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Salazar Buenaño JP, Zurita Alvarado FA, Weyand I, Rosero Montezuma T, Tapia B, Solis Olive C, Rosero K, Bermudez P, Gobbi F, Bottieau E, Huits R. Impact of dengue fever on depression, anxiety, and stress symptoms in Esmeraldas Province, Ecuador: a prospective cohort study. Trop Med Health 2024; 52:63. [PMID: 39334504 PMCID: PMC11428912 DOI: 10.1186/s41182-024-00625-0] [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: 04/19/2024] [Accepted: 08/26/2024] [Indexed: 09/30/2024] Open
Abstract
BACKGROUND Physical symptoms of dengue have been documented extensively, but knowledge gaps on dengue-associated mental health hazards remain. We investigated the frequency of psychiatric symptoms (depression, anxiety, and stress) and neurocognitive performance during the first year after a dengue episode. METHODS Using DASS-21 scores at 3, 6, and 12 months, we assessed depression, anxiety, and stress in anti-dengue IgM-positive adults and matched controls during the 2021 dengue season in Esmeraldas Province, Ecuador. Patients with DASS-21 scores ≤ 4 were considered normal; those with scores of 5-7, 8-10, and ≥ 11 indicated mild, moderate, and severe depression, respectively; cutoff scores for anxiety and stress were ≥ 5 and ≥ 9, respectively. We also assessed 'delayed matching to sample' (DMS) and 'spatial working memory' (SWM) using the Cambridge Neuropsychological Test Automated Battery. RESULTS We enrolled 102 cases and 78 controls. At 3 months, 90 cases and 70 controls were available for follow-up, among these 40/90 (44.4%) cases and 12/70 (17.1%) controls had DASS-21 scores ≥ 5 (RR 2.7, 95% CI [1.5-4.7]). Dengue remained a predictor for depression after adjusting for age, sex, and COVID-19 status. We observed no difference in anxiety between the groups, but stress scores increased at month 3 (RR 1.87, 95% CI [1.01-3.4]). DASS-21 scores normalized during follow-up. DMS and SWM did not differ between groups at 3 and 6 months. At month 12, cases had lower SWM than controls did (p value < 0.001). CONCLUSIONS Care providers should be aware of dengue-associated mood disorders and facilitate timely referral to mental health services. Future longitudinal studies are warranted to validate our observations regarding the impact of dengue on mental health and neurocognitive status in affected patients.
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Affiliation(s)
- Julio P Salazar Buenaño
- Centro de Investigaciones Para la Salud en América Latina, Pontificia Universidad Católica del Ecuador, Av. 12 de Octubre 1076, Apartado: 17-01-218, Quito, Ecuador.
- Facultad de Medicina, Pontificia Universidad Católica del Ecuador, Av. 12 de Octubre 1076, Apartado: 17-01-2184, Quito, Ecuador.
