Cana AKSOY POYRAZ, Ömer Faruk DEMİREL, Burç Çağrı POYRAZ, Şenol TURAN, Ersel BULU, Sadige OSMANLI SHİROLU, Yasin KAVLA, Elif Burcu ERSUNGUR, Rıdvan KARAALİ

COVID-19 enfeksiyonu geçiren bireylerde altı ay içinde görülen ruhsal bozukluklar

Amaç: Bir hastanın Covid-19 semptomları gösterdiği sürenin uzaması ruhsal bozukluklarla yakından ilişkilidir. Bununla birlikte, hastalığın erken evrelerinde kimde belirtilerin uzun süreceğini öngörmenin mümkün olup olmadığı hakkında çok az şey biliniyor. Bu çalışmada Covid-19 sonrası psikiyatrik semptomların zamanla nasıl geliştiğini, bu semptomları etkileyen değişkenleri anlamayı amaçladık. Gereç ve Yöntem: Covid-19 hastaları hastanede yatarken ve taburcu olduktan sonraki altı ay içinde gösterdikleri kaygı, depresyon, akut stres ve uyku bozuklukları açısından uzun dönemli olarak değerlendirildi. Yakın zamanda Covid-19 ile yoğun bakım dışındaki birimlere kabul edilen yetişkin hastalar çalışma kapsamına alındı. Ruhsal durumları, Hastane Kaygı ve Depresyon Ölçeği, Ulusal Ölçekte Stresli Olaylar Anketi, Akut Stres Bozukluğu Ölçeği Kısa Formu, Pittsburgh Uyku Kalitesi Endeksi kullanılarak değerlendirildi. Hastaların klinik verileri hastane kayıtlarından derlendi. Taburcu olduktan altı ay sonra hastalara aynı soru formu ve dirençli fiziksel semptomların değerlendirilmesi için de bir semptomlar listesi WhatsApp aracılığıyla gönderildi. Bulgular: Çalışmaya dahil edilen 143 katılımcıdan 47'si çalışmayı tamamladı. Sonuçlar hastaların depresyon, anksiyete ve uykusuzluğunun takip sırasında önemli ölçüde azaldığını gösterdi. Ancak akut stres semptomları bildiren hasta sayısında artış oldu. Akut enfeksiyon sırasındaki en yüksek C-reaktif protein seviyesi (OR=1.09), takip sırasındaki depresyonu öngörmüştür. Hastanede yatış sırasında daha fazla enfeksiyöz semptom yaşamanın, altı ay sonra daha fazla sayıda uzamış semptom öngördüğü saptandı (OR=1.5). Sonuç: Akut Covid-19 enfeksiyonu sırasındaki sistemik iltihaplanmanın şiddeti depresyon belirtilerinin direnmesine yol açabilir. Buna göre, akut enfeksiyon sırasında daha çok sayıda semptom gösteren hastalar uzamış Covid-19 hastalığı geçirme tehlikesi altında olabilirler.

Anahtar Kelimeler:

Anksiyete, depresyon, travma sonrası stres, uzun süreli semptomlar, COVID-19, inflamasyon

Six-month psychiatric outcomes among survivors of COVID-19

Purpose: Long-lasting COVID-19 symptoms are closely associated with psychiatric sequelae. However, little is known about whether it is possible to predict a protracted course early in the disease. In this study, we aimed to understand how post-COVID-19 psychiatric symptomatology evolves over time and the variables that affect these symptoms. Materials and Methods: Anxiety, depression, acute stress, and sleep disorders among patients with COVID-19 were prospectively evaluated during hospitalization and six months after discharge. Adult patients recently admitted to non-intensive care units with COVID-19 were eligible. Their psychiatric status was assessed using the Hospital Anxiety and Depression Scale, National Stressful Events Survey Acute Stress Disorder Short Scale, Pittsburgh Sleep Quality Index. The patients’ clinical data were gathered from hospital records. Six months after they were discharged, the same questionnaire and a checklist to assess ongoing physical symptoms were distributed to the patients via WhatsApp. Results: 143 participants were enrolled, 47 of whom completed the study. The results showed that patients’ depression, anxiety, and insomnia significantly decreased during the follow-up. However, there was an increase in the number of patients who reported acute stress symptoms. The highest C-reactive protein level during acute infection (OR=1.09) predicted depression during the follow-up. Experiencing a higher number of infectious symptoms during hospitalization predicted a higher number of protracted symptoms six months later (OR=1.5). Conclusion: This indicates that the severity of systemic inflammation during acute COVID-19 infection may predispose patients to persistent depression. Patients with a higher number of symptoms during acute infection may be at risk of developing long-term COVID-19.

