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Houben-Wilke S, Goërtz YM, Delbressine JM, Vaes AW, Meys R, Machado FV, van Herck M, Burtin C, Posthuma R, Franssen FM, Vijlbrief H, Spies Y, van 't Hul AJ, Spruit MA, Janssen DJ. The Impact of Long COVID-19 on Mental Health: Observational 6-Month Follow-Up Study. JMIR Ment Health 2022; 9:e33704. [PMID: 35200155 PMCID: PMC8914795 DOI: 10.2196/33704] [Citation(s) in RCA: 46] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 11/28/2021] [Accepted: 01/05/2022] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The psychological impact of COVID-19 can be substantial. However, knowledge about long-term psychological outcomes in patients with COVID-19 is scarce. OBJECTIVE In this longitudinal, observational study, we aimed to reveal symptoms of posttraumatic stress disorder (PTSD) and symptoms of anxiety and depression up to 6 months after the onset of COVID-19-related symptoms in patients with confirmed COVID-19 and persistent complaints. To demonstrate the impact in nonhospitalized patients, we further aimed to compare these outcomes between nonhospitalized and hospitalized patients. METHODS Demographics, symptoms of PTSD (Trauma Screening Questionnaire [TSQ] ≥6 points) and symptoms of anxiety and depression (Hospital Anxiety and Depression Scale [HADS] ≥8 points) were assessed at 3 and 6 months after the onset of COVID-19-related symptoms in members of online long COVID-19 peer support groups. RESULTS Data from 239 patients with confirmed COVID-19 (198/239, 82.8% female; median age: 50 [IQR 39-56] years) were analyzed. At the 3-month follow-up, 37.2% (89/239) of the patients had symptoms of PTSD, 35.6% (85/239) had symptoms of anxiety, and 46.9% (112/239) had symptoms of depression, which remained high at the 6-month follow-up (64/239, 26.8%, P=.001; 83/239, 34.7%, P=.90; 97/239, 40.6%, P=.08, respectively; versus the 3-month follow-up). TSQ scores and HADS anxiety and depression scores were strongly correlated at the 3- and 6-month follow-ups (r=0.63-0.71, P<.001). Symptoms of PTSD, anxiety, and depression were comparable between hospitalized (n=62) and nonhospitalized (n=177) patients. CONCLUSIONS A substantial percentage of patients with confirmed COVID-19 and persistent complaints reported symptoms of PTSD, anxiety, or depression 3 and 6 months after the onset of COVID-19-related symptoms. The prevalence rates of symptoms of PTSD, anxiety, and depression were comparable between hospitalized and nonhospitalized patients and merely improved over time. Health care professionals need to be aware of these psychological complications and intervene on time in post-COVID-19 patients with persistent complaints. TRIAL REGISTRATION Netherlands Trial Register NTR8705; https://www.trialregister.nl/trial/8705.
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Affiliation(s)
| | - Yvonne Mj Goërtz
- Department of Research and Education, Ciro, Horn, Netherlands.,School of Nutrition and Translational Research in Metabolism, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands.,Department of Respiratory Medicine, Maastricht University Medical Center, Maastricht, Netherlands
| | | | - Anouk W Vaes
- Department of Research and Education, Ciro, Horn, Netherlands
| | - Roy Meys
- Department of Research and Education, Ciro, Horn, Netherlands.,School of Nutrition and Translational Research in Metabolism, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands.,Department of Respiratory Medicine, Maastricht University Medical Center, Maastricht, Netherlands
| | - Felipe Vc Machado
- Department of Research and Education, Ciro, Horn, Netherlands.,School of Nutrition and Translational Research in Metabolism, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands.,Department of Respiratory Medicine, Maastricht University Medical Center, Maastricht, Netherlands
| | - Maarten van Herck
- Department of Research and Education, Ciro, Horn, Netherlands.,School of Nutrition and Translational Research in Metabolism, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands.,Department of Respiratory Medicine, Maastricht University Medical Center, Maastricht, Netherlands.,REVAL Rehabilitation Research Center, BIOMED Research Institute, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium
| | - Chris Burtin
- REVAL Rehabilitation Research Center, BIOMED Research Institute, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium
| | - Rein Posthuma
- Department of Research and Education, Ciro, Horn, Netherlands.,School of Nutrition and Translational Research in Metabolism, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands.,Department of Respiratory Medicine, Maastricht University Medical Center, Maastricht, Netherlands
| | - Frits Me Franssen
- Department of Research and Education, Ciro, Horn, Netherlands.,School of Nutrition and Translational Research in Metabolism, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands.,Department of Respiratory Medicine, Maastricht University Medical Center, Maastricht, Netherlands
| | | | - Yvonne Spies
- Lung Foundation Netherlands, Amersfoort, Netherlands
| | - Alex J van 't Hul
- Department of Pulmonary Disease, Radboud University Medical Center, Nijmegen, Netherlands
| | - Martijn A Spruit
- Department of Research and Education, Ciro, Horn, Netherlands.,School of Nutrition and Translational Research in Metabolism, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands.,Department of Respiratory Medicine, Maastricht University Medical Center, Maastricht, Netherlands
| | - Daisy Ja Janssen
- Department of Research and Education, Ciro, Horn, Netherlands.,Care and Public Health Research Institute, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
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Giannopoulou I, Galinaki S, Kollintza E, Adamaki M, Kympouropoulos S, Alevyzakis E, Tsamakis K, Tsangaris I, Spandidos DA, Siafakas N, Zoumpourlis V, Rizos E. COVID-19 and post-traumatic stress disorder: The perfect 'storm' for mental health (Review). Exp Ther Med 2021; 22:1162. [PMID: 34504607 PMCID: PMC8392877 DOI: 10.3892/etm.2021.10596] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 08/10/2021] [Indexed: 12/28/2022] Open
