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Austin TA, Thomas ML, Lu M, Hodges CB, Darowski ES, Bergmans R, Parr S, Pickell D, Catazaro M, Lantrip C, Twamley EW. Meta-analysis of Cognitive Function Following Non-severe SARS-CoV-2 Infection. Neuropsychol Rev 2024:10.1007/s11065-024-09642-6. [PMID: 38862725 DOI: 10.1007/s11065-024-09642-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 04/22/2024] [Indexed: 06/13/2024]
Abstract
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.
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Affiliation(s)
- Tara A Austin
- The VISN 17 Center of Excellence for Research on Returning War Veterans, 4800 Memorial Drive, Waco, TX, 76711, USA.
- Center of Excellence for Stress and Mental Health, San Diego Healthcare System, San Diego, CA, USA.
- Research Service, VA San Diego Healthcare System, San Diego, CA, USA.
| | - Michael L Thomas
- Department of Psychology, Colorado State University, Colorado Springs, Fort Collins, USA
| | - Min Lu
- University of Miami, Miami, FL, USA
| | - Cooper B Hodges
- Department of Psychology, Brigham Young University, Provo, UT, USA
| | | | - Rachel Bergmans
- Chronic Pain and Fatigue Research Center, Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA
| | - Sarah Parr
- The VISN 17 Center of Excellence for Research on Returning War Veterans, 4800 Memorial Drive, Waco, TX, 76711, USA
- Department of Psychology and Neuroscience, Baylor University, Waco, TX, USA
| | - Delaney Pickell
- Center of Excellence for Stress and Mental Health, San Diego Healthcare System, San Diego, CA, USA
| | - Mikayla Catazaro
- The VISN 17 Center of Excellence for Research on Returning War Veterans, 4800 Memorial Drive, Waco, TX, 76711, USA
- Department of Psychology and Neuroscience, Baylor University, Waco, TX, USA
| | - Crystal Lantrip
- The VISN 17 Center of Excellence for Research on Returning War Veterans, 4800 Memorial Drive, Waco, TX, 76711, USA
- Department of Psychology and Neuroscience, Baylor University, Waco, TX, USA
| | - Elizabeth W Twamley
- Center of Excellence for Stress and Mental Health, San Diego Healthcare System, San Diego, CA, USA
- Research Service, VA San Diego Healthcare System, San Diego, CA, USA
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
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2
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Rittmannsberger H, Barth M, Lamprecht B, Malik P, Yazdi-Zorn K. [Interaction of somatic findings and psychiatric symptoms in COVID-19. A scoping review]. NEUROPSYCHIATRIE : KLINIK, DIAGNOSTIK, THERAPIE UND REHABILITATION : ORGAN DER GESELLSCHAFT OSTERREICHISCHER NERVENARZTE UND PSYCHIATER 2024; 38:1-23. [PMID: 38055146 DOI: 10.1007/s40211-023-00487-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 10/24/2023] [Indexed: 12/07/2023]
Abstract
An infection with SARS-CoV‑2 can affect the central nervous system, leading to neurological as well as psychiatric symptoms. In this respect, mechanisms of inflammation seem to be of much greater importance than the virus itself. This paper deals with the possible contributions of organic changes to psychiatric symptomatology and deals especially with delirium, cognitive symptoms, depression, anxiety, posttraumatic stress disorder and psychosis. Processes of neuroinflammation with infection of capillary endothelial cells and activation of microglia and astrocytes releasing high amounts of cytokines seem to be of key importance in all kinds of disturbances. They can lead to damage in grey and white matter, impairment of cerebral metabolism and loss of connectivity. Such neuroimmunological processes have been described as a organic basis for many psychiatric disorders, as affective disorders, psychoses and dementia. As the activation of the glia cells can persist for a long time after the offending agent has been cleared, this can contribute to long term sequalae of the infection.
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Affiliation(s)
- Hans Rittmannsberger
- Abteilung Psychiatrie und psychotherapeutische Medizin, Pyhrn-Eisenwurzen Klinikum Steyr, Steyr, Österreich.
| | - Martin Barth
- Abteilung Psychiatrie und psychotherapeutische Medizin, Pyhrn-Eisenwurzen Klinikum Steyr, Steyr, Österreich
| | - Bernd Lamprecht
- Med Campus III, Universitätsklinik für Innere Medizin mit Schwerpunkt Pneumologie, Kepler Universitätsklinikum GmbH, Linz, Österreich
- Medizinische Fakultät, Johannes Kepler Universität Linz, Linz, Österreich
| | - Peter Malik
- Abteilung Psychiatrie und psychotherapeutische Medizin, Pyhrn-Eisenwurzen Klinikum Steyr, Steyr, Österreich
| | - Kurosch Yazdi-Zorn
- Neuromed Campus, Klinik für Psychiatrie mit Schwerpunkt Suchtmedizin, Kepler Universitätsklinikum GmbH, Linz, Österreich
- Medizinische Fakultät, Johannes Kepler Universität Linz, Linz, Österreich
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3
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Bachtiar E, Bachtiar BM, Kusumaningrum A, Sunarto H, Soeroso Y, Sulijaya B, Apriyanti E, Theodorea CF, Putra Pratomo I, Yudhistira Y, Efendi D, Lestari W. The utility of salivary CRP and IL-6 as a non-invasive measurement evaluated in patients with COVID-19 with and without diabetes. F1000Res 2024; 12:419. [PMID: 38269064 PMCID: PMC10806364 DOI: 10.12688/f1000research.130995.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/08/2024] [Indexed: 01/26/2024] Open
Abstract
Background The available evidence suggests that inflammatory responses, in both systemic and oral tissue, contribute to the pathology of COVID-19 disease. Hence, studies of inflammation biomarkers in oral fluids, such as saliva, might be useful to better specify COVID-19 features. Methods In the current study, we performed quantitative real-time PCR to measure salivary levels of C-reactive protein (CRP) and interleukin-6 (IL-6) in saliva obtained from patients diagnosed with mild COVID-19, in a diabetic group (DG; n = 10) and a non-diabetic group (NDG; n = 13). All participants were diagnosed with periodontitis, while six participants with periodontitis but not diagnosed with COVID-19 were included as controls. Results We found increases in salivary total protein levels in both the DG and NDG compared to control patients. In both groups, salivary CRP and IL-6 levels were comparable. Additionally, the levels of salivary CRP were significantly correlated with total proteins, in which a strong and moderate positive correlation was found between DG and NDG, respectively. A linear positive correlation was also noted in the relationship between salivary IL-6 level and total proteins, but the correlation was not significant. Interestingly, the association between salivary CRP and IL-6 levels was positive. However, a moderately significant correlation was only found in COVID-19 patients with diabetes, through which the association was validated by a receiver operating curve. Conclusions These finding suggest that salivary CRP and IL-6 are particularly relevant as potential non-invasive biomarker for predicting diabetes risk in mild cases of COVID-19 accompanied with periodontitis.