Keywords:

anxiety, depression, post-traumatic stress, protracted symptoms, COVID-19, inflammation,

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Mazza MG, De Lorenzo R, Conte C, Poletti S, Vai B, Bollettini I et al. Anxiety and depression in covid-19 survivors: role of inflammatory and clinical predictors. Brain Behav Immun. 2020;89:594-600.
Townsend L, Dyer AH, Jones K, Dunne J, Mooney A, Gaffney F et al. Persistent fatigue following sars-cov-2 infection is common and independent of severity of initial infection. Plos One. 2020;15:e0240784.
Liu N, Zhang F, Wei C, Jia Y, Shang Z, Sun L et al. Prevalence and predictors of ptss during covid-19 outbreak in china hardest-hit areas: gender differences matter. Psychiatry Res. 2020;287:112921.
Tomasoni D, Bai F, Castoldi R, Barbanotti D, Falcinella C, Mulè G, et al. Anxiety and depression symptoms after virological clearance of covid-19: a cross-sectional study in milan, italy. J Med Virol. 2021;93:1175-9.
Deng J, Zhou F, Hou W, Silver Z, Wong CY, Chang O et al. The prevalence of depression, anxiety, and sleep disturbances in covid-19 patients: a meta-analysis. Ann Ny Acad Sci. 2021;1486:90-111.
de Graaf MA, Antoni ML, Ter Kuile MM, Arbous MS, Duinisveld AJF, Feltkamp MCW et al. Short-term outpatient follow-up of covid-19 patients: a multidisciplinary approach. Eclinicalmedicine. 2021;32. 100731. doi: 10.1016/j.eclinm.2021.100731.
Halpin SJ, McIvor C, Whyatt G, Adams A, Harvey O, McLean L et al. Postdischarge symptoms and rehabilitation needs in survivors of covid-19 infection: a cross-sectional evaluation. J Med Virol. 2021;93:1013-22.
Korman M, Tkachev V, Reis C, Komada Y, Kitamura S, Gubin D et al. Covid-19-mandated social restrictions unveil the impact of social time pressure on sleep and body clock. Sci Rep. 2020;10:22225.
Vai B, Cazzetta S, Ghiglino D, Parenti L, Saibene G, Toti M et al. Risk perception and media in shaping protective behaviors: insights from the early phase of covid-19 italian outbreak. Front Psychol. 2020;11:563426.
Troyer EA, Kohn JN, Hong S. Are we facing a crashing wave of neuropsychiatric sequelae of covid-19? neuropsychiatric symptoms and potential immunologic mechanisms. Brain Behav Immun. 2020;87:34-9.
Debnath M, Berk M, Maes M. Changing dynamics of psychoneuroimmunology during the covid-19 pandemic. Brain Behav Immun Health. 2020;5:100096.
Yuan B, Li W, Liu H, Cai X, Song S, Zhao J et al. Correlation between immune response and self-reported depression during convalescence from covid-19. Brain Behav Immun. 2020;88:39-43.
WHO. Clinical Management Of Covıd-19, Interim Guidance Geneva, WHO, 2020.
Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatrica Scandinavica. 1983;67:361-70.
Kilpatrick DG, Resnick HS, Milanak ME, Miller MW, Keyes KM, Friedman MJ. National estimates of exposure to traumatic events and ptsd prevalence using DSM-IV and DSM-5 criteria. J Trauma Stress. 2013;26:537-47.
Buysse DJ, Reynolds CF, 3rd, Monk TH, Berman SR, Kupfer DJ. The pittsburgh sleep quality index: a new instrument for psychiatric practice and research. Psychiatry Res. 1989;28:193-213.
Aydemir O. Validity and reliability of turkish version of hospital anxiety and depression scale. Turkish Journal of Psychiatry. 1997;8:280-7.
Aşçıbaşı K, Çökmüş F, Aydemir O, Grubu DSM. Reliability and validity of turkish form of severity of acute stress symptoms scale. Anatolian Journal of Psychiatry. 2017;18:38.
Poyraz BÇ, Poyraz CA, Olgun Y, Gürel Ö, Alkan S, Özdemir YE et al. Psychiatric morbidity and protracted symptoms after covid-19. Psychiatry research. 2021;295:113604.
