Neslişah ŞİYVE, Ahmet Naci EMECEN, Salih KESKİN, Ecem BAŞOĞLU ŞENSOY, Öykü TURUNÇ, Ahmet Furkan SÜNER, Can CİMİLLİ, Belgin ÜNAL

COVID-19 tanısı almış hastalarda 6 aylık izlemde beyana dayalı anksiyete ve depresyon varlığı ve ilişkili faktörler: Prospektif Kohort Çalışması

Giriş: COVID-19'un uykusuzluk, depresyon ve anksiyete gibi semptomlara ve hastalıklara neden olabileceği gösterilmiştir. Bu çalışma, altı aylık takip süresinde COVID-19 hastaları arasında endişeli veya depresif hissetme prevalansını ve bunun başlangıçtaki bağımsız faktörlerle ilişkisini tanımlamayı amaçladı. Yöntem: Bu prospektif kohort çalışmasına, 1 Kasım 2020 ile 31 Mayıs 2021 tarihleri arasında Türkiye'de Dokuz Eylül Üniversite Hastanesi'nde SARS-CoV-2 testi pozitif çıkan 18 yaş ve üstü hastalar dahil edilmiştir. Katılımcılarla tanı sonrası 1., 3. ve 6. aylarda telefon görüşmesi yapılmıştır. Çalışmanın bağımlı değişkeni, EQ-5D-3L genel yaşam kalitesi ölçeğine dayalı olarak kendi bildirdiği orta veya şiddetli anksiyete veya depresyondur. SARS-CoV-2 enfeksiyonundan sonra endişeli ve depresif hissetmekle ilişkili faktörleri belirlemek için genelleştirilmiş tahmin denklemleri kullanılmıştır. Bulgular: Toplam 5446 hasta çalışmaya katılmayı kabul etti. Tanı sonrası 1., 3. ve 6. aylarda kaygılı veya depresif hissetme sıklığı sırasıyla %18.5, %17.9 ve %15.4 idi. İleri yaş (≥65 yaş; olasılık oranı-OR:1,17, %95 güven aralığı-GA: 0,95-1,44), kadın cinsiyet (OR:1,76 (1,58-1,96), kötü ekonomik durum (OR: 1,62 (1,34-1,97) )), daha fazla semptoma sahip (4-5, OR:1.48 (1.21-1.81); ≥5, OR:1.65 (1.35-2.01)), daha fazla altta yatan sağlık sorunu (1-2, OR:1.35 (1.19-1.54) ); ≥3: OR:1.50 (1.13-1.99)), yoğun bakım ünitesine yatış (OR: 2.58 (1.70-3.90)), kişinin bildirdiği anksiyete ve depresyon ile ilişkiliydi. Sonuç: COVID-19 hastalarında anksiyete ve depresyon duyguları yaygındır ve uzun vadede devam edebilir. Çalışmamızda, anksiyete ve depresyon cinsiyet, ekonomik durum ve hastalık şiddeti ile ilişkiliydi. COVID-19 sonrası anksiyete ve depresyona yatkın grupların belirlenmesi, erken teşhis ve ruhsal bakım hizmetlerinin başlatılması için yardımcı olabilir.

Anahtar Kelimeler:

post-COVID, anksiyete, depresyon, kohort

Self-reported anxiety and depression among COVID-19 patients within six months of follow-up: A prospective cohort study