| | - Fabián A Zurita Alvarado
- Facultad de Medicina, Pontificia Universidad Católica del Ecuador, Av. 12 de Octubre 1076, Apartado: 17-01-2184, Quito, Ecuador
| | - Ines Weyand
- Institute of Psychology, Goethe-Universität, Campus Westend, PEG Theodor-W-Adorno-Platz 6, 60323, Frankfurt am Main, Germany
| | - Tamara Rosero Montezuma
- Posgrado de Medicina Familiar y Comunitaria, Pontificia Universidad Católica del Ecuador, Av. 12 de Octubre 1076, Apartado: 17-01-2184, Quito, Ecuador
| | - Boris Tapia
- Posgrado de Medicina Familiar y Comunitaria, Pontificia Universidad Católica del Ecuador, Av. 12 de Octubre 1076, Apartado: 17-01-2184, Quito, Ecuador
| | - Cecilia Solis Olive
- Posgrado de Medicina Familiar y Comunitaria, Pontificia Universidad Católica del Ecuador, Av. 12 de Octubre 1076, Apartado: 17-01-2184, Quito, Ecuador
| | - Karen Rosero
- Posgrado de Medicina Familiar y Comunitaria, Pontificia Universidad Católica del Ecuador, Av. 12 de Octubre 1076, Apartado: 17-01-2184, Quito, Ecuador
| | - Pablo Bermudez
- Posgrado de Medicina Familiar y Comunitaria, Pontificia Universidad Católica del Ecuador, Av. 12 de Octubre 1076, Apartado: 17-01-2184, Quito, Ecuador
| | - Federico Gobbi
- Department of Infectious Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Via don A. Sempreboni, 5, 37024, Verona, Negrar, Italy
| | - Emmanuel Bottieau
- Department of Clinical Sciences, Institute of Tropical Medicine, 155 Nationalestraat, 2000, Antwerp, Belgium
| | - Ralph Huits
- Department of Infectious Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Via don A. Sempreboni, 5, 37024, Verona, Negrar, Italy
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Shih HI, Wang YP, Chi CY, Chien YW. Risks of anxiety disorders, depressive disorders, and sleep disorders in patients with dengue fever: A nationwide, population-based cohort study. PLoS Negl Trop Dis 2024; 18:e0012239. [PMID: 38959212 PMCID: PMC11221675 DOI: 10.1371/journal.pntd.0012239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 05/22/2024] [Indexed: 07/05/2024] Open
Abstract
BACKGROUND Dengue virus (DENV) infection, a common mosquito-borne disease, has been linked to several mental disorders like depression and anxiety. However, the temporal risk of these disorders after DENV infection is not well studied. METHODS This population-based cohort study encompassed 45,334 recently lab-confirmed dengue patients in Taiwan spanning 2002 to 2015, matched at a 1:5 ratio with non-dengue individuals based on age, gender, and residence (n = 226,670). Employing subdistribution hazard regression analysis, we assessed the immediate (<3 months), intermediate (3-12 months), and prolonged (>12 months) risks of anxiety disorders, depressive disorders, and sleep disorders post DENV infection. Corrections for multiple comparisons were carried out using the Benjamini-Hochberg procedure. RESULTS A significant increase in depressive disorder risk across all timeframes post-infection was observed (<3 months [aSHR 1.90, 95% CI 1.20-2.99], 3-12 months [aSHR 1.68, 95% CI 1.32-2.14], and >12 months [aSHR 1.14, 95% CI 1.03-1.25]). Sleep disorder risk was higher only during 3-12 months (aSHR 1.55, 95% CI 1.18-2.04). No elevated anxiety disorder risk was found. Subgroup analysis of hospitalized dengue patients showed increased risk of anxiety disorders within 3 months (aSHR 2.14, 95% CI 1.19-3.85) and persistent risk of depressive disorders across all periods. Hospitalized dengue patients also had elevated sleep disorder risk within the first year. CONCLUSION Dengue patients exhibited significantly elevated risks of depressive disorders in both the short and long term. However, dengue's impact on sleep disorders and anxiety seems to be short-lived. Further research is essential to elucidate the underlying mechanisms.
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Affiliation(s)
- Hsin-I Shih
- Department of Emergency Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- School of Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yu-Ping Wang
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- National Mosquito-Borne Diseases Control Research Center, National Health Research Institutes, Miaoli County, Taiwan
| | - Chia-Yu Chi
- National Mosquito-Borne Diseases Control Research Center, National Health Research Institutes, Miaoli County, Taiwan
- Department of Microbiology & Immunology, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yu-Wen Chien
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Occupational and Environmental Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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Dinakaran D, Sreeraj VS, Venkatasubramanian G. Dengue and Psychiatry: Manifestations, Mechanisms, and Management Options. Indian J Psychol Med 2022; 44:429-435. [PMID: 36157026 PMCID: PMC9460008 DOI: 10.1177/02537176211022571] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Dengue is an arboviral infection endemic in tropical countries. Neurological sequelae to dengue infection are not uncommon, and psychiatric manifestations are increasingly reported. This narrative review aims to present the varied manifestations, postulated mechanisms, and the available treatment options for psychiatric morbidity associated with dengue. The evidence available from eight observational studies is summarized in this review. Depression and anxiety are noted to be prevalent during both the acute and convalescent stages of the infection. The presence of encephalopathy and other neurological conditions is not a prerequisite for developing psychiatric disorders. However, treatment options to manage such psychiatric manifestations were not specified in the observational studies. Anecdotal evidence from case reports is outlined. Special attention is paid to the role of epigenetic modifications following dengue infections and the role of histone deacetylase inhibitors in the management. DNA methylation inhibitors such as valproic acid play a significant role in reversing stress-, viral-, or drug-induced epigenetic modifications.
