of the virus. Our findings emphasize the need to pay attention to the long-term brain-related consequences of mild COVID-19 infections during the original stream.

Multimodal neuroimaging in Long-COVID and its correlates with cognition 1.8 years after SARS-CoV-2 infection: a cross-sectional study of the Aliança ProHEpiC-19 Cognitiu

Introduction

There is a growing interest in the effect of Long-COVID (LC) on cognition, and neuroimaging allows us to gain insight into the structural and functional changes underlying cognitive impairment in LC. We used multimodal neuroimaging data in combination with neuropsychological evaluations to study cognitive complaints in a cohort of LC patients with mild to moderate severity symptoms.

Methods

We conducted a 3T brain magnetic resonance imaging (MRI) study with diffusion tensor imaging (DTI) and functional MRI (fMRI) sequences on 53 LC patients 1.8 years after acute COVID-19 onset. We administered neuropsychological tests to evaluate cognitive domains and examined correlations with Tract-Based Spatial Statistics (TBSS) and resting state.

Results

We included 53 participants with LC (mean age, 48.23 years; 88.7% females). According to the Frascati criteria, more than half of the participants had deficits in the executive (59%) and attentional (55%) domains, while 40% had impairments in the memory domain. Only one participant (1.89%) showed problems in the visuospatial and visuoconstructive domain. We observed that increased radial diffusivity in different white matter tracts was negatively correlated with the memory domain. Our results showed that higher resting state activity in the fronto-parietal network was associated with lower memory performance. Moreover, we detected increased functional connectivity among the bilateral hippocampus, the right hippocampus and the left amygdala, and the right hippocampus and the left middle temporal gyrus. These connectivity patterns were inversely related to memory and did not survive false discovery rate (FDR) correction.

Discussion

People with LC exhibit cognitive impairments linked to long-lasting changes in brain structure and function, which justify the cognitive alterations detected.

Impact of vortioxetine on depressive symptoms moderated by symptoms of anxiety in persons with post-COVID-19 condition: A secondary analysis

OBJECTIVE

Recovery from a COVID-19 infection can lead to post-COVID-19 condition (PCC), which causes a multitude of debilitating symptoms that negatively affect an individual's health-related quality of life, including depressive and anxiety symptoms. We aim to examine the mediatory effects of anxiety on depressive symptoms in persons with PCC receiving vortioxetine.

METHODS

We performed a post-hoc analysis of a randomized, double-blinded, placebo-controlled clinical trial investigating vortioxetine treatment on cognitive functioning in persons with PCC. Anxiety and depressive symptoms were measured by the 7-Item Generalized Anxiety Disorder (GAD-7) Scale and the 16-Item Quick Inventory of Depressive Symptomatology (QIDS-SR-16), respectively.

RESULTS

Based on data of 147 participants, GAD-7 scores were significantly positively associated with QIDS-SR-16 scores (β=0.038, 95 % CI [0.029,0.047], p < 0.001). After adjusting for covariates, a significant group (χ2=176.786, p < 0.001), time (χ2=8.914, p = 0.003), and treatment x time x GAD-7 score interaction (χ2=236.483, p < 0.001) effect was observed. Vortioxetine-treated participants had a significant difference in overall change in depressive symptoms (mean difference=-3.15, SEM=0.642, 95 % CI [-4.40,-1.89], p < 0.001).

CONCLUSION

Anxiety symptoms were significantly associated with depressive symptoms in persons with PCC. Antidepressant efficacy on ameliorating depressive symptoms is dependent on improving anxiety symptoms, underscoring significant implications in improving treatment efficacy and patient quality of life.

A Journey Through Grief: Experiences of Loss Among Patients With Long COVID

Long COVID is a growing health concern with data continuing to emerge about the psychosocial consequences of this new chronic condition. We aimed to improve understanding of the experiences of patients with Long COVID, focusing on emotional impacts arising from experiences of loss and grief caused by persistent physical symptoms and changes in lifestyle and social support. Patients (n = 21) were recruited August to September 2022 from a post-COVID recovery clinic to participate in semistructured interviews. We found that Long COVID patients (1) reported experiencing loss across multiple domains including loss of physical health, mental health, social support and connections, roles in their families, and self-identities, and (2) described experiences of grief that mirrored the 5 stages of grief in the Kubler-Ross model: denial, anger, bargaining, depression, and for some, acceptance. Our findings highlight the importance of evaluating the experiences of loss and grief among Long COVID patients as well as support systems for this patient population. Providers may be encouraged to incorporate mental health and bereavement support resources to address critical needs of Long COVID patients.