Abstract
Since its outbreak, in December, 2019, in the Chinese city of Wuhan, coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has evolved into an ongoing global pandemic. Due to the novel antigenic properties of this virus, the world population could not develop immunity effectively and this led to the subsequent spread of COVID-19. This caused an unprecedented emergency situation with significant negative effects on health and well-being both on an individual and societal level. Apart from health, economic and social consequences, the impact of this pandemic on mental health is increasingly being reported in the scientific literature. The present review aimed to provide a comprehensive discussion of the possible neurological and neuropsychiatric manifestations of SARS-CoV-2, together with the related underlying molecular pathways. In addition, the present review focused on populations which are at a higher risk of developing psychiatric disturbances due to the COVID-19 pandemic and discussed possible routes of clinical management and therapeutics to minimize the burden associated with psychiatric disorders. Moreover, research findings exploring the prevalence of COVID-19-related post-traumatic stress disorder (PTSD) symptoms across vulnerable groups, including children, adolescents and COVID-19 survivors are presented, with particular emphasis on those with severe disease who required hospitalization and/or intensive care unit admission. Based on the available literature, the identification of potential determinants associated with PTSD across the different populations is underlined. Lessons learnt from the pandemics across the globe together with the ongoing research on COVID-19 and its impact on mental health, highlight the utmost importance for evidence-based, proactive and targeted interventions in high-risk groups aiming to mitigate the risks and manage vulnerabilities.
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Affiliation(s)
- Ioanna Giannopoulou
- Second Department of Psychiatry, National and Kapodistrian University of Athens, Attikon University General Hospital, Athens 12462, Greece
| | - Sofia Galinaki
- Second Department of Psychiatry, National and Kapodistrian University of Athens, Attikon University General Hospital, Athens 12462, Greece
| | - Evangelia Kollintza
- Second Department of Psychiatry, National and Kapodistrian University of Athens, Attikon University General Hospital, Athens 12462, Greece
| | - Maria Adamaki
- Biomedical Applications Unit, Institute of Chemical Biology, National Hellenic Research Foundation (NHRF), Athens 11635, Greece
| | - Stylianos Kympouropoulos
- Second Department of Psychiatry, National and Kapodistrian University of Athens, Attikon University General Hospital, Athens 12462, Greece
| | - Evangelos Alevyzakis
- Second Department of Psychiatry, National and Kapodistrian University of Athens, Attikon University General Hospital, Athens 12462, Greece
| | - Konstantinos Tsamakis
- Second Department of Psychiatry, National and Kapodistrian University of Athens, Attikon University General Hospital, Athens 12462, Greece
| | - Iraklis Tsangaris
- Second Department of Critical Care Medicine, Attikon University Hospital, Athens 12462, Greece
| | - Demetrios A Spandidos
- Laboratory of Clinical Virology, School of Medicine, University of Crete, Heraklion 71003, Greece
| | - Nikolaos Siafakas
- Clinical Microbiology Laboratory, School of Medicine, National and Kapodistrian University of Athens, Attikon University General Hospital, Athens 12462, Greece
| | - Vassilios Zoumpourlis
- Biomedical Applications Unit, Institute of Chemical Biology, National Hellenic Research Foundation (NHRF), Athens 11635, Greece
| | - Emmanouil Rizos
- Second Department of Psychiatry, National and Kapodistrian University of Athens, Attikon University General Hospital, Athens 12462, Greece
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Einvik G, Dammen T, Ghanima W, Heir T, Stavem K. Prevalence and Risk Factors for Post-Traumatic Stress in Hospitalized and Non-Hospitalized COVID-19 Patients. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18042079. [PMID: 33672759 PMCID: PMC7924607 DOI: 10.3390/ijerph18042079] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 02/14/2021] [Accepted: 02/18/2021] [Indexed: 12/23/2022]
Abstract
This population-based study assessed the prevalence and determinants of symptom-defined post-traumatic stress disorder (PTSD) in a cohort of hospitalized and non-hospitalized patients about 1.5–6 months after their COVID-19 onset. The data were acquired from two mixed postal/web surveys in June–September 2020 from patients all aged ≥18 years with a positive polymerase chain reaction for severe acute respiratory syndrome Coronavirus-2 (SARS-CoV-2) until 1 June 2020, comprising both hospitalized and non-hospitalized subjects. The catchment areas of the two included hospitals covers about 17% of the population of Norway. In total, 211 hospitalized and 938 non-hospitalized subjects received invitation. The prevalence of symptom-defined PTSD was assessed using the PTSD checklist for DSM-5 (PCL-5). Determinants of symptom-defined PTSD and PTSD symptoms were analyzed using multivariable logistic and linear regression analysis. In total, 583 (51%) subjects responded at median 116 (range 41–200) days after COVID-19 onset. The prevalence of symptom-defined PTSD was 9.5% in hospitalized and 7.0% in non-hospitalized subjects (p = 0.80). Female sex, born outside of Norway, and dyspnea during COVID-19 were risk factors for persistent PTSD symptoms. In non-hospitalized subjects, previous depression and COVID-19 symptom load were also associated with persistent PTSD symptoms. In conclusion, COVID-19 symptom load, but not hospitalization, was associated with symptom-defined PTSD and PTSD symptom severity.
