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Post-COVID-19 psychiatric and cognitive morbidity: Preliminary findings from a Brazilian cohort study
Abstract
Objective
The present study aims to investigate the occurrence of psychiatric and cognitive impairments in a cohort of survivors of moderate or severe forms of COVID-19.
Method
425 adults were assessed 6 to 9 months after hospital discharge with a structured psychiatric interview, psychometric tests and a cognitive battery. A large, multidisciplinary, set of clinical data depicting the acute phase of the disease, along with relevant psychosocial variables, were used to predict psychiatric and cognitive outcomes using the ‘Least Absolute Shrinkage and Selection Operator’ (LASSO) method.
Results
Diagnoses of ‘depression’, ‘generalized anxiety disorder’ and ‘post-traumatic stress disorder’ were established respectively in 8%, 15.5% and 13.6% of the sample. After pandemic onset (i.e., within the previous year), the prevalence of ‘depression’ and ‘generalized anxiety disorder’ were 2.56% and 8.14%, respectively. Memory decline was subjectively reported by 51.1% of the patients. Psychiatric or cognitive outcomes were not associated with any clinical variables related to the severity of acute-phase disease, nor by disease-related psychosocial stressors.
Conclusions
This is the first study to access rates of psychiatric and cognitive morbidity in the long-term outcome after moderate or severe forms of COVID-19 using standardized measures. As a key finding, there was no significant association between clinical severity in the acute-phase of SARS-CoV-2 infection and the neuropsychiatric impairment 6 to 9 months thereafter.
... Finally, the Brazilian study conducted by Damian et al. (2022) ...
... The study carried out by Charul et al. (2023) consistently showed a significant increase in MDD cases globally, affecting certain segments of the population more pronouncedly than others. Despite this, articles by Leung et al. (2023) and Damian et al. (2022) suggest that, after the peak in TM diagnoses on a global scale, incidence rates tend to stabilize again, although it is important to highlight that sequelae may persist in more susceptible individuals. ...
... Indeed, a significant association was observed between clinical severity in the acute phase of SARS-CoV-2 infection and neuropsychiatric impairment. However, initial studies indicate that sequelae tend to decrease over time after infection, but there is still insufficient data for long-term assessment of symptom recurrence and possible neurobiological complications in the clinical approach (Damian et al., 2022). ...
The COVID-19 pandemic has had a multifaceted impact on people's daily lives and has adversely affected the population's mental health in several aspects. Therefore, the objective of this study is to analyze the impact of COVID-19 on the prevalence of major depressive disorder in adults, aiming to summarize the current literature to provide a broader understanding of the topic in pre- and post-pandemic scenarios. For this purpose, a literature review was conducted between October 2023 and February 2024, based on articles published in health databases. The PRISMA method and the PECO strategy were employed alongside the GRADE methodology to analyze the evidence. The study found that while the prevalence of depressive disorders varied geographically, there was a significant global increase due to the pandemic. After a worldwide peak in diagnoses, incidence rates tend to stabilize; however, it is important to note that some sequelae may persist in more vulnerable individuals or those who have contracted COVID-19. In summary, the adverse effects on mental health following the pandemic were evident, with health system responses influencing how countries addressed this increase, underscoring the importance of prioritizing mental health as a public health issue.
... Other studies aimed to assess the cognitive outcomes and potential risks associated with COVID-19, taking into account factors such as severity of illness, education level, comorbidities, and time since infection or intensive care unit (ICU) discharge (Crivelli et al., 2022;Damiano et al., 2022;Del Brutto et al., 2021;Delgado-Alonso et al., 2022;Duindam et al., 2022;Ferrando et al., 2022;Ferrucci et al., 2021;Frontera et al., 2021;Vannorsdall et al., 2022). Comorbid conditions, such as hypertension, cardiac conditions, chronic obstructive pulmonary disease, asthma, diabetes, and other conditions were noted in COVID -19 patients with higher prevalence in the older age groups. ...
... The diverse utilization of demographic adjustments presented additional obstacles when comparing findings among studies. Research employing adjustments for factors like age, education, cultural background, and gender yielded varying rates of impaired scores compared to those studies not implementing such adjustments (Damiano et al., 2022;Pilotto et al., 2021). As expected, research employing looser definitions of impaired scores tended to document elevated rates of cognitive impairment. ...
... Twenty of the included studies (Becker et al., 2021;Birberg Thornberg et al., 2022;Damiano et al., 2022;Delgado-Alonso et al., 2022;Duindam et al., 2022;Ferrando et al., 2022;Ferrucci et al., 2021;García-Sánchez et al., 2022;Graham et al., 2021;Hampshire et al., 2022;He et al., 2023;Krishnan et al., 2022;Lauria et al., 2022;Matias-Guiu et al., 2023;Miskowiak et al., 2021Miskowiak et al., , 2023Ortelli et al., 2021;Rubega et al., 2022;Vannorsdall et al., 2022) administered tests to assess executive function. ...
Objective
Although Coronavirus disease 2019 (COVID-19) is primarily a respiratory infectious disease, it has also been associated with a wide range of other clinical manifestations. It is widely accepted in the scientific community that many patients after recovery continue to experience COVID-19-related symptoms, including cognitive impairment. The aim of this systematic review was to investigate the cognitive profile of patients with long-COVID syndrome.
Methods
A systematic search of empirical studies was conducted through the PubMed/Medline and Scopus electronic databases. Cross-sectional and longitudinal studies published between 2020 and 2023 were included.
Results
Of the 516 studies assessed for eligibility, 36 studies met the inclusion criteria. All included studies support the presence of persistent cognitive changes after COVID-19 disease. Executive function, memory, attention, and processing speed appear to be the cognitive domains that are predominantly associated with long-COVID syndrome, whereas language is an area that has not been sufficiently investigated.
Conclusions
In this review, the high frequency of cognitive impairment after COVID-19 is evident. If we consider that cognitive functioning affects our ability to live independently and is a key determinant of our quality of life, it is imperative to precisely define those factors that may induce cognitive impairment in COVID-19 survivors, with the ultimate goal of early diagnosis of cognitive changes and, consequently, the development of targeted rehabilitation interventions to address them.
... Recent evidence has identified a set of characteristics, including long-lasting symptoms in individuals infected with the novel coronavirus disease Sars-CoV-2 (hereafter, COVID-19) [1][2][3][4][5], including cognitive impairment associated with recovered patients who required hospitalization [5][6][7][8][9]. Many individuals who recovered from the illness and needed hospitalization have reported persistent cognitive symptoms [6][7][8][9][10]. ...
... Another study analyzed mental health and cognitive factors in 425 COVID-19 survivors between six and nine months after the acute phase of infection. Approximately 51.1% of participants reported subjective memory complaints [10]. ...
... Moreover, acute, and severe cases of SARS-CoV-2 infection may introduce psychiatric changes, encompassing depression, anxiety, stress, insomnia, and psychosis [10,[29][30][31][32][33][34]. This multifaceted spectrum of influences underscores the complexity of the impact of COVID-19 on cognitive function and mental health, highlighting the need for comprehensive research to unravel these intricate connections and pave the way for targeted interventions and support strategies. ...
Background
Studying individuals with varying symptoms, from mild to severe, can provide valuable insights into the spectrum of cognitive outcomes after COVID-19. We investigated the cognitive performance of adults who recovered from the novel coronavirus disease (COVID-19) without prior cognitive complaints, considering mild (not hospitalized), moderate (ward), and severe (intensive care unit) symptoms.
Methods
This cross-sectional study included 302 patients who recovered from COVID-19 (mild, n = 102; moderate, n = 102; severe, n = 98). We assessed intellectual quotient (IQ), attention, memory, processing speed, visual-constructive ability, as well as symptoms of depression, anxiety, and stress, at least eighteen months after infection. The mean length of hospitalization was Mdays=8.2 (SD = 3.9) and Mdays=14.4 (SD = 8.2) in the moderate and severe groups, respectively.
Results
Cognitive difficulties were present in all three groups: mild (n = 12, 11.7%), moderate (n = 40, 39.2%), and severe (n = 48, 48.9%). Using Multinomial Logistic Regression and considering the odds ratio, our results indicated that a one-point increase in sustained attention, visual memory, and working memory might decrease the odds of being categorized in the severe group by 20%, 24%, and 77%, respectively, compared to the mild group.
Conclusions
Our findings provide empirical evidence regarding the long-term cognitive effects of COVID-19, particularly in individuals experiencing severe manifestations of the disease. We also highlighted the need for a comprehensive, multidimensional approach in rehabilitation programs to address the enduring cognitive impacts of COVID-19.
... In addition, 31% out of 325 patients who recovered from COVID-19, and evaluated with the PHQ-9 scale, showed symptoms of depression: 87.8% of them had mild depression, 8.1% moderate depression, and 4% severe depression 8 . Thus, prolonged symptoms and neuropsychiatric state (anxious, depressive symptoms, and sleep disorders) are known as post-acute COVID-19 syndrome (PACS) 9,10 . According to NICE guidelines defined post COVID-19 syndrome as persistent neurological, respiratory, and cardiovascular symptoms beyond 12 weeks or months of the onset of acute COVID-19 11,12,13 . ...
... Post-covid-19 condition in Mexican healthcare personnel Hamilton Rating Scale for Depression (HRSD) is a validated asses in Spanish (Cronbach's alpha of 0.92), which evaluate the severity of depressive symptoms such as no depression (0-6) and scores indicate mild depression (7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17), moderate (18)(19)(20)(21)(22)(23)(24) and severe (>24) depression. Furthermore, include somatic symptoms, vegetative, cognitive and anxiety symptoms. ...
... Hamilton Rating Scale for Anxiety (HARS) is a validated version with permitted to assess the severity of anxiety symptoms (Cronbach's alpha of 0.89.); mild anxiety (6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17); moderate anxiety (18)(19)(20)(21)(22)(23)(24); severe anxiety (25)(26)(27)(28)(29)(30) and very severe anxiety . It consists of 14 items, evaluating psychological and somatic symptoms, which include anxious mood, tension, fears, insomnia, cognition, depressed mood, somatic and autonomic symptoms. ...
Objective:
The aim of the present study was to identify anxiety and depression in health personnel who suffered COVID-19, and to associate them with blood inflammatory markers.
Materials and methods:
The design of this study was descriptive and cross-sectional. We evaluated 51 healthcare workers who survived COVID-19 disease with Hamilton scales for anxiety and depression, also we calculated inflammatory markers (systemic immune-inflammation index, SII; monocyte lymphocyte ratio, MLR; platelet lymphocyte ratio, PLR; and neutrophil lymphocyte ratio, NLR) using blood venous samples. This study was carried out from August 2021 to December 2022. Statistical analysis was performed using SPSS v. 26.
Results:
Our study included 51 healthcare personnel, females (n=29) and males (n=22). The mean age was 40.54 ± 11.00 years. The most frequent acute symptoms for COVID-19 presented were dysgeusia (n=20), anosmia (n=18), and headache (n=17). The most common comorbidities were overweight (n=24), obesity (n=22), and hypertension (n=11). According to the Hamilton Rating Scale for Anxiety (HARS) and Hamilton Rating Scale for Depression Rating (HRSD) we identify anxiety and depression in 72.5% (n=37) and 51% (n=26) within the health personnel, respectively.