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Affiliation(s)
- Endang Bachtiar
- Department of Oral Biology and Oral Sciences Research Center, Faculty of Dentistry Universitas Indonesia, Jakarta, Indonesia, 10430, Indonesia
| | - Boy M Bachtiar
- Department of Oral Biology and Oral Sciences Research Center, Faculty of Dentistry Universitas Indonesia, Jakarta, Indonesia, 10430, Indonesia
| | - Ardiana Kusumaningrum
- Department of Microbiology, Faculty of Medicine, Universitas Indonesia; Clinical Microbiology Medicine Staff Group, Universitas Indonesia Hospital, Jakarta, Indonesia, 10430, Indonesia
| | - Hari Sunarto
- Department of Periodontology, Faculty of Dentistry, Universitas Indonesia, Jakarta, Indonesia, 10430, Indonesia
- Dental Center, Universitas Indonesia Hospital, Depok, West Java, Indonesia
| | - Yuniarti Soeroso
- Department of Periodontology, Faculty of Dentistry, Universitas Indonesia, Jakarta, Indonesia, 10430, Indonesia
| | - Benso Sulijaya
- Department of Periodontology, Faculty of Dentistry, Universitas Indonesia, Jakarta, Indonesia, 10430, Indonesia
| | - Efa Apriyanti
- Department of Pediatric Nursing, Faculty of Nursing Universitas Indonesia, and Paediatric Intensive Care Unit, Universitas Indonesia Hospital, West Java, Indonesia
| | - Citra Fragrantia Theodorea
- Department of Oral Biology and Oral Sciences Research Center, Faculty of Dentistry Universitas Indonesia, Jakarta, Indonesia, 10430, Indonesia
| | - Irandi Putra Pratomo
- Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, Universitas Indonesia, Salemba Raya 6, Jakarta, 10430, Indonesia
| | - Yudhistira Yudhistira
- Clinical Pathology Medicine Staff Group,, Universitas Indonesia Hospital., Depok, West Java, Indonesia
| | - Defi Efendi
- Department of Pediatric Nursing, Faculty of Nursing Universitas Indonesia, and Neonatal Intensive Care Unit, Universitas Indonesia Hospital, Depok, West Java, Indonesia
| | - Widya Lestari
- Oral Biology Unit, Fundamental Dental and Medical Sciences Kuala Lumpur, Malaysia International Islamic University Malaysia, Kuala Lumpur, Malaysia
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Shetty PA, Ayari L, Madry J, Betts C, Robinson DM, Kirmani BF. The Relationship Between COVID-19 and the Development of Depression: Implications on Mental Health. Neurosci Insights 2023; 18:26331055231191513. [PMID: 37608908 PMCID: PMC10441207 DOI: 10.1177/26331055231191513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 07/17/2023] [Indexed: 08/24/2023] Open
Abstract
Initially, Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), the virus responsible for coronavirus disease-2019 (COVID-19), was predominantly considered to primarily affect the respiratory system. However, later studies revealed that it also affects brain function through its ability to bind to the angiotensin-converting enzyme type 2 (ACE2) receptors expressed on neural cells. Our study involved a comprehensive review of literature aiming to investigate the relationship between COVID-19 and the development of depression. Our analysis shows a connection between these 2 conditions, as a consequence of the inflammatory response in the nervous system to the COVID-19 virus and the psychophysiological effects of the pandemic. In COVID-19 patients, depression can arise either due to the direct viral infection of the brain or as a result of an indirect immune response triggering neuroinflammation after a cytokine storm. The resulting depression can be treated with non-pharmacological therapies such as psychotherapy, antidepressant medications, or a combination of these treatments depending on the severity of the symptoms.
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Affiliation(s)
- Padmashri A Shetty
- Institute for Regenerative Medicine, Department of Cell Biology and Genetics, Texas A&M University School of Medicine, College Station, TX, USA
| | - Lena Ayari
- School of Medicine, Texas A&M Health Science Center, Bryan, TX, USA
| | - Jessica Madry
- School of Medicine, Texas A&M Health Science Center, Bryan, TX, USA
| | - Colton Betts
- School of Medicine, Texas A&M Health Science Center, Bryan, TX, USA
| | - Diana M Robinson
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Batool F Kirmani
- School of Medicine, Texas A&M Health Science Center, Bryan, TX, USA
- Department of Neurology, CHI St. Joseph Health, Bryan, TX, USA
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Păunescu RL, Miclu£ia IV, Verişezan OR, Crecan-Suciu BD. Acute and long‑term psychiatric symptoms associated with COVID‑19 (Review). Biomed Rep 2022; 18:4. [PMID: 36544852 PMCID: PMC9756282 DOI: 10.3892/br.2022.1586] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 10/27/2022] [Indexed: 11/18/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19) started spreading at the end of 2019 and despite the immediate actions of various governments with strict control, more and more individuals became infected daily. Due to the uncertainty and insecurity that still exists around this pandemic, there is an acute need for information and knowledge of what severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection entails. Respiratory and other physical symptoms received most of the medical attention, however, infected patients were also at risk for developing psychiatric and mental health disorders, such as depression, anxiety, and sleep disturbances. Available research reports a so-called 'post-COVID-19 syndrome', which refers to new and/or persistent signs and symptoms for over 12 weeks, following SARS. The aim of the present review was to provide a general overview of the psychiatric symptoms developed during SARS-CoV-2 infection and their long-term outcome, highlighting that, through follow-up with surviving patients it was revealed that some of the psychiatric symptoms of COVID-19 persisted for a long time after discharge and were also associated with negative effects on global functioning and lower quality of life.
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Affiliation(s)
- Ramona L. Păunescu
- Department of Neurosciences, ‘Iuliu Hațieganu’ University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania,Psychiatric Clinic, Emergency County Hospital, 400012 Cluj-Napoca, Romania
| | - Ioana V. Miclu£ia
- Department of Neurosciences, ‘Iuliu Hațieganu’ University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania,Psychiatric Clinic, Emergency County Hospital, 400012 Cluj-Napoca, Romania
| | - Olivia Roşu Verişezan
- Department of Neurosciences, ‘Iuliu Hațieganu’ University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania,RoNeuro Institute for Neurological Research and Diagnostic, 400354 Cluj-Napoca, Romania
| | - Bianca D. Crecan-Suciu
- Department of Neurosciences, ‘Iuliu Hațieganu’ University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania,Psychiatric Clinic, Emergency County Hospital, 400012 Cluj-Napoca, Romania,Correspondence to: Dr Bianca D. Crecan-Suciu, Department of Neurosciences, ‘Iuliu Hațieganu’ University of Medicine and Pharmacy, 43 Victor Babeș Street, 400012 Cluj-Napoca, Romania
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6
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Park YJ, Jung YE, Kim MD, Bahk WM. COVID-19-Related Functional Impairment in a Community Sample of Korean Adults: Associations With Depression, COVID-19 Infection Fear, and Resilience. Psychiatry Investig 2022; 19:919-926. [PMID: 36444155 PMCID: PMC9708862 DOI: 10.30773/pi.2022.0138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 08/29/2022] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE We aimed to determine the effects of depression, COVID-19 infection fear, and resilience on COVID-19-related functional impairment. METHODS We obtained data from 476 community-dwelling adults aged 20-69 years living in Jeju, South Korea, and evaluated the relationships between COVID-19-related functional impairment (work/school, social, and home life) and sociodemographic and healthrelated characteristics, COVID-19-related life changes (financial difficulties since the pandemic, employment change, interpersonal conflict), and clinical characteristics, including depression, COVID-19 infection fear, and resilience. RESULTS Functional impairment in the home life domain was associated with marital status and monthly income. Greater work/school, social, and home life functional impairment was significantly associated with all COVID-19-related life changes. Regression analysis indicated that resilience modulated the positive associations of COVID-19-related functional impairment with symptoms of depression and COVID-19 infection fear when relevant factors were controlled for. CONCLUSION Our results suggest the importance of clinical characteristics, including depression, COVID-19 infection fear, and resilience for understanding functional impairment related to COVID-19. These results have important implications for interventions aimed at reducing depression and COVID-19 infection fear, and enhancing resilience.