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Affiliation(s)
- Gunnar Einvik
- Pulmonary Department, Akershus University Hospital, 1478 Lørenskog, Norway;
- Institute of Clinical Medicine, University of Oslo, 0450 Oslo, Norway; (W.G.); (T.H.)
| | - Toril Dammen
- Department of Behavioral Medicine, Institute of Basic Medical Sciences, University of Oslo, 0317 Oslo, Norway;
| | - Waleed Ghanima
- Institute of Clinical Medicine, University of Oslo, 0450 Oslo, Norway; (W.G.); (T.H.)
- Haematology and Oncology, Østfold Hospital Trust Kalnes, 1714 Grålum, Norway
| | - Trond Heir
- Institute of Clinical Medicine, University of Oslo, 0450 Oslo, Norway; (W.G.); (T.H.)
- Norwegian Centre for Violence and Traumatic Stress Studies, 0484 Oslo, Norway
| | - Knut Stavem
- Pulmonary Department, Akershus University Hospital, 1478 Lørenskog, Norway;
- Institute of Clinical Medicine, University of Oslo, 0450 Oslo, Norway; (W.G.); (T.H.)
- Health Services Research Unit, Akershus University Hospital, 1478 Lørenskog, Norway
- Correspondence:
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4
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Butler M, Delvi A, Mujic F, Broad S, Pauli L, Pollak TA, Gibbs S, Fai Lam CCS, Calcia MA, Posporelis S. Reduced Activity in an Inpatient Liaison Psychiatry Service During the First Wave of the COVID-19 Pandemic: Comparison With 2019 Data and Characterization of the SARS-CoV-2 Positive Cohort. Front Psychiatry 2021; 12:619550. [PMID: 33603687 PMCID: PMC7884445 DOI: 10.3389/fpsyt.2021.619550] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 01/11/2021] [Indexed: 12/23/2022] Open
Abstract
Background: The COVID-19 pandemic led to changes in the way that healthcare was accessed and delivered in the United Kingdom (UK), particularly during the peak of the first lockdown period (the "first wave") beginning in March 2020. In some patients, COVID-19 is associated with acute neuropsychiatric manifestations, and there is suggestion that there may also be longer term neuropsychiatric complications. Despite this, at the time of writing there are only emerging data on the direct effects of the COVID-19 pandemic on psychiatric care. Methods: In this retrospective study we analyzed referrals to an inpatient liaison psychiatry department of a large acute teaching hospital during the first wave of covid-19 in the UK and compared this data to the same period in 2019. Results: We saw a 40% reduction in the number of referrals in 2020, with an increase in the proportion of referrals for both psychosis or mania and delirium. Almost one third (28%) of referred patients tested positive for COVID-19 at some point during their admission, with 40% of these presenting with delirium as a consequence of their COVID-19 illness. Save delirium, we did not find evidence for high prevalence of new-onset acute mental illness in COVID-19 positive patients. Conclusion: Our data indicate decreased clinical activity in our inpatient psychiatry liaison department during the first wave of the COVID-19 pandemic, although a relative increase in relative increase in referrals for psychosis or mania, suggesting less of a relative decrease in more severe cases of mental illness. The reasons for this are likely multifactorial, including structural changes in the NHS and patient reluctance to present to emergency departments (ED) due to infection fears and Government advice. Our data also supports the literature suggesting the high relative prevalence of delirium in COVID-19, and we support integration of psychiatry liaison teams in acute general hospital wards to optimize delirium management. Finally, consideration should be given to adequate staffing of community and crisis mental health teams to safely manage the mental health of people reluctant to visit EDs.
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Affiliation(s)
- Matthew Butler
- South London and Maudsley NHS Foundation Trust, London, United Kingdom.,Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom
| | - Afraa Delvi
- South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Fedza Mujic
- South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Sophie Broad
- Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom
| | - Lucy Pauli
- South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Thomas A Pollak
- South London and Maudsley NHS Foundation Trust, London, United Kingdom.,Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom
| | - Soraya Gibbs
- South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | | | - Marilia A Calcia
- South London and Maudsley NHS Foundation Trust, London, United Kingdom.,Section of Women's Mental Health, IoPPN, London, United Kingdom
| | - Sotirios Posporelis
- South London and Maudsley NHS Foundation Trust, London, United Kingdom.,Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom
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