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Affiliation(s)
- Damodharan Dinakaran
- Dept. of Psychiatry, National Institute of Mental Health And Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Vanteemar S Sreeraj
- Dept. of Psychiatry, National Institute of Mental Health And Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Ganesan Venkatasubramanian
- Dept. of Psychiatry, National Institute of Mental Health And Neurosciences (NIMHANS), Bengaluru, Karnataka, India
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Alharbi AA, Alqassim AY, Muaddi MA, Makeen AM, Hagawi AM, Shaabi LA, Alhweity SM, Alharbi MA, Sultan MA, Alshamakhi AH, Aburasain NS, Horner RD. Generalized anxiety disorder symptoms during COVID-19 pandemic in Jazan, Saudi Arabia. Heliyon 2022; 8:e09424. [PMID: 35601230 PMCID: PMC9106396 DOI: 10.1016/j.heliyon.2022.e09424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 12/11/2021] [Accepted: 05/10/2022] [Indexed: 12/01/2022] Open
Abstract
The aim of this study was to measure anxiety levels and many co-factors that might influence the levels of anxiety during the COVID-19 outbreak in southern Saudi Arabia (KSA). A cross-sectional self-reporting survey was conducted to determine the level of generalized anxiety disorder (GAD) symptoms related to COVID-19 and quarantining. We selected a convenience sample of eligible participants who had been invited online through social media apps. The survey instrument was distributed, and 981 participants responded. Of the total sample, almost 90% were under the age of 40, 75% were women, and 77% had an educational level beyond high school. Just over half were single, with nearly all participants Saudi nationals. The overall prevalence of anxiety related to COVID-19 was 27%. Factors most strongly related to reporting anxiety included having a diagnosis of COVID-19, spending 1- ≥ 3 h focused on COVID-19, having a previous mental illness history, being a current or former smoker, being female, having a previous diagnosis of chronic or respiratory illness, being below age 40, having a limited standard of living, and being a student. Our study reveals how critical it is to emphasize preventive mental health care during pandemics and what factors may make some individuals most vulnerable to anxiety. Further research is recommended to examine GAD levels pre, during and post pandemic. Additional research to explore the long-term impact of the pandemic on mental health is also needed. being a student, and a limited standard of living.