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Affiliation(s)
- Yun-Ju Park
- Department of Psychiatry, Jeju National University Hospital, Jeju, Republic of Korea
| | - Young-Eun Jung
- Department of Psychiatry, Jeju National University Hospital, Jeju, Republic of Korea.,Department of Psychiatry, Jeju National University School of Medicine, Jeju, Republic of Korea
| | - Moon-Doo Kim
- Department of Psychiatry, Jeju National University Hospital, Jeju, Republic of Korea.,Department of Psychiatry, Jeju National University School of Medicine, Jeju, Republic of Korea
| | - Won-Myong Bahk
- Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Gomzyakova N, Palchikova E, Tumova M, Kasyanov E, Sorokin M. Association of Anxiety and Depression with Objective and Subjective Cognitive Decline in Outpatient Healthcare Consumers with COVID-19: А Cross-Sectional Study. CONSORTIUM PSYCHIATRICUM 2022; 3:45-55. [PMID: 39044914 PMCID: PMC11262122 DOI: 10.17816/cp189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 09/21/2022] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND In addition to the neurological complications affecting people infected with COVID-19, cognitive impairment symptoms and symptoms of anxiety and depression remain a frequent cause of complaints. The specificity of cognitive impairment in patients with COVID-19 is still poorly understood. AIM An exploratory study of factors that may be associated with cognitive decline during the COVID-19 pandemic. METHODS The cross-sectional multicentre observational study was conducted in a polyclinic unit in Saint Petersburg and in the regions of the North-Western Federal Region. During the study, socio-demographic parameters and information about the somatic condition of patients who applied for primary health care was collected. Emotional and cognitive state were investigated using the Hospital Anxiety and Depression Scale (HADS) and Montreal Cognitive Assessment (MoCA). Mathematical and statistical data processing was carried out using SPSS and RStudio statistical programs. RESULTS The study included 515 participants, 60% (n=310) of which were women. The sample was divided into those who did (28.5%, n=147) and did not (71.4%, n=368) complain of cognitive decline. Patients with complaints of cognitive decline were significantly older, had lower levels of education and higher levels of depression and anxiety according to HADS (p <0.05). Patients with complaints of cognitive decline underwent the MoCA test (24.3%, n=125). The median MoCA test scores were within the normal range (Median=27, Q1=25, Q3=28), and cognitive decline (MoCA less than 26 points) was detected in 40% (n=50) of patients with complaints of cognitive decline. No significant correlations were found between the MoCA scores and the levels of anxiety and depression according to the HADS (p >0.05). Patients with mild severity of the COVID-19 course were more successful with MoCA subtests than patients with moderate and severe courses. CONCLUSION We found no linear association between objective cognitive deficit and the affective state of respondents. Patients' subjective complaints about cognitive dysfunction were mostly caused by their emotional state than an objective decrease of their cognitive functions. Therefore, in case of subjective complaints on cognitive decline, it is necessary to assess not only the cognitive but also the affective state of the patient. The severity of the COVID-19 course affects the functions of the cognitive sphere, including attention, regulatory functions and speech fluency. Mild and moderate severity of the COVID-19 correlates with clinically determined depression. The absence of this relationship with the severe course of the disease is probably explained by the significant somatic decompensation of patients.
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ERAY U, AYRIBAŞ B, ÇAĞLAR ÖF, HACIOĞLU T, ALİBEYOĞLU F. Post-COVID syndrome? COVID-19 survivors suffer from cognitive difficulties, somatic complaints and anxiety. JOURNAL OF HEALTH SCIENCES AND MEDICINE 2022. [DOI: 10.32322/jhsm.1108001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Aim: Although primarily known as a respiratory system pathology, COVID-19 may cause various systems and cause serious complications including neuropsychiatric problems. These complications may be formulized as post-COVID syndrome. The current study aims to investigate prolonged cognitive, somatic and psychiatric effects of COVID-19.
Material and Method: A total number of 120 COVID-19 survivors were compared with 120 health controls in means of three measures, which are Cognitive Failures Questionnaire (CFQ), Body Sensations Questionnaire (BSQ), Hospital Anxiety and Depression Scale (HADS) to assess cognitive difficulties, body perceptions and anxiety/depression.
Results: Our findings show that COVID-19 survivors have reported significantly more cognitive difficulties, increased body sensations and higher levels of anxiety. The groups did not differ in means of depression scores. Further, the measures were significantly correlated with each other.
Conclusion: This study reveal that COVID-19 survivors suffer from significant cognitive deficits in everyday activities, are significantly more sensitive to various body sensations and have increased anxiety levels. In discordance with the current literature, our findings showed that COVID-19 patients are not more depressed than healthy subjects. In summary, the current study showed that various neuropsychiatric complications may be an important part of prolonged effects of COVID-19.
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Affiliation(s)
- Uğur ERAY
- KARS HARAKANİ STATE HOSPİTAL, DEPARTMENT OF PSYCHİATRY
| | | | | | | | - Fatih ALİBEYOĞLU
- KAFKAS UNIVERSITY, FACULTY OF ENGINEERING AND ARCHITECTURE, DEPARTMENT OF BIOENGINEERING
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She R, Li L, Yang Q, Lin J, Ye X, Wu S, Yang Z, Guan S, Zhang J, Ling RHY, Lau JTF. Associations between COVID-19 Work-Related Stressors and Posttraumatic Stress Symptoms among Chinese Doctors and Nurses: Application of Stress-Coping Theory. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:6201. [PMID: 35627736 PMCID: PMC9140888 DOI: 10.3390/ijerph19106201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 05/11/2022] [Accepted: 05/12/2022] [Indexed: 02/04/2023]
Abstract
Healthcare workers are vulnerable to posttraumatic stress symptoms (PTSS) due to stressful work during the COVID-19 pandemic. This study aimed to investigate whether the associations between COVID-19 work-related stressors and PTSS would be mediated by maladaptive and adaptive coping strategies and moderated by perceived family support based on stress-coping theory. An anonymous online survey was conducted among 1449 doctors and nurses in five hospitals in China between October and November 2020 during the "post-outbreak" period. The prevalence of PTSS assessed by the Posttraumatic Symptom Scale Self-Report was 42%. Logistic regression analysis revealed that worries about being infected with COVID-19, perceived difficulties in family caregiving, coping strategies of rumination, catastrophizing, acceptance, and perceived family support were independently associated with PTSS. Furthermore, maladaptive and adaptive coping partially mediated the association between COVID-19 work-related stressors and PTSS.The results of multi-group analyses showed that perceived family support tended to intensify the associations between COVID-19 work-related stressors and adaptive coping and between adaptive coping and PTSS, whereas perceived family support attenuated the positive association between COVID-19 work-related stressors and PTSS. The findings suggest tailor-made health interventions with respect to alleviation of work-related stressors and coping skill training to reduce the risk of PTSS among healthcare workers, especially for those with lower perceived family support.
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Affiliation(s)
- Rui She
- Centre for Health Behaviours Research, JC School of Public Health and Primary Care, The Chinese University of Hong Kong, New Territory, Hong Kong, China; (R.S.); (R.H.Y.L.)
| | - Lijuan Li
- School of Public Health, Dali University, Dali 671000, China;
| | - Qian Yang
- Center for Health Policy Studies, Department of Endocrinology, School of Public Health, Children’s Hospital, National Clinical Research Center for Child Health, Zhejiang University School of Medicine, Hangzhou 310003, China;
| | - Jianyan Lin
- The Fourth People’s Hospital of Nanning, Nanning 530023, China;
| | - Xiaoli Ye
- The Children’s Hospital Zhejiang University School of Medicine, Hangzhou 310003, China;
| | - Suliu Wu
- Wuyi First People’s Hospital, Jinhua 321200, China;
| | - Zhenggui Yang
- No. 4 Hospital of Ningxia Hui Autonomous Region, Yinchuan 750021, China;
| | - Suzhen Guan
- Key Laboratory of Environmental Factors and Chronic Disease Control, School of Public Health and Management, Ningxia Medical University, Yinchuan 750004, China;
| | - Jianxin Zhang
- Huaxi School of Public Health, Sichuan University, Chengdu 610041, China;
| | - Rachel Hau Yin Ling
- Centre for Health Behaviours Research, JC School of Public Health and Primary Care, The Chinese University of Hong Kong, New Territory, Hong Kong, China; (R.S.); (R.H.Y.L.)
| | - Joseph Tak Fai Lau
- Centre for Health Behaviours Research, JC School of Public Health and Primary Care, The Chinese University of Hong Kong, New Territory, Hong Kong, China; (R.S.); (R.H.Y.L.)