Schou TM, Joca S, Wegener G, Bay-Richter C. Psychiatric and neuropsychiatric sequelae of covid-19 - a systematic review. Brain Behav Immun. 2021;97:328-48.
Taquet M, Geddes JR, Husain M, Luciano S, Harrison PJ. 6-month neurological and psychiatric outcomes in 236 379 survivors of covid-19: a retrospective cohort study using electronic health records. Lancet Psychiatry. 2021;8:416-27.
Taquet M, Luciano S, Geddes JR, Harrison PJ. Bidirectional associations between covid-19 and psychiatric disorder: retrospective cohort studies of 62 354 covid-19 cases in the usa. Lancet Psychiat. 2021;8:130-40.
Rogers JP, Chesney E, Oliver D, Pollak TA, McGuire P, Fusar-Poli P et al. Psychiatric and neuropsychiatric presentations associated with severe coronavirus infections: a systematic review and meta-analysis with comparison to the covid-19 pandemic. The Lancet Psychiatry. 2020;7:611-27.
Mazza MG, Palladini M, De Lorenzo R, Magnaghi C, Poletti S, Furlan R et al. Persistent psychopathology and neurocognitive impairment in covid-19 survivors: effect of inflammatory biomarkers at three-month follow-up. Brain Behav Immun. 2021;94:138-47.
Iglesias-González M, Boigues M, Sanagustin D, Giralt-López M, Cuevas-Esteban J, Martínez-Cáceres E et al. Association of serum interleukin-6 and c-reactive protein with depressive and adjustment disorders in covid-19 inpatients. Brain Behav Immun Health. 2022;19:100405.
Huang C, Huang L, Wang Y, Li X, Ren L, Gu X et al. 6-month consequences of covid-19 in patients discharged from hospital: a cohort study. Lancet. 2021;397:220-32.
Yuan K, Gong YM, Liu L, Sun YK, Tian SS, Wang YJ et al. Prevalence of posttraumatic stress disorder after infectious disease pandemics in the twenty-first century, including covid-19: a meta-analysis and systematic review. Mol Psychiatry. 2021;26:4982-98.
DE Lorenzo R, Cinel E, Cilla M, Compagnone N, Ferrante M, Falbo E et al. Physical and psychological sequelae at three months after acute illness in covid-19 survivors. Panminerva Med. 2021; doi: 10.23736/S0031-0808.21.04399-8..
Kyzar EJ, Purpura LJ, Shah J, Cantos A, Nordvig AS, Yin MT. Anxiety, depression, insomnia, and trauma-related symptoms following covid-19 infection at long-term follow-up. Brain, Behavior, & Immunity - Health. 2021;16:100315.
Sudre CH, Murray B, Varsavsky T, Graham MS, Penfold RS, Bowyer RC et al. Attributes and predictors of long covid. Nat Med. 2021;27:626-31.
Chevinsky JR, Tao G, Lavery AM, Kukielka EA, Click ES, Malec D et al. Late conditions diagnosed 1-4 months following an initial coronavirus disease 2019 (covid-19) encounter: a matched-cohort study using inpatient and outpatient administrative data-united states, 1 march-30 june 2020. Clin Infect Dis. 2021;73:5-16.
Iqbal A, Iqbal K, Arshad Ali S, Azim D, Farid E, Baig MD et al. The covid-19 sequelae: a cross-sectional evaluation of post-recovery symptoms and the need for rehabilitation of covid-19 survivors. Cureus. 2021;13:e13080.
Bai F, Tomasoni D, Falcinella C, Barbanotti D, Castoldi R, Mulè G, et al. Female gender is associated with long covid syndrome: a prospective cohort study. Clin Microbiol Infect. 2021.
Al-Ameri LT, Hameed EK, Maroof BS. Sleep quality in covid-19 recovered patients. Sleep Sci. 2022;15:168-71.
Chhajer R, Shukla SD. Sleep quality of covid-19 recovered patients in india. Neurosci Insights. 2022;17:26331055221109174.
Kalamara E, Pataka A, Boutou A, Panagiotidou E, Georgopoulou A, Ballas E et al. Persistent sleep quality deterioration among post-covid-19 patients: results from a 6-month follow-up study. J Pers Med. 2022;12:1909.