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Affiliation(s)
- Abdullah A Alharbi
- Family and Community Medicine Department, Faculty of Medicine, Jazan University, Jazan City, Jazan, Saudi Arabia
| | - Ahmad Y Alqassim
- Family and Community Medicine Department, Faculty of Medicine, Jazan University, Jazan City, Jazan, Saudi Arabia
| | - Mohammed A Muaddi
- Family and Community Medicine Department, Faculty of Medicine, Jazan University, Jazan City, Jazan, Saudi Arabia
| | - Anwar M Makeen
- Family and Community Medicine Department, Faculty of Medicine, Jazan University, Jazan City, Jazan, Saudi Arabia
| | - Ahmed M Hagawi
- Jazan Health Affairs, Ministry of Health, Jazan City, Jazan, Saudi Arabia
| | - Layla A Shaabi
- Jazan Health Affairs, Ministry of Health, Jazan City, Jazan, Saudi Arabia
| | - Sabreen M Alhweity
- Tabuk Health Affairs, Ministry of Health, Tabuk City, Tabuk, Saudi Arabia
| | | | - Maryam A Sultan
- Faculty of Medicine, Jazan University, Jazan City, Jazan, Saudi Arabia
| | | | - Nada S Aburasain
- Faculty of Medicine, Jazan University, Jazan City, Jazan, Saudi Arabia
| | - Ronnie D Horner
- Health Services Research and Administration Department, College of Public Health, University of Nebraska Medical Center, Omaha City, Nebraska, USA
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Pariwatcharakul P, Srifuengfung M. Clonidine and Tizanidine for Management of Bipolar Disorder Due to Dengue Encephalopathy: A Case Report. PSYCHOSOMATICS 2020; 61:727-731. [PMID: 32917393 DOI: 10.1016/j.psym.2020.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 08/03/2020] [Accepted: 08/03/2020] [Indexed: 01/18/2023]
Affiliation(s)
- Pornjira Pariwatcharakul
- Department of Psychiatry, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Maytinee Srifuengfung
- Department of Psychiatry, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
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Qureshi I, Qureshi A. Psychological and social aspects of Dengue virus illness virus infection. DENGUE VIRUS DISEASE 2020. [DOI: 10.1016/b978-0-12-818270-3.00008-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
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Herbuela VRDM, de Guzman FS, Sobrepeña GD, Claudio ABF, Tomas ACV, Arriola-Delos Reyes CM, Regalado RA, Teodoro MM, Watanabe K. Depressive and Anxiety Symptoms among Pediatric In-Patients with Dengue Fever: A Case-Control Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 17:ijerph17010099. [PMID: 31877808 PMCID: PMC6981716 DOI: 10.3390/ijerph17010099] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 12/16/2019] [Accepted: 12/17/2019] [Indexed: 01/10/2023]
Abstract
BACKGROUND Psychiatric symptoms have been reported in adult patients with dengue fever (DF); however, information on pediatric patients remains inadequate. We sought to identify the prevalence and predictors of depressive and anxiety symptoms and identify other psychiatric symptoms among pediatric patients with DF. This case-control study involved pediatric in-patients (n = 225) who had clinical or serologic-confirmed DF and healthy school-based controls (n = 260). Participants completed the Revised Child Anxiety and Depression Scale (RCADS). RESULTS The prevalence of depressive (13.3%) and anxiety (34.2%) symptoms among pediatric patients with DF was significantly (p < 0.001) higher than that among controls (3.5% and 16.2%, respectively). Multiple linear regression analysis found that age, family history of DF, ≤2 days of hospitalization, myalgia, and arthralgia were predictors of increased depressive and anxiety symptoms among the patients. Further, 26.7% of pediatric patients reported irritability, agitation, visual hallucinations, and aggressiveness. CONCLUSION Pediatric patients present depressive and anxiety symptoms whose levels were associated with social and clinical factors. However, whether these symptoms are present only during the infection or may still persist after recovery or are brought by children's adverse reactions to hospitalization are unknown, and thus, further studies are needed.