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Yao M, Wang H, Chen W. Clinical research-When it matters. Injury 2022:S0020-1383(22)00079-1. [PMID: 35144806 DOI: 10.1016/j.injury.2022.01.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 01/29/2022] [Indexed: 02/02/2023]
Abstract
Clinical research runs through the entire progress of the science and technology which has been currently and previously applied to the medical field. It has gradually developed into a standardized procedure and played an important role in understanding the etiology and characteristics of diseases. Clinical researchs assess the effectiveness and safety of new/improved diagnostic or therapeutic technologies, implants, instruments, or drug applications, to discover new data and improve potential deficiencies in previous medical knowledge.
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Affiliation(s)
- Mengxuan Yao
- Trauma Emergency Center, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei 050051, China; Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang 050051, Hebei, China; Orthopaedic Institution of Hebei Province, Shijiazhuang, Hebei 050051, China
| | - Haicheng Wang
- Trauma Emergency Center, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei 050051, China; Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang 050051, Hebei, China; Orthopaedic Institution of Hebei Province, Shijiazhuang, Hebei 050051, China
| | - Wei Chen
- Trauma Emergency Center, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei 050051, China; NHC Key Laboratory of Intelligent Orthopeadic Equipment, Shijiazhuang, Hebei 050051, China.
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11
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Huynh G, Nguyen HV, Vo LY, Le NT, Nguyen HTN. Assessment of Insomnia and Associated Factors Among Patients Who Have Recovered from COVID-19 in Vietnam. Patient Prefer Adherence 2022; 16:1637-1647. [PMID: 35837086 PMCID: PMC9275485 DOI: 10.2147/ppa.s371563] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 07/01/2022] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION The COVID-19 pandemic has been affecting the lives of millions of people globally. Patients recovering from COVID-19 are facing, not only the symptom of long COVID, but also psychological problems, such as sleep disturbance. This study aims to assess the proportion of COVID-19 recovered adult patients that suffer from insomnia and associated factors in Vietnam. METHODS A cross-sectional study was performed between January and March 2022 among patients who have recovered from a COVID-19 infection. Data were collected based on a self-administered questionnaire that included sociodemographic and standardized questionnaires from the Hospital Anxiety and Depression Scale (HADS), the Perceived stress scale (PSS) and the dependent variable using Insomnia Severity Index (ISI). Multivariable logistic regression was conducted to explore factors associated with the patients' insomnia disorder. RESULTS A total of 325 participants were included in this analysis, 34.5% of participants had insomnia. According to multivariable logistic regression, participants who were equal to and over 50 years of age, feeling alienated from others, and were not supported by families or relatives, reported significantly higher levels of insomnia disorders over those aged under 50 years, having closer ties with family and had received support from family or relatives. Besides, respondents who recorded mental health problems that included anxiety, depression and stress were more likely to get insomnia disorders than those without mental health symptoms (OR 2.7, 95% CI 1.1-6.6) (OR 4.5, 95% CI 2.3-8.9) (OR 2.3, 95% CI 1.1-5.3), respectively, all p < 0.05. CONCLUSION There was a remarkable rate of COVID-19 recovered patients experiencing insomnia disorders. Older age, alienated relationships and not being supported by families or relatives, as well as had mental health problems, are factors that affected the patients' insomnia, which showed that these sleep issues need to be screened and managed among adults who have recovered from COVID-19.
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Affiliation(s)
- Giao Huynh
- Faculty of Public Health, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Hau Viet Nguyen
- Emergency Department, University Medical Center Ho Chi Minh City, Ho Chi Minh City, Vietnam
- Correspondence: Hau Viet Nguyen, Emergency Department, University Medical Center Ho Chi Minh City, 215 Hong Bang Street, District 5, Ho Chi Minh City, Vietnam, Tel +84918764092, Email
| | - Lan Y Vo
- Faculty of Public Health, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Ngoc Thi Le
- Faculty of Medicine, Nguyen Tat Thanh University, Ho Chi Minh City, Vietnam
| | - Han Thi Ngoc Nguyen
- Infection Control Department, University Medical Center Ho Chi Minh City, Ho Chi Minh City, Vietnam
- Han Thi Ngoc Nguyen, Infection Control Department, University Medical Center Ho Chi Minh City, 201 Nguyen Chi Thanh Street, District 5, Ho Chi Minh City, Vietnam, Tel +84397975519, Email
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12
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Pandey K, Thurman M, Johnson SD, Acharya A, Johnston M, Klug EA, Olwenyi OA, Rajaiah R, Byrareddy SN. Mental Health Issues During and After COVID-19 Vaccine Era. Brain Res Bull 2021; 176:161-173. [PMID: 34487856 PMCID: PMC8414813 DOI: 10.1016/j.brainresbull.2021.08.012] [Citation(s) in RCA: 55] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 08/01/2021] [Accepted: 08/27/2021] [Indexed: 02/07/2023]
Abstract
The COVID-19 pandemic has persisted for more than a year, and post-COVID-19 sequelae of neurological complications, including direct and indirect effects on the central nervous system (CNS), have been recognized. There is a plethora of evidence for neurological, cognitive, and emotional deficits in COVID-19 patients. Acute neurological symptoms like neuroinflammation, cognitive impairment, loss of smell, and brain stroke are common direct effects among SARS-CoV-2 infected individuals. Work-associated stress, lockdowns, social distancing, and quarantine in response to contain SARS-CoV-2 have also affected the mental health of large populations, regardless of age. Public health emergencies have affected individuals and communities, resulting in emotional reactions and unhealthy behaviors. Although vaccines have been widely distributed and administered among large populations, vaccine hesitancy still exists and may be due to apprehension about vaccine efficacy, preliminary trials, and associated side effects. This review highlights the impact of COVID-19 on the CNS by outlining direct and indirect effects and factors contributing to the decline in people's mental health throughout the COVID-19 pandemic both during and after vaccine administration. Furthermore, we also discuss reasons for vaccine hesitancy and why some groups of people are deprived of vaccines. Finally, we touched upon the social determinants of mental health and their impact on disadvantaged populations during times of crisis which may help policymakers set up some action plans to mitigate the COVID-19 mental health turmoil during this ongoing pandemic.
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Affiliation(s)
- Kabita Pandey
- Department of Pharmacology and Experimental Neuroscience, University of Nebraska Medical Center, Omaha, NE, USA; Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Michellie Thurman
- Department of Pharmacology and Experimental Neuroscience, University of Nebraska Medical Center, Omaha, NE, USA
| | - Samuel D Johnson
- Department of Pharmacology and Experimental Neuroscience, University of Nebraska Medical Center, Omaha, NE, USA; Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Arpan Acharya
- Department of Pharmacology and Experimental Neuroscience, University of Nebraska Medical Center, Omaha, NE, USA
| | - Morgan Johnston
- Department of Pharmacology and Experimental Neuroscience, University of Nebraska Medical Center, Omaha, NE, USA
| | - Elizabeth A Klug
- Department of Pharmacology and Experimental Neuroscience, University of Nebraska Medical Center, Omaha, NE, USA; Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Omalla A Olwenyi
- Department of Pharmacology and Experimental Neuroscience, University of Nebraska Medical Center, Omaha, NE, USA; Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Rajesh Rajaiah
- Department of Pharmacology and Experimental Neuroscience, University of Nebraska Medical Center, Omaha, NE, USA
| | - Siddappa N Byrareddy
- Department of Pharmacology and Experimental Neuroscience, University of Nebraska Medical Center, Omaha, NE, USA; Department of Genetics, Cell Biology, and Anatomy, University of Nebraska Medical Center, Omaha, NE, USA; Department of Biochemistry and Molecular Biology, University of Nebraska Medical Center, Omaha, NE, USA.
