The correlation between mental health status, sleep quality, and inflammatory markers, virus negative conversion time among patients confirmed with 2019-nCoV during the COVID-19 outbreak in China

Abstract

The 2019 coronavirus disease (COVID-19) has spread to the whole world. Psychological and sleep problems among confirmed patients have drawn extensive attention which may be highly related to immune function and inflammatory responses of people. The aim of this study is to examine the correlation of mental health status, sleep quality, and inflammatory markers, virus negative conversion time (NCT) among confirmed patients during the COVID-19 outbreak. A cross-sectional survey was conducted in this study. Data from 66 patients assessed with demographic information, anxious symptom, depressive symptom, stress, and sleep quality were collected using a smartphone-based questionnaire platform and then clinical characteristics and laboratory indicators were collected using case review. Nearly 30% of the participants reported depression, anxiety, perceived pressure, and poor sleep quality. Compared with the group without depression, neutrophil count, and ratio of neutrophil count to lymphocyte count (NLR) in the depression disorder group were increased ( P = .028, 0.043). There was also a significant difference in NLR and NCT between the anxiety group and the non-anxiety group ( P = .021, .024). Similarly, compared with the good sleep quality group, NLR in the poor sleep quality group was increased ( P = .011). Correlation analysis indicated that Self-Rating Depression Scale score was positively related to neutrophil count and NLR ( r = 0.366, 0.330, P = .016, .031). The total score of Pittsburgh Sleep Quality Index (PSQI) was negatively related to lymphocyte count ( r = −0.317, P = .049), and the sleep disturbance as 1 of the 7 dimensions of PSQI scale was positively correlated with NCT and NLR ( r = 0.370, 0.340, P = .020, .034). In our study, confirmed patients were prone to have psychological and sleep problems. The level of inflammation in patients with psychological and sleep problems was higher than that in patients without corresponding problems. The inflammatory level increased with the increase of Self-Rating Depression Scale score, and the lymphocyte count decreased with the increase of the PSQI score. NCT was prolonged in the anxiety group and sleep disturbance was positively correlated with NCT.

Post-COVID-19 Depressive Symptoms: Epidemiology, Pathophysiology, and Pharmacological Treatment

“…Studies scoring ≥ 3 were regarded as low risk of bias, while studies scoring < 3 were regarded as high risk of bias (Table 2 ). The most investigated inflammatory markers were readily available routine biomarkers of inflammation, especially CRP [ 10 , 13 , 26 , 34 , 98 , 110 – 115 ] and neutrophil/lymphocyte ratio (NLR) [ 10 , 13 , 110 , 112 , 114 – 117 ]. Among cytokines, the most investigated were IL-6 [ 34 , 111 – 115 , 118 , 119 ], IL-10 [ 34 , 111 , 112 , 120 ], and TNF-α [ 111 , 112 , 118 , 120 ].…”

“…Finally, two studies investigated T-cell subpopulations [ 111 , 120 ]. Among the included studies, 13 studies [ 10 , 13 , 26 , 34 , 98 , 111 – 113 , 115 – 117 , 119 , 120 ] found a significant association between inflammatory markers and COVID-19-related depressive symptoms, while three studies did not find any statistical association [ 110 , 114 , 118 ]. Specifically, post-COVID-19 depressive symptoms were found to be associated with NLR in four studies [ 112 , 115 – 117 ], with CRP in four studies [ 34 , 98 , 113 , 115 ], with systemic inflammation index (SII) in three studies [ 10 , 13 , 26 ], with the neutrophil count in two studies [ 115 , 117 ], and with IL-6 in two studies [ 34 , 113 ].…”

Sleep During the COVID-19 Pandemic

“…Zhang et al found that poor sleep quality in infected patients was associated with increased neutrophil-to-lymphocyte ratio (NLR), lower recovery from lymphopenia, longer hospitalization, and higher risk of ICU admission [ 25 •]. Li et al exhibited that NLR was increased in patients with poor sleep quality and sleep deprivation was positively correlated with virus negative conversion time [ 26 ]. In a prospective cohort study, poor sleep quality in COVID-19 patients was significantly associated with prolonged hospitalization, major dysregulation of immune system, indicated by several biomarkers, and increased risk of developing severe or critical pneumonia [ 27 ••].…”

Risiko Kesehatan Mental Pada Pasien Coronavirus Disease 2019 (Covid-19) Di Masyarakat: Literature Review

“…Hasil analisis kajian dari penelitian yang dilakukan oleh Gennaro et al (2020); Kandeğer et al (2021); Guo et al (2020); dan; Li et al (2021) menunjukkan bahwa konsekuensi kejiwaan terhadap infeksi SARS-CoV-2 dapat disebabkan oleh respons kekebalan terhadap virus itu sendiri. Ditemukan kajian terkait respon imun dalam tubuh yang memicu peradangan atau inflamasi dasar (SII) pada status psikopatologis menemukan efek yang signifikan terhadap gangguan kesehatan mental seperti depresi dan insomnia.…”