Anxiety and depression symptoms after virological clearance of COVID‐19: A cross‐sectional study in Milan, Italy

Tomasoni, Daniele; Bai, Francesca; Castoldi, Roberto; Barbanotti, Diletta; Falcinella, Camilla; Mulè, Giovanni; Mondatore, Debora; Tavelli, Alessandro; Vegni, Elena; Marchetti, Giulia; Monforte, Antonella d’Arminio

doi:10.1002/jmv.26459

Cited by 137 publications

(184 citation statements)

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“…Across both hospitalised and non-hospitalised populations, the most frequently reported symptoms were breathlessness, found in 13 studies (46%), [9,28–31,35–39,47,48,53] followed by persisting smell and taste disturbance documented in 12 studies (43%) [25–28,33–35,39–41,47,53] and fatigue in 11 studies (39%). [9,28,29,34,37,39,42,44,49,50,53] Psychological symptoms were also frequently reported, of which anxiety was most common (25%), [29,38,43,44,47,49,52] followed by depression, [38,43,44,47,52] sleep disorders, [28,38,42,52] and post-traumatic stress disorder (PTSD). [43,44,52] Increased dependency in activities of daily living (ADLs), comprising personal care and social activities, was reported by almost half of participants in one study (47.5%, 49/103), [46] as well as reduced quality of life (QoL).…”

Section: Resultsmentioning

confidence: 99%

Characterising long term Covid-19: a living systematic review

Michelen

Cheng

Manoharan³

et al. 2020

Preprint

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Objective To understand the frequency, profile, and duration of persistent symptoms of covid-19 and to update this understanding as new evidence emerges. Design: A living systematic review produced in response to the rapidly evolving evidence base for long covid. Data sources Medline and CINAHL (EBSCO), Global Health (Ovid), WHO Global Research Database on covid-19, LitCOVID, and Google Scholar to 28th September 2020. Study selection Studies reporting long-term symptoms and complications among people with confirmed or suspected covid-19, both in those previously hospitalised and those never hospitalised. Only studies incorporating over 100 participants qualified for data extraction and were assessed for risk of bias. Results were analysed using descriptive statistics. Quality assessment Risk of bias was assessed using a quality assessment checklist for prevalence studies. Results Twenty-eight studies qualified for data extraction; 16 of these were cohort studies, ten cross-sectional, and two large case series. The analysis included 9,442 adults with covid-19 from 13 countries. The longest mean follow-up period was 111 (SD: 11) days post-hospital discharge. A wide range of systemic, cardiopulmonary, gastrointestinal, neurological, and psychosocial symptoms was reported, of which the most common were breathlessness, fatigue, smell and taste disturbance, and anxiety. Persistent symptoms were described across both previously hospitalised and non-hospitalised populations. The quality of evidence was low, with a high risk of bias and heterogeneity in prevalence. The incorporated studies demonstrated limited external validity, a lack of control subjects, and inconsistent data collection methods. Few studies were conducted in primary care, no studies focused solely on children, and no studies were set in low- and middle-income countries. Conclusion: Our findings suggest that long covid is a complex, heterogeneous condition; however, the limited evidence base currently precludes a precise definition of its symptoms and prevalence. There is a clear need for robust, controlled, prospective cohort studies, including different at-risk populations and settings, incorporating appropriate investigations, collected and recorded in a standardised way.

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Section: Resultsmentioning

confidence: 99%

Characterising long term Covid-19: a living systematic review

Michelen

Cheng

Manoharan³

et al. 2020

Preprint

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“…In this study, the prevalence of significant PTSD was 12% ( Liu et al 2020 ). In another study, one-third of the patients with COVID-19 infection reported clinically significant anxiety and/or depression, at a median of 46 days after the virus clearance ( Tomasoni et al 2020 ).…”

Section: Discussionmentioning

confidence: 99%

“…While delirium, insomnia, and symptoms of depression, anxiety, and posttraumatic stress disorder (PTSD) have been reported as common features in the acute (and immediate convalescent) period, data are sparse on the psychiatric status in the post-illness phase ( Rogers et al 2020 ). To our knowledge, only three studies investigated the psychiatric symptomatology inpatients who had recovered from the acute COVID-19 infection, and these reported high rates of insomnia, and symptoms of PTSD, depression, and anxiety, about one month after the infection ( Liu et al 2020 ; Mazza et al 2020 ; Tomasoni et al 2020 ). These preliminary findings suggest substantial psychiatric morbidity following the COVID-19 infection, comparable to what was reported after the previous coronavirus epidemics (Severe Acute Respiratory Syndrome (SARS) and Middle East Respiratory Syndrome (MERS) (Wu et al 2020; Mak et al 2009; Lee et al 2007)).…”