Conclusions:
In our study, we observed a high frequency of anxiety and depression in healthcare workers with post COVID-19 condition. However, we did not observe an association between inflammatory markers (NLR, PLR, MLR, and SII) with anxiety and depression in health personnel postCOVID-19. We suggest follow-up assessments in healthcare personnel with post-COVID-19 condition, to evaluate if mixed emotional disorders persist.
... In the study by Miskowiak et al., hospitalized and non-hospitalized patients showed a similar degree of cognitive impairment in analyses adjusted for age and time elapsed since acute infection [28]. The results of a study during the recovery phase of COVID-19 in a middle-aged population found that disease severity, from asymptomatic to those requiring hospitalization, positively correlated with the degree of cognitive changes [32]. Likewise, other authors have reported that the longer the ICU stay, the greater the risk of long-term physical, cognitive, and emotional impairment [33]. ...
... Other studies have suggested that an executive dysfunction profile may better characterize the findings; however, this profile is not specific to the etiology and may reflect complex multisystem effects of the disease [20]. It is clear that reported cognitive impairment encompasses various domains [32], making it difficult to establish a unique cognitive profile. At least three types of clinical presentation may appear, predominantly attentional executive dysfunction, another with greater memory and language impairment, and a third that includes the former in a mixed presentation consistent with the description of what has been called "brain fog." ...
... For those with long-term cognitive symptoms, there are limited evidencebased interventions, even though these patients could benefit from programs that include cognitive training. Physicians should be aware of the risk of cognitive decline, closely monitoring cognitive health, and requesting formal neuropsychological evaluations [32]. The best available rehabilitation evidence for COVID-19 survivors is synthesized in the WHO Rehcover Cochrane Rehabilitation initiative, where interventions aim to improve autonomy, quality of life, and individual reintegration into their family and community. ...
Post-COVID syndrome has been defined as signs and symptoms that develop after an infection consistent with COVID-19 and continue for more than 12 weeks, including neurocognitive signs and symptoms that have an impact on the functioning and quality of life of middle-aged adult and older survivors. This systematic review describes the current knowledge of long-term cognitive impairments in COVID-19 survivors, approaches strategies, and their impact on public and private health services worldwide. The systematic review was conducted under the criteria and flowchart established in the PRISMA statement, considering studies from the PubMed, Scopus, and Web of Science databases between 2020 and 2023. The included studies considered participants over 40 years of age, COVID-19 survivors. A total of 68 articles were included, most of which had high to excellent quality. The analysis showed the presence of heterogeneous cognitive symptoms in COVID survivors, persistent for at least 12 weeks from the onset of infection, mostly unsystematized and nonspecific approaches strategies, and a lack of methods for monitoring their effectiveness, with a significant economic and logistical impact on health systems. Specific protocols are required for the rehabilitation of persistent cognitive dysfunction in COVID-19 survivors, as well as longitudinal studies to evaluate the effectiveness of these interventions.
... Indeed, these post-acute sequelae syndrome (PASC) has been termed long-COVID-19; defined as displaying COVID-19 related symptoms that persist after 3 months following initial infection and lasting for more than 2 weeks. Critically, this impairment is not related to any pre-existing clinical or emotional disturbances (9). Further, a recent report has shown a potential link between a deficit in cognitive performance and chemosensory impairment in long-COVID-19 patients (10,11). ...
... The 'HCFMUSP post-COVID-19 cohort' was constituted to facilitate multidisciplinary studies addressing long-term medical, functional and neuropsychiatric outcomes among adults and elders who survived moderate or severe forms of COVID-19. Previously we reported a preliminary assessment of psychiatric and cognitive outcomes in an interim sample of 425 patients (i.e., half the size of the present test group) indicating high rates of mood and cognitive symptoms 6-11 months following infection (9). Details about the methodological protocol can also be found elsewhere (32). ...
... Instead, after controlling for multiple variables, we found that the presence of higher comorbidity and more severe frailty pre-COVID-19, as well as lower physical exercise in the weeks prior to the follow-up assessment, predicted poorer cognitive performance. The first two variables (comorbidity and frailty) have been previously discussed (7,9), however, the latter variable (physical exercise) is a new finding that might be an important target for neuropsychological rehabilitation techniques in PASC patients. Such a strategy would be consistent with the protective effect of physical exercise observed in individuals with AD (49), (51). ...
Objective
To analyze the potential impact of sociodemographic, clinical and biological factors on the long-term cognitive outcome of patients who survived moderate and severe forms of COVID-19.
Methods
We assessed 710 adult participants (Mean age = 55 ± 14; 48.3% were female) 6 to 11 months after hospital discharge with a complete cognitive battery, as well as a psychiatric, clinical and laboratory evaluation. A large set of inferential statistical methods was used to predict potential variables associated with any long-term cognitive impairment, with a focus on a panel of 28 cytokines and other blood inflammatory and disease severity markers.
Results
Concerning the subjective assessment of cognitive performance, 36.1% reported a slightly poorer overall cognitive performance, and 14.6% reported being severely impacted, compared to their pre-COVID-19 status. Multivariate analysis found sex, age, ethnicity, education, comorbidity, frailty and physical activity associated with general cognition. A bivariate analysis found that G-CSF, IFN-alfa2, IL13, IL15, IL1.RA, EL1.alfa, IL45, IL5, IL6, IL7, TNF-Beta, VEGF, Follow-up C-Reactive Protein, and Follow-up D-Dimer were significantly (p<.05) associated with general cognition. However, a LASSO regression that included all follow-up variables, inflammatory markers and cytokines did not support these findings.
Conclusion
Though we identified several sociodemographic characteristics that might protect against cognitive impairment following SARS-CoV-2 infection, our data do not support a prominent role for clinical status (both during acute and long-stage of COVID-19) or inflammatory background (also during acute and long-stage of COVID-19) to explain the cognitive deficits that can follow COVID-19 infection.
... Moreover, a cohort study of 506 American adults with a past COVID-19 diagnosis showed significantly higher SI and SB scores up to one year after infection [101]. Furthermore, some neuropsychiatric risk factors of SB, such as MDD, were recently linked to a subset of long COVID-19 patients [102,103], suggesting that long COVID-19-associated depression might increase SB. In this regard, mid-to long-term studies (6-9 months) of long COVID-19 patients in France (n = 60) and Brazil (n = 425) revealed a prevalence of depression exceeding 30% in the French study [102] and 8% in the Brazilian study [103]. ...
... Furthermore, some neuropsychiatric risk factors of SB, such as MDD, were recently linked to a subset of long COVID-19 patients [102,103], suggesting that long COVID-19-associated depression might increase SB. In this regard, mid-to long-term studies (6-9 months) of long COVID-19 patients in France (n = 60) and Brazil (n = 425) revealed a prevalence of depression exceeding 30% in the French study [102] and 8% in the Brazilian study [103]. In addition, depressive symptoms reportedly persisted beyond 6 months in COVID-19 long-haulers [104], with possible association to female sex [105]. ...
Background: Long COVID-19 is an emerging chronic illness of significant public health concern due to a myriad of neuropsychiatric sequelae, including increased suicidal ideation (SI) and behavior (SB). Methods: This review provides a concise synthesis of clinical evidence that points toward the dysfunction of astrocytes, the most abundant glial cell type in the central nervous system, as a potential shared pathology between SI/SB and COVID-19. Results: Depression, a suicide risk factor, and SI/SB were both associated with reduced frequencies of various astrocyte subsets and complex proteomic/transcriptional changes of astrocyte-related markers in a brain-region-specific manner. Astrocyte-related circulating markers were increased in depressed subjects and, to a less consistent extent, in COVID-19 patients. Furthermore, reactive astrocytosis was observed in subjects with SI/SB and those with COVID-19. Conclusions: Astrocyte dysfunctions occurred in depression, SI/SB, and COVID-19. Reactive-astrocyte-mediated loss of the blood–brain barrier (BBB) integrity and subsequent neuroinflammation—a factor previously linked to SI/SB development—might contribute to increased suicide in individuals with long COVID-19. As such, the formulation of new therapeutic strategies to restore astrocyte homeostasis, enhance BBB integrity, and mitigate neuroinflammation may reduce SI/SB-associated neuropsychiatric manifestations among long COVID-19 patients.
... Among PC patients, cognitive symptoms belong to the most frequently reported complaints (22-51.1% of PCpatients, [6][7][8]) and so far have been described to mainly affect concentration/attention, memory [9], receptive language and/or executive function [3]. Further, patients seem to be at higher risk of developing psychiatric diseases (i.e. ...
... Neurocognitive manifestations are among the most frequent symptoms of the PC condition [3,[6][7][8]. Nevertheless, the exact cognitive domains affected, the level of cognitive Content courtesy of Springer Nature, terms of use apply. ...
Cognitive symptoms (CS) belong to the most common manifestations of the Post COVID-19 (PC) condition. We sought to objectify CS in PC patients using routine diagnostic assessments: neurocognitive testing (NCT) and brain imaging (BI). Further, we investigated possible associations of CS with patient reported outcomes (PROs), and risk factors for developing CS. Clinical data and PROs of 315 PC patients were assessed at a mean of 6 months after SARS-CoV-2 infection. 231 (73.3%) patients reported any sort of CS. Among them, 78 underwent NCT and 55 received BI. In NCT, the cognitive domains most affected were the working memory, attention, and concentration. Nonetheless, pathological thresholds were exceeded only in few cases. Neurocognitive performance did not differ significantly between patients complaining of severe (n = 26) versus non-severe (n = 52) CS. BI findings were abnormal in 8 (14.5%) cases with CS but were most likely not related to PC. Patients reporting high severity of CS scored worse in the PHQ-9, FSS, WHOQOL-BREF, were more likely to report impaired sleep, and had a higher prevalence of psychiatric diagnoses. Overall, NCT could confirm mild impairment in some but not all PC patients with CS, while BI studies were abnormal in only few cases. CS severity did not affect NCT results, but severe CS were associated with symptoms of depression (PHQ-9), fatigue (FSS), reduced quality of life (WHOQOL-BREF) and higher prevalence of psychiatric illnesses. These findings support the importance of NCT, BI, and neuro-psychological assessment in the work-up of PC patients reporting CS.
Trial registration
Trial registration number and date of registration: DRKS00030974, 22 Dec 2022, retrospectively registered.
... When considering depression and anxiety as symptoms of PASC, the risk factors varied across different studies, resulting in inconsistent findings [9]. Some studies, including Ahmed (2021) and Damiano (2022), have indicated that acute COVID-19 severity and diseaserelated psychosocial stressors may not be solely responsible for depression and anxiety in post-COVID patients [54,55]. However, existing evidence suggests that individuals facing multiple long-term COVID symptoms may encounter significant challenges in their work performance and overall quality of life [8,56]. ...
... When considering depression and anxiety as symptoms of PASC, the risk factors varied across different studies, resulting in inconsistent findings [9]. Some studies, including Ahmed (2021) and Damiano (2022), have indicated that acute COVID-19 severity and diseaserelated psychosocial stressors may not be solely responsible for depression and anxiety in post-COVID patients [54,55]. However, existing evidence suggests that individuals facing multiple long-term COVID symptoms may encounter significant challenges in their work performance and overall quality of life [8,56]. ...
