Left alone outside: A prospective observational cohort study on mental health outcomes among relatives of COVID-19 hospitalized patients

Abstract

Hospitalization due to COVID-19 bears many psychological challenges. While focusing on infected patients, their relatives are being largely neglected. Here, we investigated the mental health implications of hospitalization among relatives over a one-month course. A single center study was conducted to assess relatives of COVID-19 patients during the first month from their admission to the hospital and elucidate risk and protective factors for mental health deterioration. Ninety-one relatives of the first patients to be hospitalized in Israel were contacted by phone and screened for anxiety, depression, and posttraumatic stress symptoms (PTSS) at three time points (25-72 hours, 7-18 days, and one month). We found that anxiety and depression decreased significantly during the first month from their admission. Risk factors for deteriorated mental health at one month included feelings of mental exhaustion, financial concerns, and social disconnection. Being ultra-orthodox was a protective factor for anxiety and depression but not PTSS. Our findings emphasize the importance of addressing the mental health status of close relatives and adjust support for the unique setting of COVID-19.

A 16-Month Longitudinal Investigation of Risk and Protective Factors for Mental Health Outcomes Throughout Three National Lockdowns and a Mass Vaccination Campaign: Evidence from a Weighted Israeli Sample During COVID-19

“…To reduce dimensionality in these environmental stressors, we conducted an exploratory factor analysis that converged with the theoretical constructs of the PRSF inventory and concluded in four latent factors: financial, health-related, fatigue, and sense of protection by the authorities. In line with our findings among healthcare workers (Mosheva et al, 2020) and caregivers of COVID-19 patients (Hertz-Palmor et al, 2022), we hypothesized that fatigue would be the strongest predictor for depression, anxiety and PTSS. In line with our previous findings among the general population (Hertz-Palmor et al, 2021), we expected that financial concerns would most strongly associate with depression, and would exceed the association of health-related concerns with depression.…”

“…PROMIS have validated cutoffs for probable depression (Choi et al, 2014) and anxiety (Schalet et al, 2014), equivalent to the common ≥10 cutoff of PHQ-9 and GAD-7. We previously used PROMIS cutoffs to portray the prevalence of depression and anxiety among relatives of COVID-19 patients (Hertz-Palmor et al, 2022). Posttraumatic stress symptoms were screened with the validated Hebrew version of the Primary Care PTSD Screen for DSM-5 (PC-PTSD-5; Spoont et al, 2015).…”

“…While ‘pandemic fatigue’ was considered a controversial phenomenon in the early days of the pandemic (Reicher & Drury, 2021), especially since many people viewed it as a common excuse for disobeying governmental restrictions, there have been accumulating evidence to its existence ever since, two years into the pandemic (Morgul et al, 2021; Petherick et al, 2021). We have previously demonstrated the substantial contribution of mental exhaustion and sleep difficulties to adverse mental outcomes among healthcare workers (Mosheva et al, 2021, 2020) and relatives of COVID-19 infected patients (Hertz-Palmor et al, 2022) during the early phase of the pandemic in Israel. In both cases, mental exhaustion was the strongest predictor for anxiety, depression, and posttraumatic stress symptoms (PTSS).…”

COVID-19 Infection among Family and Friends: The Psychological Impact on Non-Infected Persons

“…Compared to those who did not know anyone who was infected, those who knew one or more infected persons were statistically significantly more likely to have symptoms of both depression and anxiety (25% vs. 37% vs. 39%). The fear of getting infected by someone in the social networks, having a family member/friend in quarantine, uncertainty about the outcome of infection among family members/friends, work-family disruption, and stress due to the illness of a member in the social network could have led to the higher risk of anxiety and depression symptoms among non-infected individuals [ 7 , 8 , 9 , 12 , 18 , 22 , 23 , 24 ]. Similarly, compared to those who did not have a family member/friend hospitalized due to COVID-19 infection, those who had one or more family members/friends hospitalized due to COVID-19 were more likely to have symptoms of both depression and anxiety (23% vs. 37% vs. 46%).…”

“…Also, the rates of psychological distress were found to be higher in relatives of COVID-19 intensive care patients than relatives of intensive care patients who had other health problems [ 23 , 24 , 25 , 26 , 27 ]. There are a myriad of reasons postulated for psychological distress, such as caregiver burden, uncertainty about infection outcomes in family members, fear of death of a dear one, not being supported by healthcare facilities and providers, communication-related challenges with medical providers and other family members, lack of social connections and support, financial concerns, added household responsibilities, and inability to see/meet COVID-19 infected family members (especially, if they are in an intensive care unit) [ 23 , 24 , 25 , 26 , 27 , 28 , 29 ]. Unfortunately, healthcare workers who took care of COVID-19 patients have also been shown to suffer similar or nearly the same levels of psychological distress [ 10 , 11 ].…”