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13
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Rahman MH, Banik G, Ahmed A, Arifeen SE, Hossain AT, Hasan MA, Rahman AE. Anxiety and depressive symptoms among COVID-19 patients admitted to three isolation facilities in Bangladesh. Health Psychol Open 2021; 8:20551029211046106. [PMID: 34646569 PMCID: PMC8504249 DOI: 10.1177/20551029211046106] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
The COVID-19 pandemic can impose a profound impact on the mental health of hospitalised patients infected with SARS-CoV-2. However, there have been no studies that explored the psychological distress of the COVID-19 inpatients in Bangladesh. Therefore, this study aimed to assess the prevalence of anxiety and depressive symptoms and explore the associated factors among inpatients with COVID-19. A cross-sectional study was conducted among 138 COVID-19 patients admitted to three isolation facilities in Dhaka, Bangladesh, from September to October 2020. Participants' sociodemographic and clinical data were obtained. Mental health symptoms were evaluated with the Hospital Anxiety and Depression Scale (HADS). Descriptive statistics, bivariate and multivariate logistic regression models were performed to analyse the data. The prevalence of anxiety and depressive symptoms were 57.2% (95% CI: 48.2-65.2) and 52.2% (95% CI: 43.8-62.7), respectively. Presence of comorbidity (aOR: 5.64, 95% CI: 2.21-14.35) and having ≥3 COVID-19 physical symptoms (aOR: 6.90, 95% CI: 2.71-17.56) were associated with anxiety symptoms. Besides, presence of comorbidity (aOR: 2.73, 95% CI: 1.07-6.99), having ≥3 COVID-19 physical symptoms (aOR: 4.46, 95% CI: 1.78-11.20) and patient with ≤93% oxygen saturation (aOR: 2.33, 95% CI: 1.01-5.36) were associated with depressive symptoms. Considerable numbers of COVID-19 patients in Bangladesh experienced psychological distress during hospitalisation, requiring more attention and timely mental health interventions.
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Affiliation(s)
- Md Hafizur Rahman
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Goutom Banik
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Anisuddin Ahmed
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Shams El Arifeen
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Aniqa Tasnim Hossain
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Md Aminul Hasan
- Directorate General of Health Services (DGHS), Ministry of Health and Family Welfare (MoHFW), Dhaka, Bangladesh
| | - Ahmed Ehsanur Rahman
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
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14
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Yang L, Zhou M, Li L, Luo P, Fan W, Xu J, Chen Q, Pan F, Lei P, Zheng C, Jin Y. Characteristics of mental health implications and plasma metabolomics in patients recently recovered from COVID-19. Transl Psychiatry 2021; 11:307. [PMID: 34021116 PMCID: PMC8138845 DOI: 10.1038/s41398-021-01426-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 04/23/2021] [Accepted: 05/04/2021] [Indexed: 12/26/2022] Open
Abstract
This study aimed to explore the associations between cerebral white matter (WM) alterations, mental health status, and metabolism in recovered COVID-19 patients. We included 28 recovered COVID-19 patients and 27 healthy controls between April 2020 and June 2020. Demographic data, the mental health scores, diffusion-tensor imaging (DTI) data, and plasma metabolomics were collected and compared between the two groups. Tract-based spatial statistics and graph theory approaches were used for DTI data analysis. Untargeted metabolomics analysis of the plasma was performed. Correlation analyses were performed between these characteristics. Recovered COVID-19 patients showed decreased fractional anisotropy, increased mean diffusivity and radial diffusivity values in widespread brain regions, and significantly lower global efficiency, longer shortest path length, and less nodal local efficiency in superior occipital gyrus (all, P < 0.05, Bonferroni corrected). Our results also demonstrated significantly different plasma metabolic profiling in recovered COVID-19 patients even at 3 months after their hospital discharge, which was mainly related to purine pathways, amino acids, lipids, and amine metabolism. Certain regions with cerebral WM alterations in the recovered patients showed significant correlations with different metabolites and the mental health scores. We observed multiple alterations in both WM integrity and plasma metabolomics that may explain the deteriorated mental health of recovered COVID-19 patients. These findings may provide potential biomarkers for the mental health evaluation for the recovered COVID-19 patients and potential targets for novel therapeutics.
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Affiliation(s)
- Lian Yang
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 430022, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, 430022, Wuhan, China
| | - Mei Zhou
- Department of Respiratory and Critical Care Medicine, NHC Key Laboratory of Pulmonary Diseases, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 430022, Wuhan, Hubei, China
| | - Lingli Li
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 430022, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, 430022, Wuhan, China
| | - Ping Luo
- Department of Translational Medicine Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 430022, Wuhan, Hubei, China
| | - Wenliang Fan
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 430022, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, 430022, Wuhan, China
| | - Juanjuan Xu
- Department of Respiratory and Critical Care Medicine, NHC Key Laboratory of Pulmonary Diseases, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 430022, Wuhan, Hubei, China
| | - Qing Chen
- Health Checkup Department, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 430022, Wuhan, Hubei, China
| | - Feng Pan
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 430022, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, 430022, Wuhan, China
| | - Ping Lei
- Department of Immunology, School of Basic Medicine, Tongji Medical College, Huazhong University of Science and Technology, 430022, Wuhan, Hubei, China
| | - Chuansheng Zheng
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 430022, Wuhan, China.
- Hubei Province Key Laboratory of Molecular Imaging, 430022, Wuhan, China.
| | - Yang Jin
- Department of Respiratory and Critical Care Medicine, NHC Key Laboratory of Pulmonary Diseases, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 430022, Wuhan, Hubei, China.
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15
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Bandala C, Cortes-Altamirano JL, Reyes-Long S, Lara-Padilla E, Ilizaliturri-Flores I, Alfaro-Rodríguez A. Putative mechanism of neurological damage in COVID-19 infection. Acta Neurobiol Exp (Wars) 2021; 81:69-79. [PMID: 33949163 DOI: 10.21307/ane-2021-008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Accepted: 01/28/2021] [Indexed: 11/11/2022]
Abstract
The recent pandemic of the coronavirus infectious disease 2019 (COVID-19) has affected around 192 countries, and projections have shown that around 40% to 70% of world population could be infected in the next months. COVID-19 is caused by the virus SARS- CoV-2, it enters the cells through the ACE2 receptor (angiotensin converting enzyme 2). It is well known that SARS-CoV-2 could develop mild, moderate, and severe respiratory symptoms that could lead to death. The virus receptor is expressed in different organs such as the lungs, kidney, intestine, and brain, among others. In the lung could cause pneumonia and severe acute respiratory syndrome (SARS). The brain can be directly affected by cellular damage due to viral invasion, which can lead to an inflammatory response, by the decrease in the enzymatic activity of ACE2 that regulates neuroprotective, neuro-immunomodulatory and neutralizing functions of oxidative stress. Another severe damage is hypoxemia in patients that do not receive adequate respiratory support. The neurological symptoms that the patient presents, will depend on factors that condition the expression of ACE2 in the brain such as age and sex, as well as the mechanism of neuronal invasion, the immune response and the general state of the patient. Clinical and histopathological studies have described neurological alterations in human patients with COVID-19. These conditions could have a possible contribution to the morbidity and mortality caused by this disease and may even represent the onset of neurodegenerative activity in recovered patients. The recent pandemic of the coronavirus infectious disease 2019 (COVID-19) has affected around 192 countries, and projections have shown that around 40% to 70% of world population could be infected in the next months. COVID-19 is caused by the virus SARS- CoV-2, it enters the cells through the ACE2 receptor (angiotensin converting enzyme 2). It is well known that SARS-CoV-2 could develop mild, moderate, and severe respiratory symptoms that could lead to death. The virus receptor is expressed in different organs such as the lungs, kidney, intestine, and brain, among others. In the lung could cause pneumonia and severe acute respiratory syndrome (SARS). The brain can be directly affected by cellular damage due to viral invasion, which can lead to an inflammatory response, by the decrease in the enzymatic activity of ACE2 that regulates neuroprotective, neuro-immunomodulatory and neutralizing functions of oxidative stress. Another severe damage is hypoxemia in patients that do not receive adequate respiratory support. The neurological symptoms that the patient presents, will depend on factors that condition the expression of ACE2 in the brain such as age and sex, as well as the mechanism of neuronal invasion, the immune response and the general state of the patient. Clinical and histopathological studies have described neurological alterations in human patients with COVID-19. These conditions could have a possible contribution to the morbidity and mortality caused by this disease and may even represent the onset of neurodegenerative activity in recovered patients.