Background and aims
Fatigue and neuropsychiatric (NP) symptoms are frequently observed in patients with Post-Acute Sequelae of SARS-CoV-2 Infection (PASC). This study aims to explore the relationship between clinical characteristics, inflammatory markers, and severity of fatigue and NP manifestations in COVID-19 survivors following the acute phase.
Methods
This cross-sectional study included adult participants who experienced any post-COVID NP symptoms. Questionnaires for fatigue (CFQ-11), anxiety-depression (DASS-21), insomnia (PSQI), cognitive impairment (ACE-III), and delayed processing speed (TMT-B) were administered. Demographic data, clinical characteristics of COVID-19 infection, and laboratory tests for inflammatory markers (CRP, IL-6, albumin, hemoglobin, and NL-ratio) were collected.
Results
The most common symptoms reported by 82 participants were fatigue (85.4%), insomnia (84.2%), anxiety (62.2%), subjective brain fog (61%), and depression (50%). There was no observed association between the severity of any target symptoms and the inflammatory markers. In multivariable analysis, a strong positive correlation was found between the number of PASC symptoms and the severity of fatigue, depression, anxiety, and sleep problems (p < 0.01). Those who had been infected more than once experienced more fatigue (p = 0.03). Patients with respiratory tract diseases were more likely to experience depression (p = 0.01), and smoking was associated with more sleep disturbances (p = 0.02). Lack of exercise was associated with slower processing speed (p = 0.02).
Conclusion
The severity of fatigue and NP symptoms of PASC is not correlated with changes in the inflammatory markers. However, certain clinical factors can predict the severity, including the number of PASC symptoms, frequency of COVID-19 infections, respiratory tract diseases, smoking, and exercise.
KEYWORDS:
COVID-19post-acute sequelae of COVID-19 (PASC)fatigueneuropsychiatric symptomsinflammatory markers
... Mazza et al. [12] showed that COVID-19 survivors presented a high occurrence of post-traumatic stress disorder (PTSD), MDD, and anxiety. High prevalence of depression, anxiety, and PTSD, as well as cognitive impairment among individuals with moderate or severe SARS-CoV-2 infection, were also found in previous literature [13]. Although the mechanisms associated with the development of psychiatric disorders resulting from COVID-19 have not been fully elucidated, it is suggested that changes in the immune system may be a crucial factor involved [12]. ...
... In addition, we previously found greater severity of depressive symptoms and stress levels in individuals with COVID-19 compared to controls [11]. Many other studies have linked COVID-19 with the presence of psychiatric conditions [12,13]. Finally, it is possible that psychiatric conditions after COVID-19 infection are associated with brain microstructural abnormalities [30] and dysregulation in the immune system [11,12]. ...
Although many efforts have been made to understand the pathophysiological mechanisms of COVID-19, critical gaps remain to be explored. This study aimed to investigate potential alterations in adipokine levels (specifically adiponectin, leptin, and resistin) among individuals with COVID-19. Within this population, we further assessed the association between these markers with both, body mass index (BMI) and psychiatric symptoms. This cross-sectional study included an age- and sex-matched sample of adults with COVID-19 (cases) and without COVID-19 (controls). We evaluated the severity of psychiatric symptoms, BMI, and adipokines. Individuals with COVID-19 presented greater BMI, stress levels, and leptin levels when compared to controls. Leptin levels were greater in individuals with moderate/severe COVID-19 as compared to individuals with COVID-19 who were asymptomatic or having mild symptoms. Leptin levels were positively correlated with BMI, severity of depressive and anxiety symptoms, and stress levels in the total sample. Leptin levels were also positively correlated with BMI, severity of anxiety symptoms, and stress levels in controls. In cases, there was a positive correlation between adiponectin and the severity of depressive symptoms and stress levels and leptin/resistin with BMI. A linear regression model revealed that BMI, severity of anxiety symptoms, and the diagnosis of COVID-19 are independently associated with increased leptin levels. Thus, leptin levels seem to be impacted by the COVID-19 infection, anxiety, and BMI.
... Post-COVID-19 syndrome may affect various organs and organ systems, including the respiratory, cardiovascular, musculoskeletal, and gastrointestinal systems, as well as the central nervous system (CNS) (Crook et al., 2021). Notably, it may develop not only after a severe infection but even after a mild case of COVID-19 (Damiano et al., 2022). ...
... Moreover, 51.1% of the participants reported subjective memory decline. With a prevalence of 32.2% the most frequent category was 'Common Mental Disorder' , defined as a score ≥12 in the sum of all 14-dimensional symptoms identified in a structured psychiatric interview (Damiano et al., 2022). A meta-analysis on the prevalence of post-COVID mental health problems, including anxiety, depression, general distress, and post-traumatic symptoms found that the prevalence of mental health problems decreased from 46.3% during the acute stage (within 1 month) to 38.8% during the post-illness stage (longer than 3 months) (Zürcher et al., 2022). ...
Objective: Psychiatric symptoms are common and bothersome in individuals with post-COVID-19 syndrome. Because they are often mixed and subthreshold, established treatment regimens cannot be applied. There is an urgent need to identify therapeutics for affected patients. Silexan, a proprietary essential oil from Lavandula angustifolia, has demonstrated efficacy against anxiety, comorbid symptoms, and subthreshold and mixed syndromes. The aim of the current narrative review is to examine the therapeutic potential of Silexan for psychiatric manifestations in patients with post-COVID-19 syndrome.
Methods: We reviewed clinical evidence regarding the efficacy of Silexan and first clinical experience in patients with psychiatric symptoms attributable to the post-COVID-19 syndrome. Furthermore, we discussed potential modes of action based on nonclinical data.
Results: Silexan has demonstrated therapeutic efficacy for the treatment of generalised anxiety disorder; subsyndromal anxiety disorders; comorbid depressive, somatic, and sleep disturbance symptoms; and mixed anxiety and depression. Emerging clinical experience also suggests the effectiveness and tolerability of Silexan for patients with post-COVID-19 syndrome. This can be explained by the fact that the therapeutic profile of Silexan overlaps with the spectrum of psychiatric symptoms in such patients.
Conclusion: Preliminary findings indicate a promising potential of Silexan for the treatment of psychiatric manifestations in patients with post-COVID-19 syndrome.
• Key points
• Anxiety and mixed neuropsychiatric manifestations are commonly observed in patients with post-COVID-19 syndrome.
• Silexan has anxiolytic properties and can alleviate comorbid depressive, somatic, and sleep impairment symptoms.
• Silexan exhibits several biological mechanisms, such as neurotrophic and anti-inflammatory properties, which have the potential to positively impact post-COVID-19 disease.
• Silexan has a favourable safety profile and high acceptance among patients.
• Emerging data suggest that Silexan can alleviate neuropsychiatric symptoms in patients with post-COVID-19 syndrome.
• Silexan should be considered as a therapeutic in patients with psychiatric manifestations of post-COVID-19 syndrome.
... Studies indicate that the prevalence of long COVID can vary significantly, ranging from 3 to 93%, depending on the study's definition and methodology (3,4). In Brazil, it is estimated that among those who have recovered from COVID-19, approximately 5.6 million individuals will require healthcare for long COVID, with 81% of them needing to seek medical services (5). ...
Background
Access to healthcare services for the population with long COVID is a challenge, as healthcare systems have been tasked with responding effectively to the extensive clinical heterogeneity of this disease.
Objective
To analyze the factors associated with access to health services among people with long COVID in the Brazilian Amazon.
Methods
This is a cross-sectional study using a quantitative method, conducted through an online survey between May 2023 and January 2024. The study included participants aged 18 years or older, residing in the northern region of Brazil, with a confirmed diagnosis of COVID-19 and who experienced long COVID. Participants completed an adapted version of the questionnaire on the Research Electronic Data Capture platform. Data were analyzed by multiple logistic regression.
Results
A total of 364 people with long COVID participated in the study, of which only 167 (45.88%) had access to healthcare to treat the symptoms of this clinical condition. In the final multiple logistic regression model, only factors related to the need for services were associated with healthcare access. Participants with symptoms of dermatological alterations (AOR = 2.57; p = 0.01), a pre-COVID-19 diagnosis of chronic disease (AOR = 5.62; p = 0.04), those who treated their most severe COVID-19 infection with the assistance of a healthcare professional (AOR = 4.97; p = 0.01), and those who used antibiotics during their most severe COVID-19 infection (AOR = 3.24; p = 0.01) were more likely to access healthcare services for treating long COVID.
Conclusion
Factors related to the need for services were the only ones associated in this population. It is important to know these aspects to identify the most affected populations and propose measures.
... Various studies by Badinlou et al. (2022), Damiano et al. (2022), and Premraj et al. (2022) have reported that several psychological factors may contribute to the decline in cognitive performance associated with COVID-19. Increased emotional activity, such as mood disturbances, can impair a person's ability to attend to new information, process and store it in memory, and recall it later. ...
The chapter explores the role of neuropsychology in understanding brain fog as a subjective complaint in the context of COVID-19. It discusses the historical and medical significance of the term “brain fog” and its psychological and neurological aspects. The chapter identifies the cognitive domains commonly affected by brain fog, such as attention, executive function, memory, and language. Additionally, it emphasizes the impact of societal changes during the COVID-19 pandemic on the general population as a crucial backdrop for understanding the issue. The chapter also highlights the important role of clinical and research neuropsychologists in gaining clarity on grouped data and individual patients’ cognitive and emotional difficulties after COVID-19 infection. It discusses indications for neuropsychological rehabilitation and therapy and describes typical therapy phases and methods, including new approaches like telemedicine, virtual reality, and mobile app-based rehabilitation and self-tracking. The chapter underscores that experiences of brain fog can vary among COVID-19 patients and may change over time. It provides clinicians and interested parties with an in-depth understanding of brain fog and its manifestations, concomitant subtypes, and concrete strategies for addressing it. The chapter emphasizes the critical role of neuropsychology in scientifically examining brain fog and advocating for personalized approaches to cognitive rehabilitation.
... Another hypothesis was that the therapies were conducted during the COVID-19 pandemic, which may have directly influenced the participants' differentiated routines during this period. In addition, studies report the worsening of mental disorders and psychological suffering during the pandemic and post-COVID, especially in developing countries such as Brazil (Damiano et al., 2022;Suen et al., 2022). ...
Objective: To compare the effectiveness of an acceptance and commitment therapy (ACT)-based protocol and cognitive behavior therapy (CBT) for insomnia in adults. Method: The participants comprised 227 adults with insomnia. They were randomized to six weekly group sessions consisting of acceptance and commitment therapy for insomnia (n = 76), cognitive behavioral therapy for insomnia (n = 76), or waitlist (WL; n = 75). Results: Both treatment modalities significantly reduced insomnia severity with large effect sizes in the posttreatment phase. These results were maintained during the follow-up period with large effect sizes. CBT was superior to ACT in reducing the Insomnia Severity Index at posttreatment and follow-up, with a small effect size. ACT was superior to WL at posttreatment and at follow-up, with a moderate effect size. The treatment response and remission ratios were higher with CBT at posttreatment and similar at 6-month follow-up for both therapies, as ACT made further gains in response and remission. ACT had a significantly higher proportion of response and remission than WL in both periods (posttreatment and follow-up). Both therapies improved daytime functioning at both posttreatment and follow-up, with few differential changes across the groups. Conclusions: Both cognitive behavior therapy and acceptance and commitment therapy are effective, with CBT showing superiority and ACT showing delayed improvement. ACT has proven to be an effective therapy, especially in the long term, even in the absence of behavioral techniques such as stimulus control and sleep restriction, and it is a viable option for those who have difficulties adhering to behavioral techniques.
