Anxiety, Stress and Depression in COVID-19 Survivors From an Italian Cohort of Hospitalized Patients: Results From a 1-Year Follow-Up

Abstract

BackgroundMental health-related symptoms can persist over time beyond the most common respiratory clinical features of COVID-19. A recent meta-analysis underlined that mental health sequalae may be relevant for COVID-19 survivors and reported the following prevalence rates: 20% for post-traumatic stress disorder, 22% for anxiety, 36% for psychological distress, and 21% for depression. In the context of a multi-disciplinary follow-up project, we already investigated the mid-term (4 months) psychiatric outcomes in a sample of COVID-19 survivors. Patients were re-assessed after 1-year since hospital discharge.MethodsFollow-up conducted after 1 year involved 196 individuals recovered from COVID-19. Patients were assessed with a multi-disciplinary approach; including both a clinical interview performed by an experienced psychiatrist, trained in the use of the Mini-International Neuropsychiatric Interview (MINI) to assess the presence of anxiety, stress, and depressive symptoms and the following self-administered questionnaires: Beck Anxiety Inventory, Beck Depression Inventory-II, Resilience Scale for Adults, Impact of Event Scale, and COVID-19 Peritraumatic Distress Index (CPDI).ResultsAnxiety (p < 0.0001) and depressive (p < 0.0003) symptoms registered at the clinical interview showed a significant improvement from the 4 to 12-months follow-up. Logistic regression model showed that female gender (p = 0.006), arterial hypertension (p = 0.01), obesity (0.04), anxiety (p < 0.0001), and depressive (p = 0.02) symptoms at 4-months follow-up were associated with persistence of anxiety symptoms at 12 months. At logistic regression analysis female gender (p = 0.02) and depressive symptoms at 4-months follow-up (p = 0.01) were associated with depressive symptoms after 12 months.ConclusionSeverity of the disease in the acute phase, in this study, was not a determining factor in identifying subjects at risk of developing clinically relevant anxiety and depression as a consequence of COVID-19 disease. Findings from the logistic regressions suggest that the factors most affecting depression and anxiety in COVID survivors after 12 months were female gender, the presence of anxiety and depression after 4 months and some physical symptoms, not necessarily COVID-related. Impact of infection and consequent hospitalization for COVID-19 did no longer represent a relevant issue for depressive symptoms, compared to other general factors.

Neuropsychiatric and Cognitive Outcomes in Patients 6 Months After COVID-19 Requiring Hospitalization Compared With Matched Control Patients Hospitalized for Non–COVID-19 Illness

“…Prospective follow-up questionnaire studies revealed depressive and/or anxiety symptoms in between 4% to 47% of patients, probably owing to variations in methods and case definitions. Prior prospective clinical studies without control groups investigating neuropsychiatric outcomes identified PTSD in 30% (30-120 days after COVID-19 onset) and depressive and anxiety symptoms in 30% to 33% of survivors of COVID-19 (although prevalence and not incidence). However, in survey-based studies with control groups, the burden of mental health complications among cases and controls was not significantly different, in agreement with our results.…”

“…Of all studies on post–COVID-19 conditions published by April 2021, only 21% included control individuals and 13% had matched control individuals . Most studies reporting on increased neuropsychiatric and cognitive complications in patients with COVID-19 are based on internet or telephone surveys or EHRs and have historical or no control groups . Matched and prospectively enrolled patients hospitalized during the pandemic for non-COVID-19 illnesses are required to control for the negative societal effects of the lockdown measures on mood and cognitive function, which cannot be achieved using historical cohorts .…”

Resilience After COVID-19: A Descriptive, Cross-Sectional Study

“… González-Sanguino et al (2020) , in a study of a Spanish population at the beginning of the pandemic, described that 18.70% of the population may have a possible diagnosis of depression and 21.60% have a potential diagnosis of anxiety. A recent study by Gramaglia et al (2022) , showed that female sex and depressive symptoms at 4-month follow-up were associated with depressive symptoms after 12 months ( Gramaglia et al, 2022 ). These results partially relate with those of our study, since gender is not a significant factor in our results, and age is, but they support the need for intervention in the prevention and treatment of depression to improve resilience after COVID-19.…”

Determinants of long COVID among adults hospitalized for SARS-CoV-2 infection: A prospective cohort study

“…This observation suggests that the mental health impact may be a cause, rather than a consequence of long COVID, at least for those patients without long term organ function impairment. It is well known that the prevalence of COVID-19 survivors showing anxiety/depressive symptoms is high ( 35 , 36 ). The pandemic impacted severely on the mental health of the general population: the effects on persons who required hospital admission, especially if they experienced traumatic events such as mechanical ventilation or familiar mourns, are conceivably more severe.…”