One-year predictors of PTSD symptoms, anxiety, and depression in SARS-CoV-2 survivors: psychological flexibility and major life events as main predictive factors

Introduction

The COVID-19 pandemic held considerable health-related outcomes worldwide, including mental health challenges, with elevated risk of psychiatric sequelae.

Methods

This study aimed to test the longitudinal (1 year) predictive role of psychosocial factors on post-traumatic stress disorder (PTSD), anxiety, and depressive symptoms in SARS-CoV-2 survivors (N = 209 at T1; N = 61; attrition rate 70.83%), through Pearson's correlation analyses and longitudinal multiple regression analyses. Participants (age M = 35.4, SD = 10.1) completed online self-report questionnaires of psychosocial variables, PTSD, anxiety, and depression.

Results

Depression and anxiety symptoms were increased, and 42% of survivors presented clinically meaningful PTSD symptoms. PTSD symptoms were longitudinally predicted by having children (β = 0.32, p < 0.01), number of recent major life events (β = 0.34, p < 0.01), and psychological flexibility (β = -0.36, p < 0.01). Number of major life events (β = 0.29, p < 0.05) and psychological flexibility (β = -0.29, p < 0.05) predicted anxiety. Number of recent major life events (β = 0.32, p < 0.01) was the sole predictor of depressive symptoms.

Discussion

Psychosocial variables contribute to the long-term harmful effects of the COVID-19 pandemic on psychopathological symptoms. These results suggest that, during the pandemic, mental health was impacted by both socio-contextual factors and individual self-regulatory skills, namely the ability to respond flexibily to contextual cues and guide behavior according to the direct experience. Specifically, results point out the importance of societal incentives to reduce parental burden and socioeconomic losses, as well as to promote adaptive psychological skills such as psychological flexibility.

Gut-Brain Axis: Role of Microbiome, Metabolomics, Hormones, and Stress in Mental Health Disorders

The influence of gut microbiome, metabolites, omics, hormones, and stress on general and mental health is increasingly being recognized. Ancient cultures recognized the importance of diet and gut health on the overall health of an individual. Western science and modern scientific methods are beginning to unravel the foundations and mechanisms behind some of the ancient beliefs and customs. The gut microbiome, an organ itself, is now thought to influence almost all other organs, ranging from the brain to the reproductive systems. Gut microbiome, metabolites, hormones, and biological sex also influence a myriad of health conditions that range from mental health disorders, obesity, gastrointestinal disorders, and cardiovascular diseases to reproductive health. Here, we review the history and current understanding of the gut-brain axis bidirectional talk in various mental health disorders with special emphasis on anxiety and depressive disorders, whose prevalence has increased by over 50% in the past three decades with COVID-19 pandemic being the biggest risk factor in the last few years. The vagal nerve is an important contributor to this bidirectional talk, but other pathways also contribute, and most remain understudied. Probiotics containing Lactobacillus and Bifidobacterium species seem to have the most impact on improvement in mental health symptoms, but the challenge appears to be maintaining sustained levels, especially since neither Lactobacillus nor Bifidobacterium can permanently colonize the gut. Ancient endogenous retroviral DNA in the human genome is also linked to several psychiatric disorders, including depression. These discoveries reveal the complex and intricately intertwined nature of gut health with mental health disorders.

Relationship between anhedonia and psychosocial functioning in post-COVID-19 condition: a post-hoc analysis

BACKGROUND

Post-COVID-19 condition (PCC), also known as "long COVID," is characterized by persistent symptoms, negatively affecting the well-being of individuals with PCC. Anhedonia (i.e. reduced capacity for pleasure) and compromised psychosocial functioning are notable symptoms in those with PCC. We aimed to provide insights to understand the effects of anhedonia and impaired psychosocial functioning of individuals with PCC.

METHODS

This post-hoc analysis used data from an 8-week, double-blind, randomized, placebo-controlled trial which evaluated vortioxetine for cognitive deficits in individuals with PCC (Clinicaltrials.gov Identifier: NCT05047952). A total of 147 eligible participants were randomly assigned to receive vortioxetine or matching placebo over eight weeks of double-blind treatment. Our study investigated the relationship between anhedonia, assessed by the Snaith-Hamilton Pleasure Scale (SHAPS), and psychosocial functioning, measured with the Post-COVID Functional Status (PCFS) scale. The analysis was conducted using a generalized linear model, with adjustments for relevant covariates such as age, sex, education, suspected versus confirmed COVID diagnosis, MDD diagnosis, and alcohol consumption.