... Post-viral neuropsychiatric conditions, such as depression, anxiety, or cognitive impairments among COVID-19-recovered patients, are now recognized as a primary component of post-COVID condition (PCC) (Crivelli et al. 2022;Damiano et al. 2022;Mazza et al. 2022;Premraj et al. 2022). ...
Aim
COVID-19 infection may have long-lasting implications on mental health and cognitive functions. This study aimed to estimate the prevalence of post-COVID-19-related symptoms 13–18 months post-COVID-19 infection and to study the associations between past COVID-19 infection, poor mental health, and cognitive disturbances.
Subject and methods
This national retrospective cohort study was conducted from February through June 2022 among a sample of citizens aged ≥ 21 years who performed a COVID-19 polymerase chain reaction (PCR) test 13–18 months before entering the study. Self-reported symptoms, poor mental health (a score of ≤ 60 in the 5-item Mental Health Inventory), and cognitive disturbances 13–18 months after the PCR test were compared between those who tested positive and negative.
Results
Of 1080 participants, 780 were past SARS-CoV-2-positive, and 300, were SARS-CoV-2-negative. Among the recovered participants, 31.5% reported current new or worsened symptoms that could be attributed to past COVID-19 infection. The most prevalent symptoms 13–18 months post-COVID-19 infection were fatigue, memory or concentration disorders, a decline in physical fitness, myalgia, and sleep disturbances. Past COVID-19 infection was associated with poor mental health (OR 1.54; CI 95% 1.04–2.26), difficulties in executive functioning (OR 2.97; CI 95% 1.95–4.54), and a decline in cognitive performance (OR 3.44; CI 95% 2.25–5.27) after controlling for demographic characteristics and comorbidities.
Conclusion
Post-COVID-19-related symptoms were highly prevalent 13–18 months post-COVID-19 infection. Past COVID-infection was also associated with poor mental health and cognitive disturbances. Targeted prevention and intervention management to address the long-term mental health state and cognitive well-being of recovered patients are recommended.
... Despite their brevity, these cognitive tests could detect cognitive fatigue and reduced occupational capacity in some individuals who recovered from COVID-19, even up to 1 year postinfection. This was evidenced by longer reaction times or lower performance scores on tasks requiring higher-order cognitive functions such as attention and EFs (Andrei Appelt et al., 2022;Damiano et al., 2022). ...
This review assesses neurocognitive studies on long-/post-COVID-19 adult patients, highlighting the research gaps. We categorize populations by infection severity, demographics, inclusion of controls, and psychological/biological factors. Methodologically, we analyzed 73 studies (95,600 subjects) from December 2019 to October 2022 using PRISMA-ScR guidelines and the PICO framework. Our findings revealed that most studies lacked control groups (88 %) and reported unclear overall cognitive outcomes (73 %). While the studies frequently assessed executive functions (86 %) and attention (85 %), there were few longitudinal studies. Varied reporting on sample sizes further complicated the analysis. The identified gaps encompass convenience sampling, limited longitudinal studies, and inadequate use of cognitive test batteries, leading to a discrepancy between expected and reported outcomes. The absence of standardized comparisons and inconsistent statistical methods exacerbated these gaps.
... Exposure to stressful factors implies a greater risk of mental health problems; in this context, adults are more vulnerable to psychosocial disorders such as anxiety and depression, affecting their physical and mental health (Álvarez Bermúdez & Meza Peña, 2022; Damiano et al., 2022;Morales-Chainé, 2021). However, people do not seek treatment due to the self-stigma of seeking psychological help (Larrahondo et al., 2021;Medeiros et al., 2016;Vogel et al., 2017). ...
Self-stigma for seeking help is a factor associated with various mental health problems. For its measurement, there are instruments such as SSOSH, SSOSH-7, and SSOSH-3. However, its psychometric properties have yet to be examined in the Latin American context. Faced with this, the study aimed to evaluate the factorial structure of the SSOSH, SSOSH-7, and SSOSH-3 in the Peruvian sample, identify evidence of validity based on the relationship with other variables, perform factorial invariance according to sex and determine the degree of reliability. The sample comprised 404 Peruvian citizens of both sexes (65.84% women and 34.16% men) whose ages ranged from 18 to 58 years (M = 24.27; SD = 7.9). In addition to applying the three versions of the SSOSH, the Patient Health Questionnaire (PHQ-9) and the Rosenberg Self-Esteem Scale-P (EAR-P) were applied. The present study evidenced that using the EGA and riEGA, a one-dimensional model was identified in the three versions of the SSOSH. It was shown that the SSOSH-7 and SSOSH-3 have adequate fit and reliability indices. In addition, it was shown that the factorial structure of the SSOH-3 is invariant in the group of men and women. Additionally, it was found that the self-stigma of seeking help predicts depression and self-esteem. It is concluded that the SSOSH-3 showed better psychometric performance than the other versions of the SSOSH. Therefore, SSOSH-3 proves to be a brief, valid and reliable instrument that allows the adequate measurement of self-stigma due to help-seeking in the Peruvian adult sample.
... Não há evidências de que o fator dissonância seja suficiente para produzir alterações nas habilidades visuoespaciais, nesta amostra de estudantes universitários. Marin et al. (2021) relatam o agravamento de sintomas de depressão, devido ao confinamento, e Damiano et al. (2022) relatam aumento nos diagnósticos de depressão e transtorno de ansiedade generalizado (TAG) após o início da pandemia do coronavírus , na população geral. Estes achados possivelmente explicam o alto nível de exclusão associado a presença de sintomas psiquiátricos na amostra avaliada. ...
There is evidence that music properties could modulate mood and improve the performance of visuospatial skills. Dissonances in music are interpreted as unpleasant by untrained liste-ners. We investigated whether dissonances can modulate emotions and alter the performance of a visuospatial task. Twenty-five healthy university students participated, divided into the Control Group (n=10), the Consonance Group (n=8), and the Dissonance Group (n=7). All were screened for current psychiatric symptoms, underwent a visuospatial test before and after the music listening period, and were evaluated by the OASIS, which investigates emo-tions. The results showed no effect caused by dissonance in music, both on emotions and vi-suospatial skills, in young people with little previous musical contact. These results suggest that the tempo and mode of music and the melody itself are the only known factors capable of modulating visuospatial performance.
... Viral infections not only impact physical health but have also been demonstrated to elicit mental sequelae. In the case of SARS-CoV-2, numerous conditions have been reported to affect the psychological and emotional state, including depression, insomnia, anxiety, psychotic disorders, dementia, post-traumatic stress disorder, difficulty concentrating, and hallucinations (Romero-Duarte et al., 2021;Taquet et al., 2021;Damiano et al., 2022;Izquierdo-Condoy et al., 2022a). ...
Infectious diseases have consistently served as pivotal influences on numerous civilizations, inducing morbidity, mortality, and consequently redirecting the course of history. Their impact extends far beyond the acute phase, characterized by the majority of symptom presentations, to a multitude of adverse events and sequelae that follow viral, parasitic, fungal, or bacterial infections. In this context, myriad sequelae related to various infectious diseases have been identified, spanning short to long-term durations. Although these sequelae are known to affect thousands of individuals individually, a comprehensive evaluation of all potential long-term effects of infectious diseases has yet to be undertaken. We present a comprehensive literature review delineating the primary sequelae attributable to major infectious diseases, categorized by systems, symptoms, and duration. This compilation serves as a crucial resource, illuminating the long-term ramifications of infectious diseases for healthcare professionals worldwide. Moreover, this review highlights the substantial burden that these sequelae impose on global health and economies, a facet often overshadowed by the predominant focus on the acute phase. Patients are frequently discharged following the resolution of the acute phase, with minimal long-term follow-up to comprehend and address potential sequelae. This emphasizes the pressing need for sustained vigilance, thorough patient monitoring, strategic health management, and rigorous research to understand and mitigate the lasting economic and health impacts of infectious diseases more fully.
... Additionally, certain medication use (e.g., angiotensin-converting enzyme inhibitors and metformin), genetic factors (e.g., FOXP4 locus), and environmental factors (e.g., engagement in transportation, logistics, or the discipline workforce) have been revealed to be predictive of PASC diagnosis [26][27][28][29]. Efforts have also been made to predict PASC based on these factors using various methods, including flexible machine learning models such as XGBoost [30], random forest [31,32], deep neural network [33], and logistic regression models [34,35]. These studies highlight the importance and feasibility of identifying risk factors related to PASC and predicting patients with a high risk of developing PASC. ...
Background: Post-Acute Sequelae of COVID-19 (PASC) have emerged as a global public health and healthcare challenge. This study aimed to uncover predictive factors for PASC from multi-modal data to develop a predictive model for PASC diagnoses. Methods: We analyzed electronic health records from 92,301 COVID-19 patients, covering medical phenotypes, medications, and lab results. We used a Super Learner-based prediction approach to identify predictive factors. We integrated the model outputs into individual and composite risk scores and evaluated their predictive performance. Results: Our analysis identified several factors predictive of diagnoses of PASC, including being overweight/obese and the use of HMG CoA reductase inhibitors prior to COVID-19 infection, and respiratory system symptoms during COVID-19 infection. We developed a composite risk score with a moderate discriminatory ability for PASC (covariate-adjusted AUC (95% confidence interval): 0.66 (0.63, 0.69)) by combining the risk scores based on phenotype and medication records. The combined risk score could identify 10% of individuals with a 2.2-fold increased risk for PASC. Conclusions: We identified several factors predictive of diagnoses of PASC and integrated the information into a composite risk score for PASC prediction, which could contribute to the identification of individuals at higher risk for PASC and inform preventive efforts.
... SARS-CoV-2 infection, in the initial phase, produces an acute inflammatory response and pulmonary pathologies, and in later phases, cardiovascular complications, such as ventricular wall thickening asso-ciated with an increase in the ventricular mass/body mass ratio and interstitial coronary fibrosis, elevated levels of serum cardiac troponin I, elevated cholesterol, low-density lipoprotein, and long-chain fatty acid triglycerides, and therefore emphasize our findings related to impaired neurological, circulatory, and oxygenation function. (24,25) Under this logic, it is emphasized that a symptom's intensity will vary according to an individual's emotional response, to their psychological factors and their affective variables, which makes it necessary to raise awareness of the injuries and the need for healthy and effective coping. (15,22) Based on the TUS assumptions, it is possible to understand phenomena such as time/duration, intensity, quality, suffering, which can be caused by prolonged symptoms and post-COVID-19 sequel, essential knowledge for nursing teams and health in the care of patients in these circumstances, including those who demand psychosocial care, which reinforces the need for attention to impaired psycho-emotional function, as evidenced in our study. ...