Objective: This prospective cohort study aimed to investigate the prevalence of self-reported moderate or severe anxiety and depression among COVID-19 patients during a six-month follow-up and to identify associated baseline factors. Methods: The study included patients aged ≥18 years who tested positive for SARS-CoV-2 at Dokuz Eylul University Hospital, Turkey, between November 2020 and May 2021. Telephone interviews were conducted at 1st, 3rd, and 6th months post-diagnosis to assess feelings of anxiety and depression using the EQ-5D-3L scale. Generalized estimating equations were employed to identify factors associated with anxiety and depression after infection. Results: A total of 5446 patients participated in the study. The prevalence of feeling anxious or depressive at 1st, 3rd, and 6th months post-diagnosis was 18.5%, 17.9%, and 15.4%, respectively. Several factors were associated with self-reported anxiety or depression: Older age (≥65 years; OR: 1.17, 95% CI: 0.95-1.44), female gender (OR: 1.76, 95% CI: 1.58-1.96), unfavourable economic status (OR: 1.62, 95% CI: 1.34-1.97), more symptoms (4-5, OR: 1.48, 95% CI: 1.21-1.81; ≥5, OR: 1.65, 95% CI: 1.35-2.01), having multiple underlying health conditions (1-2, OR: 1.35, 95% CI: 1.19-1.54; ≥3: OR: 1.50, 95% CI: 1.13-1.99), and intensive care unit admission (OR: 2.58, 95% CI: 1.70-3.90). Conclusion: COVID-19 patients commonly experience anxiety or depression, which may persist long-term. Gender, economic status, and disease severity play significant roles in their psychological well-being. Identifying vulnerable groups can be instrumental in early diagnosis and provision of targeted mental care services.

Keywords:

Long COVID, Anxiety, Depression, Cohort Studies,

PDF

___

Thapa P, Acharya L, Bhatta BD, et al. Anxiety, Depression and Post-Traumatic Stress Disorder after Earthquake. J Nepal Health Res Counc. 2018;16(1):53-57.
Mak IWC, Chu CM, Pan PC, Yiu MGC, Chan VL. Long-term psychiatric morbidities among SARS survivors. Gen Hosp Psychiatry. 2009;31(4):318-326.
Kar N, Bastia BK. Post-traumatic stress disorder, depression and generalised anxiety disorder in adolescents after a natural disaster: a study of comorbidity. Clin Pract Epidemiol Ment Health CP EMH. 2006;2:17.
Khan S, Siddique R, Li H, et al. Impact of coronavirus outbreak on psychological health. J Glob Health. 2022;10(1):010331.
Rogers JP, Chesney E, Oliver D, et al. Psychiatric and neuropsychiatric presentations associated with severe coronavirus infections: a systematic review and meta-analysis with comparison to the COVID-19 pandemic. Lancet Psychiatry. 2020;7(7):611-627.
Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. The Lancet. 2020;395(10223):497-506.
Risk groups and COVID-19 | RIVM. Available at: https://www.rivm.nl/en/coronavirus-covid-19/risk-groups. Accessed February 26, 2022.
Pierce M, Hope H, Ford T, et al. Mental health before and during the COVID-19 pandemic: a longitudinal probability sample survey of the UK population. Lancet Psychiatry. 2020;7(10):883-892.
Jain A, Bodicherla KP, Raza Q, Sahu KK. Impact on mental health by “Living in Isolation and Quarantine” during COVID-19 pandemic. J Fam Med Prim Care. 2020;9(10):5415-5418.
Tsamakis K, Tsiptsios D, Ouranidis A, et al. COVID‑19 and its consequences on mental health (Review). Exp Ther Med. 2021;21(3):1-1.
Holmes EA, O’Connor RC, Perry VH, et al. Multidisciplinary research priorities for the COVID-19 pandemic: a call for action for mental health science. Lancet Psychiatry. 2020;7(6):547-560.
Yahya AS, Khawaja S, Chukwuma J. The Impact of COVID-19 in Psychiatry. Prim Care Companion CNS Disord. 2020;22(2):20l02627.
Boden M, Zimmerman L, Azevedo KJ, et al. Addressing the mental health impact of COVID-19 through population health. Clin Psychol Rev. 2021;85:102006.
Mental health and COVID-19. Available at: https://www.euro.who.int/en/health-topics/health-emergencies/coronavirus-covid-19/publications-and-technical-guidance/noncommunicable-diseases/mental-health-and-covid-19. Accessed February 26, 2022.
Lopez-Leon S, Wegman-Ostrosky T, Perelman C, et al. More than 50 long-term effects of COVID-19: a systematic review and meta-analysis. Sci Rep. 2021;11(1):16144.
Nalbandian A, Sehgal K, Gupta A, et al. Post-acute COVID-19 syndrome. Nat Med. 2021;27(4):601-615.
Wu T, Zuo Z, Kang S, et al. Multi-organ Dysfunction in Patients with COVID-19: A Systematic Review and Meta-analysis. Aging Dis. 2020;11(4):874-894.
Guan W jie, Ni Z yi, Hu Y, et al. Clinical Characteristics of Coronavirus Disease 2019 in China. N Engl J Med. 2020;382(18):1708-1720.
Maiese A, Manetti AC, Bosetti C, et al. SARS‐CoV‐2 and the brain: A review of the current knowledge on neuropathology in COVID‐19. Brain Pathol. 2021;31(6):e13013.
Fabrazzo M, Russo A, Camerlengo A, et al. Delirium and Cognitive Impairment as Predisposing Factors of COVID-19 Infection in Neuropsychiatric Patients: A Narrative Review. Med Kaunas Lith. 2021;57(11):1244.
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;87:34-39.
Mazza MG, De Lorenzo R, Conte C, et al. Anxiety and depression in COVID-19 survivors: Role of inflammatory and clinical predictors. Brain Behav Immun. 2020;89:594-600.
O’Regan D, Jackson ML, Young AH, Rosenzweig I.
Understanding the Impact of the COVID-19 Pandemic, Lockdowns and Social Isolation on Sleep Quality
. Nat Sci Sleep. 2021;13:2053-2064.
Abel KM, Carr MJ, Ashcroft DM, et al. Association of SARS-CoV-2 Infection With Psychological Distress, Psychotropic Prescribing, Fatigue, and Sleep Problems Among UK Primary Care Patients. JAMA Netw Open. 2021;4(11):e2134803.
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 Psychiatry. 2021;8(2):130-140.
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(5):416-427.
Badenoch JB, Rengasamy ER, Watson C, et al. Persistent neuropsychiatric symptoms after COVID-19: a systematic review and meta-analysis. Brain Commun. 2022;4(1):fcab297.
Short H, Al Sayah F, Ohinmaa A, Johnson JA. The performance of the EQ-5D-3L in screening for anxiety and depressive symptoms in hospital and community settings. Health Qual Life Outcomes. 2021;19(1):96.
Wong AW, Shah AS, Johnston JC, Carlsten C, Ryerson CJ. Patient-reported outcome measures after COVID-19: a prospective cohort study. Eur Respir J. 2020;56(5).