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Affiliation(s)
- Cindy Bandala
- División de Neurociencias , Instituto Nacional de Rehabilitación , México ; Escuela Superior de Medicina , Instituto Politécnico Nacional , México
| | - José Luis Cortes-Altamirano
- División de Neurociencias , Instituto Nacional de Rehabilitación , México ; Universidad Estatal del Valle de Ecatepec , México
| | - Samuel Reyes-Long
- División de Neurociencias , Instituto Nacional de Rehabilitación , México ; Escuela Superior de Medicina , Instituto Politécnico Nacional , México
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16
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Hu Q, Umeda M. Stress, Anxiety, and Depression for Chinese Residents in Japan during the COVID-19 Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:4958. [PMID: 34066924 PMCID: PMC8124497 DOI: 10.3390/ijerph18094958] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 04/30/2021] [Accepted: 05/05/2021] [Indexed: 11/16/2022]
Abstract
The coronavirus disease 2019 (COVID-19) has profoundly affected the psychological well-being of foreign residents. This study examines stress, anxiety, and depression levels in Chinese residents in Japan during the COVID-19 pandemic. It identifies risk factors and the roles of disaster preparedness and social support. An online survey among Chinese residents in Japan was conducted from 22 June to 14 July 2020. The Depression, Anxiety and Stress Scale, Disaster Preparedness for Resilience Checklist, and Social Support Rate Scale were used to measure psychological symptoms. Multivariable linear regressions identified the risk factors and positive effects of disaster preparedness and social support. Of the total 497 participants, 45.3%, 66.6%, and 54.3% reported severe stress, anxiety, and depressive symptoms, respectively. People with a lower level of education, a higher level of economic influence, the presence of COVID-19 symptoms, and confirmed or suspected family or friends in China were associated with higher levels of stress, anxiety, and depression. This study, to the best of our knowledge, is the first survey to reveal the protective role of disaster preparedness in reducing psychological symptoms during the pandemic. It offers unique data for further research on how to promote the mental health of vulnerable populations including foreign residents.
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Affiliation(s)
- Qin Hu
- Graduate School of Nursing Art and Science, University of Hyogo, Akashi 673-8588, Hyogo, Japan
| | - Maki Umeda
- Research Institute of Nursing Care for People and Community, University of Hyogo, Akashi 673-8588, Hyogo, Japan;
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Mental Health of COVID-19 Patients-A Cross-Sectional Survey in Saudi Arabia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18094758. [PMID: 33946978 PMCID: PMC8125087 DOI: 10.3390/ijerph18094758] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 04/25/2021] [Accepted: 04/26/2021] [Indexed: 01/10/2023]
Abstract
Background: This study aims to investigate the mental health of COVID-19 patients in Saudi Arabia. Method: A cross-sectional study was carried out targeting confirmed cases of COVID-19 in Saudi Arabia. Due to travel and time constraints as well as the accessibility of patients, cases were included from East Jeddah Hospital, King Abdulaziz Hospital, and the Oncology Center in Jeddah. The data were collected using a predesigned self-administered questionnaire. The questionnaire addressed COVID-19 cases, personal data, medical history, smoking, traveling abroad, and work-related conditions. Additionally, data regarding contact level with COVID-19 cases were considered. The mental health statuses of the patients were assessed using a validated Arabic version of the Hospital Anxiety and Depression (HAD) scale. The study included 261 COVID-19 patients whose ages ranged from 18 to 65 years. Results: The survey findings revealed that 13% of COVID-19 patients had a borderline level of anxiety, 26.8% were considered anxiety cases, while 60.2% were normal. The findings also revealed that 29.9% had a borderline level of depression, 18.4% were considered depression cases, while 51.7% were normal. Conclusions: This study concluded that COVID-19 patients experience anxiety and depression, and as the COVID-19 epidemic continues to spread, the results of the study are particularly useful in developing a strategy to psychologically support COVID-19 patients.
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Chau SWH, Wong OWH, Ramakrishnan R, Chan SSM, Wong EKY, Li PYT, Raymont V, Elliot K, Rathod S, Delanerolle G, Phiri P. History for some or lesson for all? A systematic review and meta-analysis on the immediate and long-term mental health impact of the 2002-2003 Severe Acute Respiratory Syndrome (SARS) outbreak. BMC Public Health 2021; 21:670. [PMID: 33827499 PMCID: PMC8025448 DOI: 10.1186/s12889-021-10701-3] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Accepted: 03/24/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND The aims of this systematic review and meta-analysis are to examine the prevalence of adverse mental health outcomes, both short-term and long-term, among SARS patients, healthcare workers and the general public of SARS-affected regions, and to examine the protective and risk factors associated with these mental health outcomes. METHODS We conducted a systematic search of the literature using databases such as Medline, Pubmed, Embase, PsycInfo, Web of Science Core Collection, CNKI, the National Central Library Online Catalog and dissertation databases to identify studies in the English or Chinese language published between January 2003 to May 2020 which reported psychological distress and mental health morbidities among SARS patients, healthcare workers, and the general public in regions with major SARS outbreaks. RESULTS The literature search yielded 6984 titles. Screening resulted in 80 papers for the review, 35 of which were included in the meta-analysis. The prevalence of post-recovery probable or clinician-diagnosed anxiety disorder, depressive disorder, and post-traumatic stress disorder (PTSD) among SARS survivors were 19, 20 and 28%, respectively. The prevalence of these outcomes among studies conducted within and beyond 6 months post-discharge was not significantly different. Certain aspects of mental health-related quality of life measures among SARS survivors remained impaired beyond 6 months post-discharge. The prevalence of probable depressive disorder and PTSD among healthcare workers post-SARS were 12 and 11%, respectively. The general public had increased anxiety levels during SARS, but whether there was a clinically significant population-wide mental health impact remained inconclusive. Narrative synthesis revealed occupational exposure to SARS patients and perceived stigmatisation to be risk factors for adverse mental health outcomes among healthcare workers, although causality could not be determined due to the limitations of the studies. CONCLUSIONS The chronicity of psychiatric morbidities among SARS survivors should alert us to the potential long-term mental health complications of covid-19 patients. Healthcare workers working in high-risk venues should be given adequate mental health support. Stigmatisation against patients and healthcare workers should be explored and addressed. The significant risk of bias and high degree of heterogeneity among included studies limited the certainty of the body of evidence of the review.