RESULTS

Of the 147 participants, 143 participants had available baseline data for analysis. We observed that baseline PCFS score was statistically significantly positively correlated to baseline SHAPS score (β = 0.070, p = 0.045, 95% CI).

DISCUSSIONS

Our analysis revealed a significant relationship between measures of anhedonia and psychosocial functioning in adults with PCC. Strategies that aim to improve patient-reported outcomes with PCC need to prioritize the prevention and treatment of hedonic disturbances in patients experiencing PCC.

Effects of COVID-19 infection risk perception on depressive symptoms among pregnant women in different periods of the COVID-19 pandemic in China: A mediation model

OBJECTIVE

The study investigated the mediation mechanisms between coronavirus disease 2019 (COVID-19) infection risk perception and depressive symptoms among pregnant women during the different periods of the COVID-19 pandemic.

METHODS

Study data were derived from a sample of 463 pregnant women in Hubei Province, the province with the most severe COVID-19 outbreak in China. Data were collected in two phases (during and after the acute phase of the COVID-19 pandemic) using the COVID-19 infection risk perception scales, the Edinburg Postnatal Depression Scale (EPDS), the Perceived Stress Scale (PSS), and the Peritrauma Distress Inventory (PDI). Mediation model analysis was used for data analysis, overall and by groups.

RESULTS

The level of depressive symptoms among pregnant women after the acute phase of the COVID-19 pandemic was moderate (median, 9.00 [25th percentile, 75th percentile = 5.00, 12.00]), higher than the acute group (median, 7.00 [25th percentile, 75th percentile = 4.50, 10.00]). Perceived stress and traumatic stress fully mediated the relationship between infection worry (total indirect effect, 0.39 [95% confidence interval, 0.24-0.54])/infection possibility (total indirect effect, 0.41 [95% confidence interval, 0.22-0.61]) and depressive symptoms among pregnant women during the acute phase of the COVID-19 pandemic, whereas the relationship was only fully mediated by perceived stress after the acute pandemic.

CONCLUSIONS

Effects of risk perception on depressive symptoms varied by periods of COVID-19. These findings have important implications for developing effective prevention and early psychoeducational intervention strategies for pregnant women with a high risk of depressive symptoms during different periods of emerging infectious diseases.

A prospective cohort study on cognitive and psychological outcomes in COVID-19 ICU survivors at 3 months of follow up

Objective

The Outcomes - Short and Long term in ICU patient with COVID-19 "OUTSTRIP COVID-19" study was initiated to assess overall mortality, physical and psychiatric co-morbidities, reduction in lung function, and the ability to return to work post-ICU discharge with a follow-up period of 2 years in COVID-19 patients admitted to ICUs in Qatar. This paper focuses on the prevalence of cognitive impairment, depression, anxiety, and stress at baseline and 3 months after ICU discharge.

Methods

This prospective cohort study included 100 ICU survivors reviewed at baseline within 7 weeks of ICU discharge, with a 3-month follow-up. Demographics, clinical characteristics, and relevant medical history were collected at baseline. Cognitive outcomes were assessed using the Montreal Cognitive Assessment-Basic (MoCA-B) tool, while psychological outcomes were evaluated using the Depression Anxiety and Stress Scale-21 (DASS-21).

Results

At baseline, 72% of ICU survivors exhibited mild cognitive impairment, which significantly improved to 56% at 3 months. However, severe cognitive impairment persisted in 20% of survivors at 3 months.For psychological outcomes, the mean depression score remained below 9 (5.64 ± 6.90) at both time points, with no significant change. At baseline, 25% of survivors had clinical depression, which reduced to 16% at 3 months.The mean anxiety score at baseline (9.35 ± 8.50) significantly decreased to 6.51 ± 7.74 (p = 0.002) at 3 months. Anxiety was not reported by 48% of survivors at baseline and this increased to 66% at 3 months. Severe to extremely severe anxiety decreased from 19% to 12% during the same period.The mean stress score at baseline (8.34 ± 8.07) did not significantly change at 3 months. At baseline, 18% experienced stress, which decreased to 12% at 3 months, with 5.3% facing severe to extremely severe stress.