... SARS-CoV-2 infection, in the initial phase, produces an acute inflammatory response and pulmonary pathologies, and in later phases, cardiovascular complications, such as ventricular wall thickening asso-ciated with an increase in the ventricular mass/body mass ratio and interstitial coronary fibrosis, elevated levels of serum cardiac troponin I, elevated cholesterol, low-density lipoprotein, and long-chain fatty acid triglycerides, and therefore emphasize our findings related to impaired neurological, circulatory, and oxygenation function. (24,25) Under this logic, it is emphasized that a symptom's intensity will vary according to an individual's emotional response, to their psychological factors and their affective variables, which makes it necessary to raise awareness of the injuries and the need for healthy and effective coping. (15,22) Based on the TUS assumptions, it is possible to understand phenomena such as time/duration, intensity, quality, suffering, which can be caused by prolonged symptoms and post-COVID-19 sequel, essential knowledge for nursing teams and health in the care of patients in these circumstances, including those who demand psychosocial care, which reinforces the need for attention to impaired psycho-emotional function, as evidenced in our study. ...
Resumo Objetivo Identificar as manifestações clínicas e as repercussões dos sintomas prolongados e das sequelas pós-COVID-19, expressos sob a forma de desconfortos, por homens nas redes sociais digitais. Métodos Estudo netnográfico realizado de julho de 2020 a janeiro de 2021 nas plataformas do Facebook ®, Instagram ® e YouTube TM, em páginas e/ou comunidades brasileiras. Os dados apreendidos foram submetidos à análise temática e interpretados sob o referencial da Teoria dos Sintomas Desagradáveis. Resultados A sintomatologia prolongada e as sequelas pós-COVID-19 percebidas e relatadas pelos homens foram explicitadas pelas disfunções à saúde física, de forma sistêmica e das alterações cognitivas/psicossomáticas. Como consequência os homens vivenciaram modificações nas atividades da vida diária, incapacidades para o trabalho, precariedades no cuidado da saúde. Um conjunto de fatores influenciadores fisiológicos, psicossociais e situacionais vivenciados, configuram os sintomas desagradáveis masculinos provocados pela COVID-19. Conclusão Há repercussões na saúde física, bioenergética e psicossocial dos homens em manifestação dos sintomas prolongados e sequelas pós-COVID-19, que limitam e impactam a vida cotidiana e a prática de cuidado à saúde masculina. A configuração dessas repercussões oportuniza uma atuação clínico-mercadológica especializada e a expansão do trabalho de reabilitação em Enfermagem e Saúde.
... The psychological aspects of PCS may include increased anxiety, depression, stress, and sleep disturbances (Badinlou et al., 2022;Damiano et al., 2022;Premraj et al., 2022). In some individuals, PCS may lead to feelings of isolation, hopelessness, or even trauma. ...
Cognitive sequelae after recovery from an initial COVID-19 disease are present in a subset of affected individuals, coalescing around several important issues such as effects of age, COVID-19 disease severity, comorbidities, and other factors. Some neuropsychological symptoms appear more common among certain patient populations. Comorbidities may complicate neuropsychological assessment as well. Hence, we need a guideline-based evaluation to guide neuropsychological rehabilitation. Drawing from the recent revision of the German National Guideline for the Long and Post-COVID Syndrome and current advances in international guidance on neuropsychological assessment, this article provides practical and scientifically informed recommendations for the neuropsychological assessment of individuals recovering from coronavirus-related diseases.
... In Brazil, a group of researchers studied the cognitive effects of the disease in more than 400 patients who underwent a battery of neuropsychological examinations and tests after hospitalization. In this research, reports of memory loss exceeded 50% of participants 14 . In the case of the present study, memory also had the worst self-perception among the participants, reaching over 65% of "a little worse now" and "much worse now" answers. ...
Unlabelled:
COVID-19 is an infection, primarily respiratory, caused by the SARS-CoV-2, which can also affect the central nervous system, causing neuropsychological damage. There are studies describing post-COVID-19 cognitive deficits, but it is important to know this outcome in populations with different social, biological, and cultural characteristics.
Objective:
The aim of this study was to assess the self-perception of cognitive sequelae in post-COVID-19 individuals and identify whether there is a possible relationship between the outcome of the participants' self-perception and sociodemographic and clinical data.
Methods:
This is a cross-sectional study, carried out through an online questionnaire on the Google Forms platform, in which sociodemographic data, general health data, clinical manifestations of COVID-19, and post-COVID-19 self-perception of the cognitive domains of memory, attention, language, and executive functions were collected.
Results:
The final sample consisted of 137 participants, and it was possible to identify that memory and attention were the domains with the highest impression of worsening post-COVID-19, followed by executive functions and language. In addition, it was identified that being female may be related to a worse self-perception of all cognitive functions and that having depression or other psychiatric diseases and obesity can significantly affect at least half of the cognitive domains evaluated.
Conclusions:
This study pointed to a post-COVID-19 cognitive worsening of the participants.
... Cognitive performance was not related to acute-phase disease severity. 35 Moreover, we did not find that cognitive impairment was related to other neurological symptoms (headache, anosmia, dysgeusia), as reported previously. 36 Among participants without dementia or memory complaints, 31% ...
Introduction:
Cognitive impairment is common after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. However, associations between post-hospital discharge risk factors and cognitive trajectories have not been explored.
Methods:
A total of 1105 adults (mean age ± SD 64.9 ± 9.9 years, 44% women, 63% White) with severe coronavirus disease 2019 (COVID-19) were evaluated for cognitive function 1 year after hospital discharge. Scores from cognitive tests were harmonized, and clusters of cognitive impairment were defined using sequential analysis.
Results:
Three groups of cognitive trajectories were observed during the follow-up: no cognitive impairment, initial short-term cognitive impairment, and long-term cognitive impairment. Predictors of cognitive decline after COVID-19 were older age (β = -0.013, 95% CI = -0.023;-0.003), female sex (β = -0.230, 95% CI = -0.413;-0.047), previous dementia diagnosis or substantial memory complaints (β = -0.606, 95% CI = -0.877;-0.335), frailty before hospitalization (β = -0.191, 95% CI = -0.264;-0.119), higher platelet count (β = -0.101, 95% CI = -0.185;-0.018), and delirium (β = -0.483, 95% CI = -0.724;-0.244). Post-discharge predictors included hospital readmissions and frailty.
Discussion:
Cognitive impairment was common and the patterns of cognitive trajectories depended on sociodemographic, in-hospital, and post-hospitalization predictors.
Highlights:
Cognitive impairment after coronavirus disease 2019 (COVID-19) hospital discharge was associated with higher age, less education, delirium during hospitalization, a higher number of hospitalizations post discharge, and frailty before and after hospitalization. Frequent cognitive evaluations for 12-month post-COVID-19 hospitalization showed three possible cognitive trajectories: no cognitive impairment, initial short-term impairment, and long-term impairment. This study highlights the importance of frequent cognitive testing to determine patterns of COVID-19 cognitive impairment, given the high frequency of incident cognitive impairment 1 year after hospitalization.
... COVID-19 infection can cause neurological and psychiatric sequelae, including depression, insomnia, anxiety, and other disorders such as dementia and post-traumatic stress disorder [49][50][51][52][53]. In addition, Mazza et al., observed that lengthy hospital stays, the presence of comorbidities, and being women had higher scores for mental disorders [49]. ...
Background: COVID-19 made its debut as a pandemic in 2020; since then, more than 607 million cases and at least 6.5 million deaths have been reported worldwide. While the burden of disease has been described, the long-term effects or chronic sequelae are still being described. Objective: To describe the findings of a current systematic review of the long-term effects related to post-COVID-19 sequelae. Design: A systematic review was carried out in which cohort studies, case series, clinical case reports were included, and the PubMed, Scielo, SCOPUS and Web of Science databases were ex-tracted. Information published 2020 to June 1, 2022, was sought. Results: We reviewed 300 manuscripts during the first step of the literature review process. Then 260 abstracts were analyzed. In the end, we included 32 manuscripts: 9 for pulmonary, 6 for cardiac, 2 for renal, 9 for neurological and psychiatric, and 8 for cutaneous sequelae. Conclusion: Studies show that the most common sequelae are those linked to the lungs, followed by skin, cutaneous and psychiatric alterations. Women report a higher incidence of the sequelae, as well as those with comorbidities and severer COVID-19 history. The COVID-19 pandemic has not only caused death and disease since its apparition but has also sickened millions of people around the globe who potentially suffer from serious illnesses that will continue to add to the list of health problems and further burden healthcare systems around the world.
... for at least 2 months 2 . Early reports revealed that around 76% of patients reported at least 1 persistent symptom 6 months following hospital discharge 3 , with fatigue, dyspnea, cough, headache, loss of taste or smell, and cognitive or mental health impairments (e.g., anxiety or depression) being the most commonly reported symptoms [4][5][6][7] . ...
The aim of this study was to determine whether Post-acute Sequelae of SARS-CoV-2 Infection (PASC) are associated with physical inactivity in COVID-19 survivors. This is a cohort study of COVID-19 survivors discharged from a tertiary hospital in Sao Paulo, Brazil. Patients admitted as inpatients due to laboratory-confirmed COVID-19 between March and August 2020 were consecutively invited for a follow-up in-person visit 6 to 11 months after hospitalization. Ten symptoms of PASC were assessed using standardized scales. Physical activity was assessed by questionnaire and participants were classified according to WHO Guidelines. 614 patients were analyzed (age: 56 ± 13 years; 53% male). Frequency of physical inactivity in patients exhibiting none, at least 1, 1–4, and 5 or more symptoms of PASC was 51%, 62%, 58%, and 71%, respectively. Adjusted models showed that patients with one or more persistent PASC symptoms have greater odds of being physically inactive than those without any persistent symptoms (OR: 1.57 [95% CI 1.04–2.39], P = 0.032). Dyspnea (OR: 2.22 [1.50–3.33], P < 0.001), fatigue (OR: 2.01 [1.40–2.90], P < 0.001), insomnia (OR: 1.69 [1.16–2.49], P = 0.007), post-traumatic stress (OR: 1.53 [1.05–2.23], P = 0.028), and severe muscle/joint pain (OR: 1.53 [95% CI 1.08–2.17], P = 0.011) were associated with greater odds of being physically inactive. This study suggests that PASC is associated with physical inactivity, which itself may be considered as a persistent symptom among COVID-19 survivors. This may help in the early identification of patients who could benefit from additional interventions tailored to combat inactivity (even after treatment of PASC), with potential beneficial impacts on overall morbidity/mortality and health systems worldwide.
... Cognitive performance was not related to acute-phase disease severity. 35 Moreover, we did not find that cognitive impairment was related to other neurological symptoms (headache, anosmia, dysgeusia), as reported previously. 36 Among participants without dementia or memory complaints, 31% ...
Background
Most people with dementia already live in low‐ to middle‐income countries (LMIC). However, most evidence regarding dementia prevention comes from high‐income countries that have different socioeconomic status (SES) and risk factors prevalence than LMIC. In this session, we will present results on risk and protective factors for dementia from the Longitudinal Study of Adult Health (ELSA‐Brasil), the Brazilian Longitudinal Study of Aging (ELSI‐Brazil), and the Brazilian Biobank for Aging Studies (BAS).
Method
The ELSA‐Brasil follows 15,105 public servants since 2008‐10. The ELSI‐Brazil is a nationally representative study with 9,412 adults aged 50 years and older, who were enrolled in 2015‐16. The BAS is a neuropathology study that started in 2004 and is the largest brain bank in Latin America with a collection of 1,441 brains. The focus of this presentation will be on the associations of education, SES, and cardiovascular factors with dementia using data from these three studies.