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Affiliation(s)
- Steven W. H. Chau
- Department of Psychiatry, The Chinese University of Hong Kong, Shatin, Hong Kong
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Oscar W. H. Wong
- Department of Psychiatry, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Rema Ramakrishnan
- Nuffield Department of Women’s and Reproductive Health, University of Oxford, Oxford, UK
| | - Sandra S. M. Chan
- Department of Psychiatry, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Evelyn K. Y. Wong
- Department of Psychiatry, North District Hospital, Sheung Shui, Hong Kong
| | - Pinky Y. T. Li
- Department of Psychiatry, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Vanessa Raymont
- Oxford Brain Health Clinical Trials Unit, Department of Psychiatry, University of Oxford, Oxford, UK
| | - Kathryn Elliot
- Research & Development Department, Tom Rudd Unit, Clinical Trials Facility, Moorgreen Hospital, Southern Health NHS Foundation Trust, Southampton, SO30 3JB UK
| | - Shanaya Rathod
- School of Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Gayathri Delanerolle
- Oxford Brain Health Clinical Trials Unit, Department of Psychiatry, University of Oxford, Oxford, UK
| | - Peter Phiri
- Research & Development Department, Tom Rudd Unit, Clinical Trials Facility, Moorgreen Hospital, Southern Health NHS Foundation Trust, Southampton, SO30 3JB UK
- School of Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Southampton, UK
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19
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Adil MT, Rahman R, Whitelaw D, Jain V, Al-Taan O, Rashid F, Munasinghe A, Jambulingam P. SARS-CoV-2 and the pandemic of COVID-19. Postgrad Med J 2021; 97:110-116. [PMID: 32788312 PMCID: PMC10016996 DOI: 10.1136/postgradmedj-2020-138386] [Citation(s) in RCA: 135] [Impact Index Per Article: 45.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Indexed: 01/08/2023]
Abstract
SARS-CoV-2 is a virus that is the cause of a serious life-threatening disease known as COVID-19. It was first noted to have occurred in Wuhan, China in November 2019 and the WHO reported the first case on December 31, 2019. The outbreak was declared a global pandemic on March 11, 2020 and by May 30, 2020, a total of 5 899 866 positive cases were registered including 364 891 deaths. SARS-CoV-2 primarily targets the lung and enters the body through ACE2 receptors. Typical symptoms of COVID-19 include fever, cough, shortness of breath and fatigue, yet some atypical symptoms like loss of smell and taste have also been described. 20% require hospital admission due to severe disease, a third of whom need intensive support. Treatment is primarily supportive, however, prognosis is dismal in those who need invasive ventilation. Trials are ongoing to discover effective vaccines and drugs to combat the disease. Preventive strategies aim at reducing the transmission of disease by contact tracing, washing of hands, use of face masks and government-led lockdown of unnecessary activities to reduce the risk of transmission.
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Affiliation(s)
- Md Tanveer Adil
- Department of Upper GI and Bariatric Surgery,, Luton and Dunstable University Hospital, Luton LU4 0DZ, UK
| | - Rumana Rahman
- Department of Gynaecology & Obstetrics, Calderdale Royal Hospital, Halifax HX3 0PW, UK
| | - Douglas Whitelaw
- Department of Upper GI and Bariatric Surgery,, Luton and Dunstable University Hospital, Luton LU4 0DZ, UK
| | - Vigyan Jain
- Department of Upper GI and Bariatric Surgery,, Luton and Dunstable University Hospital, Luton LU4 0DZ, UK
| | - Omer Al-Taan
- Department of Upper GI and Bariatric Surgery,, Luton and Dunstable University Hospital, Luton LU4 0DZ, UK
| | - Farhan Rashid
- Department of Upper GI and Bariatric Surgery,, Luton and Dunstable University Hospital, Luton LU4 0DZ, UK
| | - Aruna Munasinghe
- Department of Upper GI and Bariatric Surgery,, Luton and Dunstable University Hospital, Luton LU4 0DZ, UK
| | - Periyathambi Jambulingam
- Department of Upper GI and Bariatric Surgery,, Luton and Dunstable University Hospital, Luton LU4 0DZ, UK
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Deng J, Zhou F, Hou W, Silver Z, Wong CY, Chang O, Huang E, Zuo QK. The prevalence of depression, anxiety, and sleep disturbances in COVID-19 patients: a meta-analysis. Ann N Y Acad Sci 2021; 1486:90-111. [PMID: 33009668 PMCID: PMC7675607 DOI: 10.1111/nyas.14506] [Citation(s) in RCA: 413] [Impact Index Per Article: 137.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 08/30/2020] [Accepted: 09/16/2020] [Indexed: 12/12/2022]
Abstract
Evidence from previous coronavirus outbreaks has shown that infected patients are at risk for developing psychiatric and mental health disorders, such as depression, anxiety, and sleep disturbances. To construct a comprehensive picture of the mental health status in COVID-19 patients, we conducted a systematic review and random-effects meta-analysis to assess the prevalence of depression, anxiety, and sleep disturbances in this population. We searched MEDLINE, EMBASE, PubMed, Web of Science, CINAHL, Wanfang Data, Wangfang Med Online, CNKI, and CQVIP for relevant articles, and we included 31 studies (n = 5153) in our analyses. We found that the pooled prevalence of depression was 45% (95% CI: 37-54%, I2 = 96%), the pooled prevalence of anxiety was 47% (95% CI: 37-57%, I2 = 97%), and the pooled prevalence of sleeping disturbances was 34% (95% CI: 19-50%, I2 = 98%). We did not find any significant differences in the prevalence estimates between different genders; however, the depression and anxiety prevalence estimates varied based on different screening tools. More observational studies assessing the mental wellness of COVID-19 outpatients and COVID-19 patients from countries other than China are needed to further examine the psychological implications of COVID-19 infections.
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Affiliation(s)
- Jiawen Deng
- Faculty of Health SciencesMcMaster UniversityHamiltonOntarioCanada
| | - Fangwen Zhou
- Faculty of Health SciencesMcMaster UniversityHamiltonOntarioCanada
| | - Wenteng Hou
- Faculty of Health SciencesMcMaster UniversityHamiltonOntarioCanada
| | - Zachary Silver
- Faculty of ScienceCarleton UniversityOttawaOntarioCanada
| | - Chi Yi Wong
- Faculty of Health SciencesMcMaster UniversityHamiltonOntarioCanada
| | - Oswin Chang
- Faculty of Health SciencesMcMaster UniversityHamiltonOntarioCanada
| | - Emma Huang
- Faculty of Health SciencesMcMaster UniversityHamiltonOntarioCanada
| | - Qi Kang Zuo
- Department of AnesthesiologyRutgers New Jersey Medical SchoolNewarkNew Jersey
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21
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Aamir A, Awan S, de Filippis R, Diwan MN, Ullah I. Effect of COVID-19 on Mental Health Rehabilitation Centers. JOURNAL OF PSYCHOSOCIAL REHABILITATION AND MENTAL HEALTH 2020; 8:97-100. [PMID: 33106766 PMCID: PMC7577361 DOI: 10.1007/s40737-020-00203-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 10/03/2020] [Indexed: 01/13/2023]
Abstract
The SARS-CoV-2 outbreak is an unprecedented event in modern history worldwide. To facilitate speedy and smooth recovery during this time period, an added responsibility is placed upon rehabilitation center counselors, staff and management. In this paper we expose the role that psychiatric rehabilitation plays during the COVID-19 crisis. Since COVID-19 pandemic has remarkably raised mental health concerns, one of the high risks and possibly neglected groups includes individuals undergoing mental health rehabilitation, the impact on which can be significant as compared to the rest of the population. In order to ensure that individuals on the road to recovery are not alone and forgotten during the times of coronavirus crisis they should be provided with adequate resources, such as online meetings and group therapy sessions, assessment, treatment and support by telephone and video consultation and getting the medications they need to recover. This article highlights how the coronavirus pandemic, that has hit hard the health care and all categories of patients affected by mental disorders, is likely to be particularly dramatic for mental health rehabilitation centers. Indeed, the COVID-19 crisis has severely tested the health systems worldwide, reducing sometimes the quality and quantity of care offered to psychiatric patients both hospitalized and not in rehabilitation centers. The main goal of this paper is to raise awareness of the importance, often underestimated, of mental health rehabilitation centers, on which one should invest for the both future of psychological and psychiatric rehabilitation and the current crisis as well.