Conclusion

COVID-19 ICU survivors experience significant cognitive impairment, anxiety, and stress. While cognitive impairment and anxiety showed improvements at 3 months, depression and stress remained unchanged. These outcomes strongly emphasize the requirement for thorough post-ICU care and comprehensive mental health assistance for individuals recovering from COVID-19. Customized interventions and additional research endeavors are crucial to effectively manage the cognitive and psychological consequences faced by these patients. The exploration of telemonitoring and innovative approaches can offer avenues to enhance the overall quality of life for survivors. Further investigation should encompass extended timeframes to analyze prolonged effects and consider the broader socioeconomic impact.

Association between fatigue and depressive symptoms in persons with post-COVID-19 condition: a post hoc analysis

OBJECTIVE

Post-COVID-19 Condition (PCC) is a prevalent, persistent and debilitating phenomenon occurring three or more months after resolution of acute COVID-19 infection. Fatigue and depressive symptoms are commonly reported in PCC. We aimed to further characterize PCC by assessing the relationship between fatigue and depressive symptom severity in adults with PCC.

METHODS

A post hoc analysis was conducted on data retrieved from a randomized, double-blinded, placebo-controlled study evaluating vortioxetine for cognitive deficits in persons with PCC. We sought to determine the relationship between baseline fatigue [i.e. Fatigue Severity Scale (FSS) total score] and baseline depressive symptom severity [i.e. 16-item Quick Inventory of Depressive Symptomatology (QIDS-SR-16) total score] in adults with PCC.

RESULTS

The statistical analysis included baseline data from 142 participants. After adjusting for age, sex, education, employment status, history of major depressive disorder (MDD) diagnosis, self-reported physical activity, history of documented acute SARS-CoV-2 infection and body mass index (BMI), baseline FSS was significantly correlated with baseline QIDS-SR-16 (β = 0.825, p = .001).

CONCLUSION

In our sample, baseline measures of fatigue and depressive symptoms are correlated in persons living with PCC. Individuals presenting with PCC and fatigue should be screened for the presence and severity of depressive symptoms. Guideline-concordant care should be prescribed for individuals experiencing clinically significant depressive symptoms. Fatigue and depressive symptom severity scores were not pre-specified as primary objectives of the study. Multiple confounding factors (i.e. disturbance in sleep, anthropometrics and cognitive impairment) were not collected nor adjusted for in the analysis herein.

TRIAL REGISTRATION

Unrestricted Research Grant from H. Lundbeck A/S, Copenhagen, Denmark. ClinicalTrials.gov Identifier: NCT05047952.

Unveiling long COVID symptomatology, co-occurrence trends, and symptom distress post SARS-CoV-2 infection

BACKGROUND

Long COVID, an emerging public health issue, is characterized by persistent symptoms following SARS-CoV-2 infection. This study aims to explore the relationship between post-COVID-19 symptomatology and patient distress employing Latent Class Analysis to uncover symptom co-occurrence patterns and their association with distress.

METHODS

A cross-sectional study was conducted using an online survey among 240 participants from a university and affiliated hospital of southern Taiwan. The survey quantified distress due to persistent symptoms and assessed the prevalence of Long COVID, symptom co-occurrence, and latent symptom classes. Latent Class Analysis (LCA) identified distinct symptom patterns, and multiple regression models evaluated associations between symptom patterns, distress, and demographic factors.

RESULTS

The study found that 80 % of participants experienced Long COVID, with symptoms persisting for over three months. Individuals with multiple COVID-19 infections showed a significant increase in general (β = 1.79), cardiovascular (β = 0.61), and neuropsychological symptoms (β = 2.18), and higher total distress scores (β = 6.35). Three distinct symptomatology classes were identified: "Diverse", "Mild", and "Severe" symptomatology. The "Mild Symptomatology" class was associated with lower distress (-10.61), while the "Severe Symptomatology" class showed a significantly higher distress due to symptoms (13.32).

CONCLUSION

The study highlights the significant impact of Long COVID on individuals, with distinct patterns of symptomatology and associated distress. It emphasizes the cumulative effect of multiple COVID-19 infections on symptom severity and the importance of tailored care strategies.

Post-acute COVID-19 syndrome in previously hospitalized patients

INTRODUCTION

With the prolongation of the COVID-19 pandemic, more individuals are experiencing sequelae after COVID-19 infection, also known as post-acute COVID-19 syndrome (PCS). The aims of this study were to describe the prevalence and characteristics of PCS symptoms such as fatigue, anxiety, and depression and to compare these symptoms according to participant characteristics in patients who had been previously hospitalized due to COVID-19.

DESIGN

A descriptive cross-sectional study design was used.