Result
In the BAS, 77% of the sample has less than 5 years of education and 56% unskilled occupations. Compared to the group without education, those with formal education had better cognitive performance (1‐4 years: 𝛽 = ‐0.99, 95%CI = –1.85; –0.14, p = 0.02; ≥5 years: = –1.42, 95% CI = –2.47; –0.38, p = 0.008). On the other hand, occupation complexity and demands were unrelated to cognition. Similarly, we showed that education and early‐life SES were the main contributors to cognitive performance in the ELSA‐Brasil, while later SES had a lower influence on cognitive scores. Cardiovascular factors are also important contributors to brain health. Ideal vascular health was related to better cognitive function in the ELSA‐Brasil. Participants with intermediate (β = 0.064, 95%CI = 0.033; 0.096) and optimal health (β = 0.108, 95%CI = 0.052; 0.164) had better cognitive z‐scores. Moreover, carotid artery atherosclerosis evaluated by morphometric measurements was related to cognitive impairment in BAS and with cognitive decline in the ELSA‐Brasil after 8 years of follow‐up (β = ‐0.028, 95%CI = ‐0.036; ‐0.020, p<0.001). Finally, hypertension was related to worse cognition (β = ‐0.09; 95%CI = ‐0.15, ‐0.04; p = 0.001) in ELSI‐Brazil, mainly in non‐frail participants.
Conclusion
Studies from LMIC regarding dementia risk factors are essential to implement tailored public policies for dementia primary prevention.
Introduction: Exercise programs have been recommended to individuals with persistent symptoms after COVID-19 hospital discharge. Aim: The objective of this research was to analyze the effects and feasibility of an 8-week supervised high intensity endurance and strength training plus multimodal home-based exercise program on physical, functional outcomes, levels of anxiety and in individuals with persistent symptoms after COVID-19 hospital discharge. Methods: This non-randomized study with convenience sampling, included adults reporting muscle weakness, dyspnea, and/or fatigue after COVID-19 hospitalization, with significant limitations. Exercise program included supervised high-intensity resistance and strength training sessions, as well as multimodal home exercises. The assessed outcomes included pulmonary function (spirometry), exercise capacity (6MWT); functionality capacity (STS-1min) and Post-COVID Functional Scale (PCFS), handgrip strength (HGS) and one-repetition maximum (1RM), quality of life (SF-36); and levels of anxiety and depression (total HADS). Feasibility was achieved if 50% of the sample completed 90% of the sessions of the program. Results: After intervention, individuals improved FVC, FEV1, 6MWT, STS-1mim, HGS; 1RM, SF-36 and total HADS (P< 0.005 for all results). In addition, in PCFS, 100% of the individuals showed significant improvement after intervention compared with previous functional status p<0.0001. Study retention was 66% (22 of the 33 participants), mean adherence over the 8 weeks was 90%. No adverse events were reported. Conclusion: Supervised high intensity endurance and strength training plus multimodal home-based exercise improved the functional capacity, muscle strength, symptoms of anxiety, and functional status in post-hospitalized COVID-19 patients, demonstrated its application to be feasible and safe.
This analysis article aimed to identify and analyze all articles published on the post-COVID-19 condition in Latin America and the Caribbean, focusing on epidemiology, clinical characteristics, and risk of bias. We did a systematic survey of the literature with broad inclusion criteria. The only exclusion criteria were articles referring to post-acute COVID-19 sequelae after an intensive care unit stay, which we distinguish from the post-COVID-19 condition. We searched MEDLINE/PubMed, LILACS, SciELO, Scopus, Web of Science, and Epistemonikos. We included 55 records, of which 48 were original articles (44 were observational research, 29 of which had a comparison group; and four reviews). Various definitions for long COVID were reported, or none, and few used the World Health Organization criteria. None of the included studies reported prevalence rates for the region. We extracted the reported signs and symptoms of long COVID for our region. Using the Johanna Briggs Institute critical appraisal tools for observational analytic research, we found that most included studies were prone to limitations and biases. We conclude that more research should be done on the post-COVID-19 condition in Latin America and the Caribbean, using rigorous study designs to inform public health strategies.
Introduction: The severity of depression symptoms in COVID-19 patients differs among populations investigated and changes over time. Increasing evidence supports the hypothesis about the involvement of inflammation in the development of depression. Methods: A systematic review and a meta-analysis of the cross-sectional and cohort studies published between 2019 and 2023 were conducted according to the PRISMA criteria. The outcomes of interest were the proportions of mild, moderate, and severe depression symptoms during and after hospitalisation, and associations between depression and inflammation in COVID-19 patients. Results: Thirty articles were included in the systematic review. In the quantitative meta-analysis, the overall proportions of moderate-to-severe and mild-to-severe depression were estimated at 0.21 (95% CI: 0.13–0.31) and 0.35 (95% CI: 0.23–0.48), respectively. The fixed effects model of the meta-analysis of inflammatory markers showed a difference between COVID-19 patients with and without depression, with higher concentrations of both C-reactive protein and neutrophil-lymphocyte ratio detected among people suffering mood disturbances. However, in random effects models, findings for C-reactive protein lost significance, and for neutrophil-lymphocyte ratio were on the boundary of significance (p = 0.053). Conclusions: According to the study results, the proportion of depression decreases over time after a COVID-19 diagnosis. The relationship between depression and inflammation is still uncertain and requires further research.
Cognitive impairment and symptoms of psychiatric disorders have been reported frequently as features of post-acute sequelae of SARS-CoV-2 infection. This study aims to investigate subjective memory complaints in COVID-19 survivors and determine if these are more strongly associated with objective cognitive impairment related to sequelae of SARS-CoV-2 infection or with symptoms of psychiatric conditions. A total of 608 COVID-19 survivors were evaluated in-person 6–11 months after hospitalization, with 377 patients assigned to a “no subjective memory complaint (SMC)” group and 231 patients assigned to an SMC group based on their Memory Complaint Scale scores. Follow-up evaluations included an objective cognitive battery and scale-based assessments of anxiety, depression, and post-traumatic stress symptoms. We found the perception of memory impairment in COVID-19 survivors to be more strongly associated to core symptoms of psychiatric conditions rather than to primary objective cognitive impairment. Univariate analysis indicated significant differences between the “no SMC” and SMC groups, both for the psychiatric symptom evaluations and for the cognitive evaluations (p < 0.05); however, the psychiatric symptoms all had large partial eta-squared values (ranging from 0.181 to 0.213), whereas the cognitive variables had small/medium partial eta-squared values (ranging from 0.002 to 0.024). Additionally, multiple regression analysis indicated that only female sex and depressive and post-traumatic stress symptoms were predictors of subjective memory complaints. These findings may help guide clinical evaluations for COVID-19 survivors presenting with memory complaints while also serving to expand our growing understanding of the relationship between COVID-19, subjective memory complaints, and the risk of cognitive decline.
This article aimed to assess the temporal trend of work-related mental and behavioral disorders in Brazil, as well as to measure the effect of changes in the implementation of the Social Security Technical Nexus (NTP, acronym in Portuguese) on the incidence of these disorders among beneficiaries of the General Social Security System (RGPS, acronym in Portuguese). It is an analysis of time series and interrupted time series with data from the Brazilian Ministry of Social Security information system on cases of work-related mental and behavioral disorders from 2003 to 2019. The Prais-Winsten method was employed to calculate the annual percent change (APC) of the incidence rates for the conditions under study. The average incidence of work-related mental and behavioral disorders was 35.48 per 100,000 RGPS links during the period 2003-2019, with an increasing trend (APC = 9.67%; p = 0.033) for Brazil. Before the implementation of changes in the NTP (2003-2007), this value was 15.59, with an increasing trend (APC = 29.28%; p < 0.001), and it more than doubled (43.77) after the RGPS modified the way of establishing the nexus between illness and work (2008-2019). The post-NTP trend for work-related mental and behavioral disorders was a decrease in the country (APC = -23.73%; p < 0.001), a pattern that was repeated for all regions of the country. The findings suggest that the changes in the way of establishing the NTP between illness and work represented an advancement in the system of recording and notifying work-related mental and behavioral disorders in Brazil.
The COVID-19 pandemic has brought significant changes in daily life for humanity and has had a profound impact on mental health. As widely acknowledged, the pandemic has led to notable increases in rates of anxiety, depression, distress, and other mental health-related issues, affecting both infected patients and non-infected individuals. COVID-19 patients and survivors face heightened risks for various neurological and psychiatric disorders and complications. Vulnerable populations, including those with pre-existing mental health conditions and individuals living in poverty or frailty, may encounter additional challenges. Tragically, suicide rates have also risen, particularly among young people, due to factors such as unemployment, financial crises, domestic violence, substance abuse, and social isolation. Efforts are underway to address these mental health issues, with healthcare professionals urged to regularly screen both COVID-19 and post-COVID-19 patients and survivors for psychological distress, ensuring rapid and appropriate interventions. Ongoing periodic follow-up and multidimensional, interdisciplinary approaches are essential for individuals experiencing long-term psychiatric sequelae. Preventive strategies must be developed to mitigate mental health problems during both the acute and recovery phases of COVID-19 infection. Vaccination efforts continue to prioritize vulnerable populations, including those with mental health conditions, to prevent future complications. Given the profound implications of mental health problems, including shorter life expectancy, diminished quality of life, heightened distress among caregivers, and substantial economic burden, it is imperative that political and health authorities prioritize the mental well-being of all individuals affected by COVID-19, including infected individuals, non-infected individuals, survivors, and caregivers.
Purpose:
To analyze the prevalence of lower urinary tract symptoms (LUTS) in patients who survived moderate and severe forms of COVID-19 and the risk factors for LUTS six months after hospitalization.
Materials and methods:
In this prospective cohort study, patients were evaluated six months after hospitalization due to COVID-19. LUTS were assessed using the International Prostate Symptom Score. General health was assessed through the Hospital Anxiety and Depression Scale and the EQ5D-L5 scale, which evaluates mobility, ability to perform daily activities, pain and discomfort and completed a self-perception health evaluation.
Results:
Of 255 participants, 54.1% were men and the median age was 57.3 [44.3 - 66.6] years. Pre-existing comorbidities included diabetes (35.7%), hypertension (54.5%), obesity (30.2%) and physical inactivity (65.5%). One hundred and twenty-four patients (48.6%) had a hospital stay >15 days, 181 (71.0%) were admitted to an ICU and 124 (48.6%) needed mechanical ventilation. Median IPSS was 6 [3-11] and did not differ between genders. Moderate to severe LUTS affected 108 (42.4%) patients (40.6% men and 44.4% women; p=0.610). Nocturia (58.4%) and frequency (45.9%) were the most prevalent symptoms and urgency was the only symptom that affected men (29.0%) and women (44.4%) differently (p=0.013). LUTS impacted the quality of life of 60 (23.5%) patients with women more severely affected (p=0.004). Diabetes, hypertension, and self-perception of worse general health were associated with LUTS.
Conclusions:
LUTS are highly prevalent and bothersome six months after hospitalization due to COVID-19. Assessment of LUTS may help ensure appropriate diagnosis and treatment in these patients.
Background and purpose
This review aims to characterize the pattern of post‐COVID‐19 cognitive impairment, allowing better prediction of impact on daily function to inform clinical management and rehabilitation.