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Affiliation(s)
- Alifiya Aamir
- Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Sana Awan
- Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Renato de Filippis
- Department of Health Sciences, Psychiatric Unit, University Magna Graecia of Catanzaro, Viale Europa, 88100 Catanzaro, Italy
| | | | - Irfan Ullah
- Kabir Medical College, Gandhara University, Peshawar, Pakistan
- Undergraduate Research Organization, Dhaka, Bangladesh
- Naseer Teaching Hospital, Peshawar, Pakistan
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22
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Mehl A, Bergey F, Cawley C, Gilsdorf A. Syndromic Surveillance Insights from a Symptom Assessment App Before and During COVID-19 Measures in Germany and the United Kingdom: Results From Repeated Cross-Sectional Analyses. JMIR Mhealth Uhealth 2020; 8:e21364. [PMID: 32997640 PMCID: PMC7561445 DOI: 10.2196/21364] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 07/15/2020] [Accepted: 09/15/2020] [Indexed: 12/23/2022] Open
Abstract
Background Unprecedented lockdown measures have been introduced in countries worldwide to mitigate the spread and consequences of COVID-19. Although attention has been focused on the effects of these measures on epidemiological indicators relating directly to the infection, there is increased recognition of their broader health implications. However, assessing these implications in real time is a challenge, due to the limitations of existing syndromic surveillance data and tools. Objective The aim of this study is to explore the added value of mobile phone app–based symptom assessment tools as real-time health insight providers to inform public health policy makers. Methods A comparative and descriptive analysis of the proportion of all self-reported symptoms entered by users during an assessment within the Ada app in Germany and the United Kingdom was conducted between two periods, namely before and after the implementation of “Phase One” COVID-19 measures. Additional analyses were performed to explore the association between symptom trends and seasonality, and symptom trends and weather. Differences in the proportion of unique symptoms between the periods were analyzed using a Pearson chi-square test and reported as log2 fold changes. Results Overall, 48,300-54,900 symptomatic users reported 140,500-170,400 symptoms during the Baseline and Measures periods in Germany. Overall, 34,200-37,400 symptomatic users in the United Kingdom reported 112,100-131,900 symptoms during the Baseline and Measures periods. The majority of symptomatic users were female (Germany: 68,600/103,200, 66.52%; United Kingdom: 51,200/71,600, 72.74%). The majority were aged 10-29 years (Germany: 68,500/100,000, 68.45%; United Kingdom: 50,900/68,800, 73.91%), and about one-quarter were aged 30-59 years (Germany: 26,200/100,000, 26.15%; United Kingdom: 14,900/68,800, 21.65%). Overall, 103 symptoms were reported either more or less frequently (with statistically significant differences) during the Measures period as compared to the Baseline period, and 34 of these were reported in both countries. The following mental health symptoms (log2 fold change, P value) were reported less often during the Measures period: inability to manage constant stress and demands at work (–1.07, P<.001), memory difficulty (–0.56, P<.001), depressed mood (–0.42, P<.001), and impaired concentration (–0.46, P<.001). Diminished sense of taste (2.26, P<.001) and hyposmia (2.20, P<.001) were reported more frequently during the Measures period. None of the 34 symptoms were found to be different between the same dates in 2019. In total, 14 of the 34 symptoms had statistically significant associations with weather variables. Conclusions Symptom assessment apps have an important role to play in facilitating improved understanding of the implications of public health policies such as COVID-19 lockdown measures. Not only do they provide the means to complement and cross-validate hypotheses based on data collected through more traditional channels, they can also generate novel insights through a real-time syndromic surveillance system.
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Affiliation(s)
- Alicia Mehl
- Department of Epidemiology & Public Health, Ada Health GmbH, Berlin, Germany
| | - Francois Bergey
- Department of Epidemiology & Public Health, Ada Health GmbH, Berlin, Germany
| | - Caoimhe Cawley
- Department of Epidemiology & Public Health, Ada Health GmbH, Berlin, Germany
| | - Andreas Gilsdorf
- Department of Epidemiology & Public Health, Ada Health GmbH, Berlin, Germany
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24
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Subramaney U, Kim AW, Chetty I, Chetty S, Jayrajh P, Govender M, Maharaj P, Pak E. Coronavirus Disease 2019 (COVID-19) and Psychiatric Sequelae in South Africa: Anxiety and Beyond. WITS JOURNAL OF CLINICAL MEDICINE 2020; 2:115-122. [PMID: 34056576 PMCID: PMC8162198 DOI: 10.18772/26180197.2020.v2n2a2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND The 2019 coronavirus (COVID-19) pandemic has brought unprecedented challenges to the health sector nationwide and internationally. Across all disciplines, unique and novel modes of presentation with substantial morbidity and mortality are being encountered, and growing evidence suggests that psychiatric comorbidity is likely among COVID-19 patients. OBJECTIVE This article aims to broaden the current discussion on the psychiatric sequalae of COVID-19, which has largely focused on anxiety, and examine the recently documented psychiatric sequelae of COVID-19 infection, the secondary effects of the pandemic on public mental health, and future psychiatric conditions that may arise due to COVID-19. METHODS We conducted an in-depth review of the current global psychiatric literature and describe the wide range of psychopathological presentations reported among past COVID-19 patients worldwide and those that are expected to emerge. RESULTS Current discussions in the psychiatric literature on COVID-19 report anxiety and anxiety disorders as a predominant set of clinical presentations during the pandemic. The impacts of direct COVID-19 infection, associated psychopathological sequelae, and drastic lifestyle changes due to the COVID-19 pandemic in South Africa, are associated with a broad range of psychopathologies and other neuropsychiatric presentations. Pre-existing societal conditions and burdens on the health system in South Africa prompt healthcare providers and public health planners to accordingly prepare for the expected rise in new psychiatric presentations. CONCLUSION Greater awareness of the various psychiatric conditions attributed to COVID-19 infection may allow for earlier screening, more effective treatment, and greater positive health outcomes and better prepare health systems to address the growing pandemic in South Africa.
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Affiliation(s)
- Ugasvaree Subramaney
- Department of Psychiatry, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Area 459, Charlotte Maxexe Johannesburg Academic Hospital, Jubilee Road, Parktown 2193, Po Box 10411, Vorna Valley 1686, Johannesburg, South Africa, Tel: (011)7172712 082822 4530, Fax (011) 7172423
| | - Andrew Wooyoung Kim
- SAMRC Developmental Pathways for Health Research Unit, Department of Paediatrics and Child Health, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Anthropology, Northwestern University, Evanston, IL, USA
| | - Indhrin Chetty
- Department of Psychiatry, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Area 459, Charlotte Maxexe Johannesburg Academic Hospital, Jubilee Road, Parktown 2193, Po Box 10411, Vorna Valley 1686, Johannesburg, South Africa, Tel: (011)7172712 082822 4530, Fax (011) 7172423
| | - Shren Chetty
- Department of Psychiatry, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Area 459, Charlotte Maxexe Johannesburg Academic Hospital, Jubilee Road, Parktown 2193, Po Box 10411, Vorna Valley 1686, Johannesburg, South Africa, Tel: (011)7172712 082822 4530, Fax (011) 7172423
| | - Preethi Jayrajh
- Department of Psychiatry, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Area 459, Charlotte Maxexe Johannesburg Academic Hospital, Jubilee Road, Parktown 2193, Po Box 10411, Vorna Valley 1686, Johannesburg, South Africa, Tel: (011)7172712 082822 4530, Fax (011) 7172423
| | - Mallorie Govender
- Department of Psychiatry, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Area 459, Charlotte Maxexe Johannesburg Academic Hospital, Jubilee Road, Parktown 2193, Po Box 10411, Vorna Valley 1686, Johannesburg, South Africa, Tel: (011)7172712 082822 4530, Fax (011) 7172423
| | - Pralene Maharaj
- Department of Psychiatry, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Area 459, Charlotte Maxexe Johannesburg Academic Hospital, Jubilee Road, Parktown 2193, Po Box 10411, Vorna Valley 1686, Johannesburg, South Africa, Tel: (011)7172712 082822 4530, Fax (011) 7172423
| | - EungSok Pak
- Department of Psychiatry, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Area 459, Charlotte Maxexe Johannesburg Academic Hospital, Jubilee Road, Parktown 2193, Po Box 10411, Vorna Valley 1686, Johannesburg, South Africa, Tel: (011)7172712 082822 4530, Fax (011) 7172423
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