METHODS

We included 114 individuals who had been hospitalized for COVID-19 and were discharged from the hospital at least 4 weeks before. Symptoms were assessed using the Fatigue Severity Scale, the Hospital Anxiety-Depression Scale, and the PCS symptom questionnaire developed by the authors. We used descriptive statistics, the Student's t-test, the Wilcoxon rank-sum test, and the Kruskal-Wallis test for statistical analyses.

RESULTS

The most prevalent symptoms were anxiety (66.7%), fatigue (64.0%), headache (57.9%), and concentration or memory difficulties (57.9%). Concentration or memory difficulties and sleep disturbances had the highest mean frequency. Concentration or memory difficulties were rated with the highest mean severity, and cough, loss of taste, and muscle and joint pain had the highest mean distress scores. Female participants, individuals hospitalized for more than 2 weeks, individuals discharged more than 9 months ago, unvaccinated patients, and those who tried at least one symptom relief method reported higher symptom distress.

CONCLUSION

The findings of this investigation into the frequency, severity, and distress of symptoms shed light on the identification of post-COVID symptoms in detail. To objectively evaluate and comprehend the symptom trajectories of PCS, prospective studies about the development of symptom assessment tools and studies with a longitudinal design should be conducted.

CLINICAL RELEVANCE

A substantial number of respondents reported numerous symptoms and expressed symptom distress; therefore, the development of nursing interventions and treatments to alleviate PCS symptoms is crucial.

Current epidemiology of chronic liver disease

Chronic liver disease presents a significant global health burden, characterized by several etiologies, including metabolic dysfunction-associated steatotic liver disease (MASLD), alcohol-related liver disease (ALD), chronic hepatitis B virus infection, and chronic hepatitis C virus infection. This review explored current epidemiological trends and projections for each etiology, looking into their respective burdens and challenges. MASLD, formerly known as nonalcoholic fatty liver disease, is the most prevalent cause of chronic liver disease, and its global incidence and prevalence are steadily rising. ALD, fueled by increased alcohol consumption, is also on the rise, with concerning implications for future mortality rates. Chronic hepatitis B and C infections remain major public health concerns, particularly in specific regions of the world, necessitating concerted efforts for screening and treatment. The coronavirus disease 2019 (COVID-19) pandemic has impacted the epidemiology of chronic liver disease, exacerbating mortality rates and disrupting healthcare services. Mental health issues arising from the pandemic further complicate the treatment of chronic liver disease, making comprehensive healthcare strategies essential. Despite advancements in treatment, chronic liver disease continues to impose a substantial economic burden, emphasizing the importance of preventive measures and early intervention. In conclusion, ongoing surveillance and research efforts are crucial for understanding and addressing the evolving landscape of chronic liver disease. Comprehensive strategies that encompass prevention, screening, and treatment of its different etiologies are essential for mitigating its impact and improving patient outcomes.

Meta-analysis of Cognitive Function Following Non-severe SARS-CoV-2 Infection

To effectively diagnose and treat subjective cognitive symptoms in post-acute sequalae of COVID-19 (PASC), it is important to understand objective cognitive impairment across the range of acute COVID-19 severity. Despite the importance of this area of research, to our knowledge, there are no current meta-analyses of objective cognitive functioning following non-severe initial SARS-CoV-2 infection. The aim of this meta-analysis is to describe objective cognitive impairment in individuals with non-severe (mild or moderate) SARS-CoV-2 cases in the post-acute stage of infection. This meta-analysis was pre-registered with Prospero (CRD42021293124) and utilized the PRISMA checklist for reporting guidelines, with screening conducted by at least two independent reviewers for all aspects of the screening and data extraction process. Fifty-nine articles (total participants = 22,060) with three types of study designs met our full criteria. Individuals with non-severe (mild/moderate) initial SARS-CoV-2 infection demonstrated worse objective cognitive performance compared to healthy comparison participants. However, those with mild (nonhospitalized) initial SARS-CoV-2 infections had better objective cognitive performance than those with moderate (hospitalized but not requiring ICU care) or severe (hospitalized with ICU care) initial SARS-CoV-2 infections. For studies that used normative data comparisons instead of healthy comparison participants, there was a small and nearly significant effect when compared to normative data. There were high levels of heterogeneity (88.6 to 97.3%), likely reflecting small sample sizes and variations in primary study methodology. Individuals who have recovered from non-severe cases of SARS-CoV-2 infections may be at risk for cognitive decline or impairment and may benefit from cognitive health interventions.