Section: Introductionmentioning

confidence: 99%

Psychiatric morbidity and protracted symptoms after COVID-19

Poyraz

Olgun

et al. 2021

Psychiatry Research

136

121

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Highlights We studied the psychiatric morbidity and the protracted symptoms in recently recovered COVID-19 patients We also looked at potential factors that might influence psychiatric morbidity Significant symptoms of posttraumatic stress, anxiety and depression were found PTSD symptom severity was the sole independent predictor of the presence of protracted symptoms

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“…There is a need for long-term follow up of patients with COVID-19, and especially those that have suffered ARDS, complications and ICU stay, for anxiety, depression, OCD and PTSD. For example, in one study, 107 COVID-19 patients in Milan, Italy were administered HADS to screen for anxiety and depression after viral clearance (Tomasoni et al 2021). From these patients, 30% had HADS results indicative of anxiety and depression.…”

Section: D)mentioning

confidence: 99%

Presentation and management of anxiety in individuals with acute symptomatic or asymptomatic COVID-19 infection, and in the post-COVID-19 recovery phase

Uzunova

Pallanti

Hollander

2021

International Journal of Psychiatry in Clinical Practice

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COVID-19 is associated with neuropsychiatric complications, the most frequent one being anxiety. Multiple biological and psychosocial factors contribute to anxiety in COVID-19. Among the biological factors, stress, genetics, gender, immune system, resilience, anosmia, hypogeusia, and central nervous system infection with SARS-CoV-2 are key. Anxiety is a complication of COVID-19 that may exacerbate the infection course, and the infection may exacerbate anxiety. We present the mechanisms of anxiety in symptomatic or asymptomatic COVID-19. We discuss the presentation of anxiety in patients without or with prior psychiatric illness, and with co-morbidities. Timely diagnosis and management of anxiety in COVID-19 patients is important. Given the frequent complication of COVID-19 with Acute Respiratory Distress Syndrome and Intensive Care Unit stay, anxiety may be a long-term complication. We review the diagnostic tools for anxiety in COVID-19, and summarise pharmacologic and non-pharmacologic treatments. We provide recommendations for diagnosis, treatment, prevention and follow up of anxiety in COVID-19. KEY POINTS Patients with COVID-19 (symptomatic or asymptomatic) exhibit a high frequency of neuropsychiatric complications with highest percentage attributed to anxiety. Multiple biological and psychosocial risk factors for anxiety exist in COVID-19-ill individuals. Biological risk factors include stress, resilience, genetics, gender, age, immune system, direct infection of the central nervous system (CNS) with SARS-CoV-2, comorbid psychiatric and general medical illnesses, ARDS and ICU stay. Anosmia and hypogeusia are COVID-19-specific anxiety risk factors. Knowledge of the anxiety risk factors is essential to focus on timely interventions, because anxiety may be a complication of and exacerbate the COVID-19 course. An inverse correlation exists between resilience and anxiety because of COVID-19, and therefore efforts should be made to increase resilience in COVID-19 patients. In COVID-19, important anxiety mechanism is neuroinflammation resulting from activation of the immune system and an ensuing cytokine storm. The general approach to management of anxiety in COVID-19 should be compassionate, similar to that during trauma or disaster, with efforts focussed on instilling a sense of hope and resilience. In selecting pharmacological treatment of anxiety, the stress response and immune system effects should be key. Medications with cardio-respiratory adverse effects should be avoided in patients with respiratory problems. Anxiety is a disorder that will require for long-term follow up at least one month after COVID-19.

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Anxiety and depression symptoms after virological clearance of COVID‐19: A cross‐sectional study in Milan, Italy

Cited by 137 publications

References 13 publications

Characterising long term Covid-19: a living systematic review

Characterising long term Covid-19: a living systematic review

Psychiatric morbidity and protracted symptoms after COVID-19

Presentation and management of anxiety in individuals with acute symptomatic or asymptomatic COVID-19 infection, and in the post-COVID-19 recovery phase

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