Methods
A systematic review and meta‐analysis of neurocognitive sequelae following COVID‐19 was conducted, following PRISMA‐S guidelines. Studies were included if they reported domain‐specific cognitive assessment in patients with COVID‐19 at >4 weeks post‐infection. Studies were deemed high‐quality if they had >40 participants, utilized healthy controls, had low attrition rates and mitigated for confounders.
Results
Five of the seven primary Diagnostic and Statistical Manual of Mental Disorders (DSM‐5) cognitive domains were assessed by enough high‐quality studies to facilitate meta‐analysis. Medium effect sizes indicating impairment in patients post‐COVID‐19 versus controls were seen across executive function (standardised mean difference (SMD) −0.45), learning and memory (SMD −0.55), complex attention (SMD −0.54) and language (SMD −0.54), with perceptual motor function appearing to be impacted to a greater degree (SMD −0.70). A narrative synthesis of the 56 low‐quality studies also suggested no obvious pattern of impairment.
Conclusions
This review found moderate impairments across multiple domains of cognition in patients post‐COVID‐19, with no specific pattern. The reported literature was significantly heterogeneous, with a wide variety of cognitive tasks, small sample sizes and disparate initial disease severities limiting interpretability. The finding of consistent impairment across a range of cognitive tasks suggests broad, as opposed to domain‐specific, brain dysfunction. Future studies should utilize a harmonized test battery to facilitate inter‐study comparisons, whilst also accounting for the interactions between COVID‐19, neurological sequelae and mental health, the interplay between which might explain cognitive impairment.
Introduction
The COVID-19 pandemic has prompted global research efforts to reduce infection impact, highlighting the potential of cross-disciplinary collaboration to enhance research quality and efficiency.
Methods
At the FMUSP-HC academic health system, we implemented innovative flow management routines for collecting, organizing and analyzing demographic data, COVID-related data and biological materials from over 4,500 patients with confirmed SARS-CoV-2 infection hospitalized from 2020 to 2022. This strategy was mainly planned in three areas: organizing a database with data from the hospitalizations; setting-up a multidisciplinary taskforce to conduct follow-up assessments after discharge; and organizing a biobank. Additionally, a COVID-19 curated collection was created within the institutional digital library of academic papers to map the research output.
Results
Over the course of the experience, the possible benefits and challenges of this type of research support approach were identified and discussed, leading to a set of recommended strategies to enhance collaboration within the research institution. Demographic and clinical data from COVID-19 hospitalizations were compiled in a database including adults and a minority of children and adolescents with laboratory confirmed COVID-19, covering 2020–2022, with approximately 350 fields per patient. To date, this database has been used in 16 published studies. Additionally, we assessed 700 adults 6 to 11 months after hospitalization through comprehensive, multidisciplinary in-person evaluations; this database, comprising around 2000 fields per subject, was used in 15 publications. Furthermore, thousands of blood samples collected during the acute phase and follow-up assessments remain stored for future investigations. To date, more than 3,700 aliquots have been used in ongoing research investigating various aspects of COVID-19. Lastly, the mapping of the overall research output revealed that between 2020 and 2022 our academic system produced 1,394 scientific articles on COVID-19.
Discussion
Research is a crucial component of an effective epidemic response, and the preparation process should include a well-defined plan for organizing and sharing resources. The initiatives described in the present paper were successful in our aim to foster large-scale research in our institution. Although a single model may not be appropriate for all contexts, cross-disciplinary collaboration and open data sharing should make health research systems more efficient to generate the best evidence.
Background
Post COVID-19 syndrome, also known as "Long COVID," is a complex and multifaceted condition that affects individuals who have recovered from SARS-CoV-2 infection. This systematic review and meta-analysis aim to comprehensively assess the global prevalence of depression, anxiety, and sleep disorder in individuals coping with Post COVID-19 syndrome.
Methods
A rigorous search of electronic databases was conducted to identify original studies until 24 January 2023. The inclusion criteria comprised studies employing previously validated assessment tools for depression, anxiety, and sleep disorders, reporting prevalence rates, and encompassing patients of all age groups and geographical regions for subgroup analysis Random effects model was utilized for the meta-analysis. Meta-regression analysis was done.
Results
The pooled prevalence of depression and anxiety among patients coping with Post COVID-19 syndrome was estimated to be 23% (95% CI: 20%—26%; I2 = 99.9%) based on data from 143 studies with 7,782,124 participants and 132 studies with 9,320,687 participants, respectively. The pooled prevalence of sleep disorder among these patients, derived from 27 studies with 15,362 participants, was estimated to be 45% (95% CI: 37%—53%; I2 = 98.7%). Subgroup analyses based on geographical regions and assessment scales revealed significant variations in prevalence rates. Meta-regression analysis showed significant correlations between the prevalence and total sample size of studies, the age of participants, and the percentage of male participants. Publication bias was assessed using Doi plot visualization and the Peters test, revealing a potential source of publication bias for depression (p = 0.0085) and sleep disorder (p = 0.02). However, no evidence of publication bias was found for anxiety (p = 0.11).
Conclusion
This systematic review and meta-analysis demonstrate a considerable burden of mental health issues, including depression, anxiety, and sleep disorders, among individuals recovering from COVID-19. The findings emphasize the need for comprehensive mental health support and tailored interventions for patients experiencing persistent symptoms after COVID-19 recovery.
Introduction
There are multiple reports of neuropsychiatric disorders (NDs) such as stress, depression, post-traumatic stress disorder (PTSD), or anxiety, in patients who have survived the acute phase of COVID-19, being even more frequent in people who were hospitalized with moderate or severe disease. South America (SA) was one of the most affected continents during this time due to its health, social, political and economic context. We aimed to determine the prevalence and incidence of NDs in patients following hospitalization for COVID-19 in SA.
Materials and methods
We searched in PubMed, Embase, Scopus, Web of Science, LILACS, SciELO, and Google Scholar databases up to October 2022. We performed proportion meta-analysis with a random-effect model and Freeman-Tukey Double Arcsine transformation using the STATA 16.1 program. Finally, we evaluated heterogeneity by subgroup analysis and certainty of evidence with the GRADE approach.
Results
We included eight studies from four countries. We only pooled six studies with prevalence measures. The estimated prevalence of all NDs was 31.48% (two-studies, 95%CI: 25.82–37.43). Depression, anxiety, insomnia, PTSD, and memory alterations had a pooled prevalence of 16.23% (three-studies, 95%CI: 7.18–27.93, I2: 94.22), 18.72% (three-studies, 95%CI: 11.65–26.97, I2: 87.56), 43.07% (three-studies, 95%CI: 32.77–53.37, I2: 92.61), 31.78% (three-studies, 95%CI: 14.33–52.40, I2: 97.96), and 38.24% (two-studies, 95%CI: 35.5–40.97), respectively. The evidence included was deemed as moderate to high certainty.
Conclusion
We suggest that NDs should be prioritized in research and care in South America with public policies that can support their identification and prompt management to improve the quality of life of patients. More studies are needed to adequately study the prevalence of NDs in South America, their associated factors, and evaluate the causes of heterogeneity.
Systematic review registration
https://doi.org/10.6084/m9.figshare.21901041.v1.
Background
We sought to identify potentially modifiable in‐hospital factors associated with global cognition, post‐traumatic stress disorder (PTSD) symptoms, and depression symptoms at 12 months.
Methods
This was a multi‐center prospective cohort study in adult hospitalized patients with acute COVID‐19. The following in‐hospital factors were assessed: delirium; frequency of in‐person and virtual visits by friends and family; and hydroxychloroquine, corticosteroid, and remdesivir administration. Twelve‐month global cognition was characterized by the MOCA‐Blind. Twelve‐month PTSD and depression were characterized using the PTSD Checklist for the DSM‐V and Hospital Anxiety Depression Scale, respectively.
Findings
Two hundred three patients completed the 12‐month follow‐up assessments. Remdesivir use was associated with significantly higher cognition at 12 months based on the MOCA‐Blind (adjusted odds ratio [aOR] = 1.98, 95% CI: 1.06, 3.70). Delirium was associated with worsening 12‐month PTSD (aOR = 3.44, 95% CI: 1.89, 6.28) and depression (aOR = 2.18, 95% CI: 1.23, 3.84) symptoms. Multiple virtual visits per day during hospitalization was associated with lower 12‐month depression symptoms compared to those with less than daily virtual visits (aOR = 0.40, 95% CI: 0.19, 0.85).
Conclusion
Potentially modifiable factors associated with better long‐term outcomes included remdesivir use (associated with better cognitive function), avoidance of delirium (associated with less PTSD and depression symptoms), and increased virtual interactions with friends and family (associated with less depression symptoms).
OBJECTIVE
to understand how nurses describe the challenges and construction of knowledge related to the care provided to people with post-COVID-19 syndrome.
METHOD
this is qualitative-descriptive research, guided by the social constructionist perspective, carried out with seven nurses in a 24-hour Emergency Care Unit located in Minas Gerais. Data were collected from March to June 2022 through recorded semi-structured interviews. Data analysis took place through the transcription of interviews, followed by a curious reading of the material and definition of categories, step-by-step, anchored by social constructionism. The theoretical framework was composed of the set of authors who helped in the analysis and discussion of the categories constructed to respond to the study objectives.
RESULTS
four categories emerged from the interviews, namely: 1) Initial reflexes of the pandemic, in which nurses’ feelings of fear, concern and insecurity were evidenced; 2) COVID-19 traces, of which the respiratory sequels caused by the disease stood out; 3) Knowledge about post-COVID-19 syndrome, which detected lack of knowledge about signs and symptoms and nursing care, due to lack of training and use of protocols; 4) Care for post-COVID-19 syndrome, which highlighted the lack of knowledge about referring people to rehabilitation services.
CONCLUSION
despite the lack of protocols and training provided by the institution, nursing professionals provided assistance care on knowledge provided by their experiences and the exchange of experiences with other collaborators.
DESCRIPTORS:
Coronavirus infections; COVID-19; Pandemics; Nursing care; Education continuing; Post-acute COVID-19 syndrome
ABSTRACT
OBJECTIVE: to understand how nurses describe the challenges and construction of knowledge related to the care provided to people with post-COVID-19 syndrome.
METHOD: this is qualitative-descriptive research, guided by the social constructionist perspective, carried out with seven nurses in a 24-hour Emergency Care Unit located in Minas Gerais. Data were collected from Marchto June 2022 through recorded semi-structured interviews. Data analysis took place through the transcriptionof interviews, followed by a curious reading of the material and definition of categories, step-by-step, anchored
by social constructionism. The theoretical framework was composed of the set of authors who helped in the
analysis and discussion of the categories constructed to respond to the study objectives.
RESULTS: four categories emerged from the interviews, namely: 1) Initial reflexes of the pandemic, in which nurses’ feelings of fear, concern and insecurity were evidenced; 2) COVID-19 traces, of which the respiratory sequels caused by the disease stood out; 3) Knowledge about post-COVID-19 syndrome, which detected lack
of knowledge about signs and symptoms and nursing care, due to lack of training and use of protocols; 4) Care for post-COVID-19 syndrome, which highlighted the lack of knowledge about referring people to rehabilitation services.
CONCLUSION: despite the lack of protocols and training provided by the institution, nursing professionals provided assistance care on knowledge provided by their experiences and the exchange of experiences with other collaborators.
DESCRIPTORS: Coronavirus infections. COVID-19. Pandemics. Nursing care. Education continuing. Postacute COVID-19 syndrome.