The bidirectional relationship of depression and disturbances in B cell homeostasis: Double trouble

Major depressive disorder (MDD) is a recurrent, persistent, and debilitating neuropsychiatric syndrome with an increasing morbidity and mortality, representing the leading cause of disability worldwide. The dysregulation of immune systems (including innate and adaptive immune systems) has been identified as one of the key contributing factors in the progression of MDD. As the main force of the humoral immunity, B cells have an essential role in the defense against infections, antitumor immunity and autoimmune diseases. Several recent studies have suggested an intriguing connection between disturbances in B cell homeostasis and the pathogenesis of MDD, however, the B-cell-dependent mechanism of MDD remains largely unexplored compared to other immune cells. In this review, we provide an overview of how B cell abnormality regulates the progression of MMD and the potential consequence of the disruption of B cell homeostasis in patients with MDD. Abnormalities of B-cell homeostasis not only promote susceptibility to MDD, but also lead to an increased risk of developing infection, malignancy and autoimmune diseases in patients with MDD. A better understanding of the contribution of B cells underlying MDD would provide opportunities for identification of more targeted treatment approaches and might provide an overall therapeutic benefit to improve the long-term outcomes of patients with MDD.

Reactivation of herpesvirus type 6 and IgA/IgM-mediated responses to activin-A underpin long COVID, including affective symptoms and chronic fatigue syndrome

BACKGROUND

Persistent infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), reactivation of dormant viruses, and immune-oxidative responses are involved in long COVID.

OBJECTIVES

To investigate whether long COVID and depressive, anxiety, and chronic fatigue syndrome (CFS) symptoms are associated with IgA/IgM/IgG to SARS-CoV-2, human herpesvirus type 6 (HHV-6), Epstein-Barr Virus (EBV), and immune-oxidative biomarkers.

METHODS

We examined 90 long COVID patients and ninety healthy controls. We measured serum IgA/IgM/IgG against HHV-6 and EBV and their deoxyuridine 5′-triphosphate nucleotidohydrolase (duTPase), SARS-CoV-2, and activin-A, C-reactive protein (CRP), advanced oxidation protein products (AOPP), and insulin resistance (HOMA2-IR).

RESULTS

Long COVID patients showed significant elevations in IgG/IgM-SARS-CoV-2, IgG/IgM-HHV-6, and HHV-6-duTPase, IgA/IgM-activin-A, CRP, AOPP, and HOMA2-IR. Neural network analysis yielded a highly significant predictive accuracy of 80.6% for the long COVID diagnosis (sensitivity: 78.9%, specificity: 81.8%, area under the ROC curve = 0.876); the topmost predictors were as follows: IGA-activin-A, IgG-HHV-6, IgM-HHV-6-duTPase, IgG-SARS-CoV-2, and IgM-HHV-6 (all positively) and a factor extracted from all IgA levels to all viral antigens (inversely). The top 5 predictors of affective symptoms due to long COVID were IgM-HHV-6-duTPase, IgG-HHV-6, CRP, education, IgA-activin-A (predictive accuracy of r = 0.636). The top 5 predictors of CFS due to long COVID were in descending order: CRP, IgG-HHV-6-duTPase, IgM-activin-A, IgM-SARS-CoV-2, and IgA-activin-A (predictive accuracy: r = 0.709).

CONCLUSION

Reactivation of HHV-6, SARS-CoV-2 persistence, and autoimmune reactions to activin-A combined with activated immune-oxidative pathways play a major role in the pathophysiology of long COVID as well as the severity of its affective symptoms and CFS.

Impact of SARS-CoV-2 Infection on Long-Term Depression Symptoms among Veterans

BACKGROUND

Prior research demonstrates that SARS-COV-2 infection can be associated with a broad range of mental health outcomes including depression symptoms. Veterans, in particular, may be at elevated risk of increased depression following SARS-COV-2 infection given their high rates of pre-existing mental and physical health comorbidities. However, few studies have tried to isolate SARS-COV-2 infection associations with long term, patient-reported depression symptoms from other factors (e.g., physical health comorbidities, pandemic-related stress).

OBJECTIVE

To evaluate the association between SARS-COV-2 infection and subsequent depression symptoms among United States Military Veterans.

DESIGN

Survey-based non-randomized cohort study with matched comparators.