Ünal B, Emecen AN, Keskin S, et al. Dokuz Eylul University Hospital COVID-19 Follow-up Center: Performance and Preliminary Findings. Dokuz Eylül Üniversitesi Tıp Fakültesi Derg. 2021;35(3): 333–42.
Sigfrid L, Cevik M, Jesudason E, et al. What is the recovery rate and risk of long-term consequences following a diagnosis of COVID-19? A harmonised, global longitudinal observational study protocol. BMJ Open. 2021;11(3):e043887.
Evans RA, McAuley H, Harrison EM, et al. Physical, cognitive, and mental health impacts of COVID-19 after hospitalisation (PHOSP-COVID): a UK multicentre, prospective cohort study. Lancet Respir Med. 2021;9(11):1275-1287.
Faul F, Erdfelder E, Lang AG, Buchner A. G*Power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav Res Methods. 2007;39(2):175-191.
EQ-5D-3L – EQ-5D. Published February 11, 2022. Available at: https://euroqol.org/eq-5d-instruments/eq-5d-3l-about/. Accessed February 11, 2022.
Kılıç, A., Oğuzhanoğlu, N. K. EQ-5D yaşam kalitesi ölçeğinin Türkçe uyarlamasının güvenilirliği ve geçerliliği. 1999. İç Ve Tedavi Derg. 12(2):47-51.
Fernández-de-las-Peñas C, Rodríguez-Jiménez J, Moro-López-Menchero P, et al. Psychometric properties of the Spanish version of the EuroQol-5D-5L in previously hospitalized COVID-19 survivors with long COVID. Sci Rep. 2022;12(1):12605.
Shah R, Ali FM, Nixon SJ, Ingram JR, Salek SM, Finlay AY. Measuring the impact of COVID-19 on the quality of life of the survivors, partners and family members: a cross-sectional international online survey. BMJ Open. 2021;11(5):e047680.
Azizi A, Achak D, Saad E, et al. Health-Related Quality of Life of Moroccan COVID-19 Survivors: A Case-Control Study. Int J Environ Res Public Health. 2022;19(14):8804.
Mattioli F, Stampatori C, Righetti F, Sala E, Tomasi C, De Palma G. Neurological and cognitive sequelae of Covid-19: a four month follow-up. J Neurol. 2021;268(12):4422-4428.
Schou TM, Joca S, Wegener G, Bay-Richter C. Psychiatric and neuropsychiatric sequelae of COVID-19 – A systematic review. Brain Behav Immun. 2021;97:328-348.
Firat M, Okanli A, Kanbay Y, Utkan M, Gokmen B. The Prevalence of Pandemic Anxiety, Anxiety and Depression During the COVID-19 Pandemic in Turkey. PSYCHIATRY Clin Psychopharmacol. 2021;31(2).
Nie XD, Wang Q, Wang MN, et al. Anxiety and depression and its correlates in patients with coronavirus disease 2019 in Wuhan. Int J Psychiatry Clin Pract. 2021;25(2):109-114.
Nolen-Hoeksema S. Gender Differences in Depression. Curr Dir Psychol Sci. 2001;10(5):173-176.
Jalnapurkar I, Allen M, Pigott T. Sex Differences in Anxiety Disorders: A Review. Published online February 27, 2018.
Compton MT, Shim RS. The Social Determinants of Mental Health. FOCUS. 2015;13(4):419-425.
Ueda M, Stickley A, Sueki H, Matsubayashi T. Mental health status of the general population in Japan during the COVID-19 pandemic. Psychiatry Clin Neurosci. 2020;74(9):505-506.
Shevlin M, McBride O, Murphy J, et al. Anxiety, depression, traumatic stress and COVID-19-related anxiety in the UK general population during the COVID-19 pandemic. BJPsych Open. 2020;6(6):e125.
Hashemi-Shahri SM, Tabatabaei SMN, Ansari-Moghaddam A, et al. Epidemiological and clinical risk factors related to severe COVID-19 in Iran: a multi-center study. BMC Infect Dis. 2022;22:184.
Wang D, Hu B, Hu C, et al. Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus–Infected Pneumonia in Wuhan, China. JAMA. 2020;323(11):1061-1069.
Fitzgerald PJ. Serious infection may systemically increase noradrenergic signaling and produce psychological effects. Med Hypotheses. 2020;139:109692.
Ngasa SN, Tchouda LAS, Abanda C, et al. Prevalence and factors associated with anxiety and depression amongst hospitalised COVID-19 patients in Laquintinie Hospital Douala, Cameroon. PLOS ONE. 2021;16(12):e0260819.
Rahman MH, Banik G, Ahmed A, et al. Anxiety and depressive symptoms among COVID-19 patients admitted to three isolation facilities in Bangladesh. Health Psychol Open. 2021;8(2):20551029211046104.
Hatch R, Young D, Barber V, Griffiths J, Harrison DA, Watkinson P. Anxiety, Depression and Post Traumatic Stress Disorder after critical illness: a UK-wide prospective cohort study. Crit Care Lond Engl. 2018;22(1):310.
Vincent A, Beck K, Becker C, et al. Psychological burden in patients with COVID-19 and their relatives 90 days after hospitalization: A prospective observational cohort study. J Psychosom Res. 2021;147:110526.
Li L, Wu MS, Tao J, et al. A Follow-Up Investigation of Mental Health Among Discharged COVID-19 Patients in Wuhan, China. Front Public Health. 2021;9:640352.