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Affiliation(s)
- Von Ralph Dane M Herbuela
- Graduate School of Science and Engineering, Ehime University, Bunkyo-cho 3, Matsuyama 790-8577, Japan
| | - Ferdinand S de Guzman
- Department of Family and Community Medicine, Infectious Diseases and Tropical Medicine, San Lazaro Hospital, Manila 1003, Philippines
| | - Girly D Sobrepeña
- Pediatrics Department, Quezon City General Hospital, Quezon City 1106, Philippines
| | | | - Angelica Cecilia V Tomas
- Department of Pediatrics, College of Medicine, University of the Philippines, Manila 1000, Philippines
| | | | - Rachele A Regalado
- Guidance Department, University of Santo Tomas-Angelicum College, Quezon City 1114, Philippines
| | - Mariama M Teodoro
- Counseling and Educational Psychology Department, De La Salle University, Manila 1004, Philippines
| | - Kozo Watanabe
- Graduate School of Science and Engineering, Ehime University, Bunkyo-cho 3, Matsuyama 790-8577, Japan
- Biological Control Research Unit, Center for Natural Science and Environmental Research, De La Salle University, Manila 1004, Philippines
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Uvais NA, Moideen S. Psychiatric Morbidity among Patients Admitted with Dengue Fever. ANKARA MEDICAL JOURNAL 2018. [DOI: 10.17098/amj.435269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Gunathilaka N, Chandradasa M, Champika L, Siriwardana S, Wijesooriya L. Delayed anxiety and depressive morbidity among dengue patients in a multi-ethnic urban setting: first report from Sri Lanka. Int J Ment Health Syst 2018; 12:20. [PMID: 29743940 PMCID: PMC5930431 DOI: 10.1186/s13033-018-0202-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Accepted: 04/18/2018] [Indexed: 11/10/2022] Open
Abstract
Background Although the physical consequences of dengue are well documented, delayed psychological co-morbidities are not well studied to date. Therefore, the objective of the present study was to determine the prevalence of depressive, anxiety and stress symptoms among past dengue patients. Methods A community-based, case–control study in a multi-ethnic urban setting was conducted in Sri Lanka involving adults who were diagnosed to have dengue fever by a positive dengue IgM antibody response between 6 and 24 months ago. Self-administered Depression, Anxiety and Stress Scale (DASS-21), Centre for Epidemiological Studies Depression Scale (CESD-20) and a structured clinical interview by a psychiatrist were done in the patients and in an age and gender-matched control group. Results Fifty-three participants each in the patient (mean age 42.9 years, SD 15.5) and control (mean age 41.6 years, SD 15.3) groups were surveyed. The ages ranged from 18 to 70 years and 64.2% were females. The majority (90.6%; n = 48) of the individuals had been diagnosed with dengue fever followed by dengue haemorrhagic fever (9.4% n = 5). Dengue patients had higher DASS-21 mean depressive scores (means 11.7/9.4, SD 6.4/4.0, t = 2.2, p = .028), anxiety scores (means 10.7/7.2, SD 6.8/1.8, t = 3.6, p = .0005), stress scores (means 12.0/8.8, SD 5.3/3.5, t = 3.6, p = .0004) and CESD-20 scores (means 16.1/11.7, SD 9.4/7.3, t = 2.6, p = .008) than controls. The DSM-5 depressive disorder was clinically detected by the psychiatrist among 15.1 and 7.5% in patient and control groups (OR 2.1; CI .5–7.7; p = .22). Limitations: a limitation is the small sample size. Conclusion Patients with past dengue had significantly higher depressive, anxiety and stress symptoms than the control group according to the DASS-21 and CESD-20 tools. To our knowledge, this is the first report on delayed psychological morbidity related to dengue. This may warrant healthcare professionals to incorporate mental counselling for dengue patients.
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Affiliation(s)
- Nayana Gunathilaka
- 1Department of Parasitology, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka
| | - Miyuru Chandradasa
- 2Department of Psychiatry, Faculty of Medicine, University of Kelaniya, PO Box 6, Thalagolla Road, Ragama, 11010 Sri Lanka.,3Colombo North Teaching Hospital, Ragama, Sri Lanka
| | | | - Shirom Siriwardana
- 4Department of Anatomy, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka
| | - Lakmini Wijesooriya
- 5Department of Medical Microbiology, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka
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Madeeh Hashmi A, Awais Aftab M, Mazhar N, Umair M, Butt Z. The fiery landscape of depression: A review of the inflammatory hypothesis. Pak J Med Sci 2014; 29:877-84. [PMID: 24353650 PMCID: PMC3809277 DOI: 10.12669/pjms.293.3357] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2013] [Revised: 05/06/2013] [Accepted: 05/09/2013] [Indexed: 12/11/2022] Open
Affiliation(s)
| | | | - Nauman Mazhar
- Nauman Mazhar MBBS, MD, Assistant Professor, Psychiatry
| | | | - Zeeshan Butt
- Zeeshan Butt, MBBS, Resident in Internal Medicine
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