PARTICIPANTS

A matched-dyadic sample from a larger, stratified random sample of participants with and without known to SARS-COV-2 infection were invited to participate in a survey evaluating mental health and wellness 18-months after their index infection date. Sampled participants were stratified by infection severity of the participant infected with SARS-COV-2 (hospitalized or not) and by month of index date. A total of 186 participants in each group agreed to participate in the survey and had sufficient data for inclusion in analyses. Those in the uninfected group who were later infected were excluded from analyses.

MAIN MEASURES

Participants were administered the Patient Health Questionnaire-9 as part of a phone interview survey. Demographics, physical and mental health comorbidities were extracted from VHA administrative data.

KEY RESULTS

Veterans infected with SARS-COV-2 had significantly higher depression symptoms scores compared with those uninfected. In particular, psychological symptoms (e.g., low mood, suicidal ideation) scores were elevated relative to the comparator group (MInfected = 3.16, 95%CI: 2.5, 3.8; MUninfected = 1.96, 95%CI: 1.4, 2.5). Findings were similar regardless of history of depression.

CONCLUSION

SARS-COV-2 infection was associated with more depression symptoms among Veterans at 18-months post-infection. Routine evaluation of depression symptoms over time following SARS-COV-2 infection is important to facilitate adequate assessment and treatment.

Prevalence and risk factors of psychological symptoms and quality of life in COVID-19 survivors: A cross-sectional study of three different populations

AIM

Studies of the effects of COVID-19, especially post-acute COVID-19 syndrome, on psychological health in non-severe cases are limited. We aimed to evaluate the prevalence and associated risk factors of psychological symptoms, and quality-of-life in three groups of outpatients, hospitalized and intensive care patients.

METHODS

A total 276 patients, previously confirmed with SARS-CoV-2 infection, attending the COVID-19 follow-up outpatient clinic from December 2020 to July 2021 were interviewed face-to-face. In this cross-sectional, retrospective study, all participants were asked our self-designed demographic and screening questions to assess their psychological symptoms and administered the WHQOOL-BREF survey to evaluate quality of life.

RESULTS

In screening questions, major depressive disorder symptoms were detected at a rate of 20.3%, generalized anxiety disorder symptoms at a rate of 16.7%, panic attack symptoms at a rate of 10.9%, post-traumatic stress disorder symptoms at a rate of 28.6% and obsessive-compulsive disorder symptoms at a rate of 18.1%. The outpatient group with COVID-19 infection had a higher risk of developing psychological symptoms and decreased quality of life.

CONCLUSION

COVID-19 infection was found to have a considerable psychological impact on those treated as outpatients despite the less severe course of their illness.

Prevalence and factors associated with depression and anxiety among patients recovered from COVID-19: a cross-sectional study in a tertiary care hospital in Nepal

Introduction

COVID-19 has immensely affected the mental health of all people with prominent effects among the COVID-19 survivors who underwent hospitalisation. The evidence of the long-term mental health implications among the recovered COVID-19 patients remains unknown in Nepal. The study aimed to determine the prevalence of depression and anxiety and the associated factors among COVID-19 recovered patients.

Methods

An analytical cross-sectional study was conducted from May to August 2021 among 269 COVID-19 recovered patients admitted to Dhulikhel Hospital during the first wave (July 2020 to January 2021), and second wave (April 2021 to July 2021) of the COVID-19 pandemic. Anxiety and depression of the participants were assessed using the Hospital Anxiety and Depression Scale. Multivariate logistic regression analysis was performed to determine the factors associated with anxiety and depression.

Results

The prevalence of anxiety and depression were 38.66% (95% CI 32.99 to 44.65), and 30.48% (95% CI 25.24 to 36.28), respectively. Participants who received COVID-19 related information from the radio reported higher levels of anxiety and depression symptoms. Similarly, stigma, and being a health worker were significantly associated with a higher level of anxiety and depression symptoms, respectively. However, social support and long recovery duration were protective factors against anxiety and depression symptoms. Participants receiving a higher level of social support and having a recovery duration of 3-6 months, 7 months and more reported lower odds of anxiety and depression symptoms, respectively.

Conclusions

The greater prevalence of anxiety and depression symptoms among recovered COVID-19 patients highlights the need to design and implement appropriate mental health interventions. This could be done through psychosocial support and counselling services in health facilities, mental health service in emergency situation and post-discharge rehabilitation programmes.

The prevalence, determinants, and consequences of post-COVID in healthcare workers: A cross-sectional survey

Data on post-coronavirus disease (COVID) in healthcare workers (HCWs) are scarce. We aimed to assess prevalence, determinants, and consequences of post-COVID in HCWs. In fall 2022, we performed a cross-sectional survey in a tertiary care hospital with a web-based questionnaire sent to HCWs. Post-COVID was defined as persistent/new symptoms 3 months after acute COVID. Propensity score weighting was performed to assess the impact of post-COVID on return-to-work. 1062 HCWs completed the questionnaire, 713 (68%) reported at least one COVID, and 109 (10%) met the definition for post-COVID, with workplace contamination reported in 51 (47%). On multivariable analysis, risk factors for post-COVID were female gender (p = 0.047), ≥50 years (p = 0.007), immunosuppression (p = 0.004), ≥2 COVID episodes (p = 0.003), and ≥5 symptoms during acute COVID (p = 0.005). Initial sick leave was prescribed for 94 HCWs (86% post-COVID), for a median duration of 7 [7-9] days, and extended for 23. On return-to-work, 91 (84%) had residual symptoms, primarily asthenia/fatigue (72%) and cognitive impairment (25%). Cognitive impairment at return-to-work was associated with post-COVID. Ten HCWs (9%) received a medical diagnosis of post-COVID, 8 consulted the occupational physician, and four required work adaptation. Post-COVID affected 10% of HCWs. Long-term consequences included repeated sick leaves and residual symptoms on return-to-work.

Walk-in mental health: Bridging barriers in a pandemic

'Single Session Therapy' (SST) is a service delivery model that seeks to provide an evidence-based, solution-focused, brief intervention within a single therapy session. The stand-alone session affords the opportunity to provide brief psychological interventions while clients await access to longer-term services. The COVID-19 pandemic has adversely impacted individuals' mental health. However, the majority of research has investigated patient mental health within hospital settings and community organizations that offer long-term services, whereas minimal research has focused on mental health concerns during COVID-19 within an SST model. The primary aim of the study was to measure client experiences of a brief mental health service. The nature of client mental health concerns who access such services at various points during a pandemic was also investigated. The current study utilized client feedback forms and the Computerized Adaptive Testing-Mental Health (CAT-MH) to measure client experiences and mental health concerns. Qualitative analysis of client feedback forms revealed themes of emotional (e.g., safe space) and informational support (e.g., referrals). Clients also reported reduced barriers to accessing services (e.g., no appointment necessary, no cost), as well as limitations (e.g., not enough sessions) of the Walk-in clinic. Profile analysis of the CAT-MH data indicated that clients had higher rates of depression before COVID-19 (M = 64.2, SD = 13.07) as compared to during the pandemic (M = 59.78, SD = 16.87). In contrast, higher rates of positive suicidality flags were reported during the pandemic (n = 54) as compared to before (n = 29). The lower reported rates of depression but higher rate of suicidality during the pandemic was an unanticipated finding that contradicted prior research, to which possible explanations are explored. Taken together, the results demonstrate the positive experiences of clients who access a single session therapy.

Understanding the olfactory role in post-COVID cognitive and neuropsychiatric manifestations

Introduction

Olfactory dysfunction (OD) is frequent after SARS-CoV-2 infection. The aim of this study was to examine if long-term OD is common in post-COVID condition, and the relationship between olfaction, cognition, neuropsychiatric symptoms, and disease duration in these patients.

Methods

This study included 121 participants with post-COVID condition and 51 healthy controls (HC). A comprehensive neuropsychological and neuropsychiatric assessment was conducted, encompassing various domains, including general cognition, processing speed, verbal fluency, attention, verbal memory, visual memory, visuoconstructive ability, visuospatial ability, abstraction, executive functions, anxious-depressive symptoms, general health perception, fatigue level, sleep quality, and olfaction. Statistical analyses were carried out to understand the relationship of OD with cognition, and its role as moderator variable.

Results

In total, 25% of the post-covid patients had a reduced smell capacity, while only 9.3% of HC presented OD. Post-COVID patients had statistically significantly worse cognitive performance and clinical status than HC. Verbal fluency (AUC = 0.85, p < 0.001), and attention (AUC = 0.82, p < 0.001) were the variables that best discriminate between groups. OD seemed to be a moderator between fatigue and cognition, and between disease duration and attention (β = -0.04; p = 0.014).

Discussion

The study highlights marked cognitive and neuropsychiatric sequelae in individuals post-COVID relative to HC. Olfactory impairment exhibits correlations with both cognitive performance and general health. Olfaction emerges as a potential prognostic marker owing to its moderating influence on disease severity indicators.