OBJECTIVE
to understand how nurses describe the challenges and construction of knowledge related to the care provided to people with post-COVID-19 syndrome.
METHOD
this is qualitative-descriptive research, guided by the social constructionist perspective, carried out with seven nurses in a 24-hour Emergency Care Unit located in Minas Gerais. Data were collected from March to June 2022 through recorded semi-structured interviews. Data analysis took place through the transcription of interviews, followed by a curious reading of the material and definition of categories, step-by-step, anchored by social constructionism. The theoretical framework was composed of the set of authors who helped in the analysis and discussion of the categories constructed to respond to the study objectives.
RESULTS
four categories emerged from the interviews, namely: 1) Initial reflexes of the pandemic, in which nurses’ feelings of fear, concern and insecurity were evidenced; 2) COVID-19 traces, of which the respiratory sequels caused by the disease stood out; 3) Knowledge about post-COVID-19 syndrome, which detected lack of knowledge about signs and symptoms and nursing care, due to lack of training and use of protocols; 4) Care for post-COVID-19 syndrome, which highlighted the lack of knowledge about referring people to rehabilitation services.
CONCLUSION
despite the lack of protocols and training provided by the institution, nursing professionals provided assistance care on knowledge provided by their experiences and the exchange of experiences with other collaborators.
DESCRIPTORS:
Coronavirus infections; COVID-19; Pandemics; Nursing care; Education continuing; Post-acute COVID-19 syndrome
O CRIE Pós-COVID-19 é um serviço especializado, interprofissional, em Blumenau, SC, criado para atender as necessidades de saúde de usuários do Sistema Único de Saúde com a condição pós-COVID-19. Descreveu-se a experiência do serviço nos primeiros vinte meses de trabalho. Foram atendidos 435 usuários, realizados mais de 12 mil procedimentos e desenvolvidos atividades em projetos: “Se te comove, acolhe, Integralidade do Cuidado, Práticas Integrativas-CRIE/FURB e A arte do cuidado”, contemplando a integração do ensino, pesquisa e extensão no processo do cuidado. O enfoque multidimensional e colaborativo do CRIE norteia a construção de planos terapêuticos, sendo diferencial nesse serviço especializado.
COVID-19 made its debut as a pandemic in 2020; since then, more than 607 million cases and at least 6.5 million deaths have been reported worldwide. While the burden of disease has been described, the long-term effects or chronic sequelae are still being clarified. The aim of this study was to present an overview of the information available on the sequelae of COVID-19 in people who have suffered from the infection. A systematic review was carried out in which cohort studies, case series, and clinical case reports were included, and the PubMed, Scielo, SCOPUS, and Web of Science databases were extracted. Information was published from 2020 to 1 June 2022, and we included 26 manuscripts: 9 for pulmonary, 6 for cardiac, 2 for renal, 8 for neurological and psychiatric, and 6 for cutaneous sequelae. Studies showed that the most common sequelae were those linked to the lungs, followed by skin, cutaneous, and psychiatric alterations. Women reported a higher incidence of the sequelae, as well as those with comorbidities and more severe COVID-19 history. The COVID-19 pandemic has not only caused death and disease since its appearance, but it has also sickened millions of people around the globe who potentially suffer from serious illnesses that will continue to add to the list of health problems, and further burden healthcare systems around the world.
Background: Covid-19 remains a pandemic that most countries in the world are still
dealing with. This is study aims to report the psychological impact of Covid-19 over time
on the Spanish population.
Methods: A longitudinal study (N = 1041) was carried out with two measurements:
after 2 and 5 weeks starting from the declaration of the state of emergency in Spain. The
presence of depressive symptoms, anxiety, and posttraumatic stress disease (PTSD)
was evaluated by means of screening tests. Sociodemographic data, variables about
Covid-19, loneliness, spiritual well-being, social support, discrimination, and a sense of
belonging were collected.
Results: The data showed how depressive symptomatology increased significantly over
time, while anxiety and PTSD did not show statistically significant changes. Spiritual
well-being and loneliness were the main predictors of psychological impact. A younger
age was a significant predictor of depression and anxiety, while female gender was
associated with anxiety and PTSD.
Conclusions: The impact of the pandemic is sustained over time, even increasing in
depression, and vulnerable groups that need greater psychological health support could
be identified.
Background: Mental health burden has been massively reported during the COVID-19 pandemic period. Aiming to summarise these data, we present a meta-review of meta-analyses that evaluated the impact of COVID-19 pandemic on anxiety, depressive and stress symptoms, psychological distress, post-traumatic stress disorder/symptoms (PTSD), and sleep disturbance, reporting its prevalence on general public (GP) and health care workers (HCW).
Methods: A search was performed in the PubMed, EMBASE, and the Web of Science. Sleep disturbances, psychological distress, stress, and burnout were grouped as “Psychophysiological stress,” and anxiety, depression, and PTSD were grouped as “Psychopathology.” A random-effects model, calculating the pooled prevalence together with 95% confidence interval was performed for each domain. Subgroup analyses were performed for each population type (GP and HCW) and for each mental health outcome. For anxiety and depression, subgroup analysis for population type was performed. Heterogeneity is reported as I². Publication bias was assessed through visual inspection of the funnel plot, and further tested by Egger's test and trim and fill analyses.
Results: A total of 18 meta-analyses were included. The prevalence of psychophysiological stress was 31.99% (CI: 26.88–37.58, I² = 99.9%). HCW showed a higher prevalence (37.74%, CI: 33.26–42.45, I² = 99.7%) than the GP (20.67%, 15.07–27.66, I² = 99.9%). The overall prevalence of insomnia, psychological distress, and stress were, respectively, 32.34% (CI: 25.65–39.84), 28.25% (CI: 18.12–41.20), and 36% (CI: 29.31–43.54). Psychopathology was present at 26.45% (CI: 24.22–28.79, I² = 99.9%) of the sample, with similar estimates for population (HCW 26.14%, CI: 23.37–29.12, I² = 99.9%; GP: 26.99%, CI: 23.41–30.9, I² = 99.9%). The prevalence of anxiety, depression, and PTSD was 27.77% (CI: 24.47–31.32), 26.93% (CI: 23.92–30.17), and 20% (CI: 15.54–24.37), respectively. Similar proportions between populations were found for anxiety (HCW = 27.5%, CI: 23.78–31.55; GP = 28.33%, CI: 22.1–35.5) and depression (HCW = 27.05%, CI: 23.14–31.36; GP = 26.7%, CI: 22.32–31.59). Asymmetry in the funnel plot was found, and a slight increase in the estimate of overall psychopathology (29.08%, CI: 26.42–31.89) was found after the trim and fill analysis.
Conclusions: The prevalence of mental health problems ranged from 20 to 36%. HCW presented a higher prevalence of psychophysiological stress than the general population.
Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=252221, identifier: CRD42021252221.
Introduction COVID-19 may lead to persistent and potentially incapacitating clinical manifestations (post-acute sequelae of SARS-CoV-2 infection (PASC)). Using easy-to-apply questionnaires and scales (often by telephone interviewing), several studies evaluated samples of COVID-19 inpatients from 4 weeks to several months after discharge. However, studies conducting systematic multidisciplinary assessments of PASC manifestations are scarce, with thorough in-person objective evaluations restricted to modestly sized subsamples presenting greatest disease severity.
Methods and analyses We will conduct a prospective observational study of surviving individuals (above 18 years of age) from a cohort of over 3000 subjects with laboratory-confirmed COVID-19 who were treated as inpatients at the largest academic health centre in Sao Paulo, Brazil (Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo). All eligible subjects will be consecutively invited to undergo a 1–2-day series of multidisciplinary assessments at 2 time-points, respectively, at 6–9 months and 12–15 months after discharge. Assessment schedules will include detailed multidomain questionnaires applied by medical research staff, self-report scales, objective evaluations of cardiopulmonary functioning, physical functionality and olfactory status, standardised neurological, psychiatric and cognitive examinations, as well as diagnostic laboratory, muscle ultrasound and chest imaging exams. Remaining material from blood tests will be incorporated by a local biobank for use in future investigations on inflammatory markers, genomics, transcriptomics, peptidomics and metabolomics.
Ethics and dissemination All components of this programme have been approved by local research ethics committees. We aim to provide insights into the frequency and severity of chronic/post-COVID multiorgan symptoms, as well as their interrelationships and associations with acute disease features, sociodemographic variables and environmental exposures. Findings will be disseminated in peer-reviewed journals and at scientific meetings. Additionally, we aim to provide a data repository to allow future pathophysiological investigations relating clinical PASC features to biomarker data extracted from blood samples.
Purpose of review:
COVID-19 impacts multiple organ systems and is associated with high rates of morbidity and mortality. Pathogenesis of viral infection, co-morbidities, medical treatments, and psychosocial factors may contribute to COVID-19 related neuropsychological and psychiatric sequelae. This systematic review aims to synthesize available literature on psychiatric and cognitive characteristics of community-dwelling survivors of COVID-19 infection.
Recent findings:
Thirty-three studies met inclusion/exclusion criteria for review. Emerging findings link COVID-19 to cognitive deficits, particularly attention, executive function, and memory. Psychiatric symptoms occur at high rates in COVID-19 survivors, including anxiety, depression, fatigue, sleep disruption, and to a lesser extent posttraumatic stress. Symptoms appear to endure, and severity of acute illness is not directly predictive of severity of cognitive or mental health issues. The course of cognitive and psychiatric sequelae is limited by lack of longitudinal data at this time. Although heterogeneity of study design and sociocultural differences limit definitive conclusions, emerging risk factors for psychiatric symptoms include female sex, perceived stigma related to COVID-19, infection of a family member, social isolation, and prior psychiatry history.
Summary:
The extant literature elucidates treatment targets for cognitive and psychosocial interventions. Research using longitudinal, prospective study designs is needed to characterize cognitive and psychiatric functioning of COVID-19 survivors over the course of illness and across illness severity. Emphasis on delineating the unique contributions of premorbid functioning, viral infection, co-morbidities, treatments, and psychosocial factors to cognitive and psychiatric sequelae of COVID-19 is warranted.
This is a case report of a middle-aged man with no psychiatric history who presented with severe anxiety and psychotic symptoms from COVID-19. Following his discharge from intensive care unit, he was unable to sleep, was increasingly agitated and was observed hitting his head off the walls, causing haematomas. He remained highly anxious and developed paranoid delusions and auditory and tactile hallucinations, needing admission to a psychiatric ward. Treatment with antipsychotic medication gradually improved his symptoms in a few weeks. This case report highlights the new onset of psychosis due to COVID-19 infection. It demonstrates the importance of early identification and treatment of neuropsychiatric complications within an acute hospital setting. Furthermore, there is a need for research in this area to help in the prevention and treatment of such psychiatric complications due to COVID-19.
Background: There is mixed evidence on increasing rates of psychiatric disorders and symptoms during the COVID-19 pandemic in 2020. We evaluated pandemic-related psychopathology and psychiatry diagnoses and their determinants in the Brazilian Longitudinal Study of Health (ELSA Brasil) Sao Paulo Research Center. Methods: Between pre-pandemic ELSA-Brasil assessments in 2008-10 (Wave-1), 2012-2014 (Wave 2), 2016-2018 (Wave-3) and 3 pandemic assessments in 2020 (COVID-19 waves in May-July, July September, October-December), rates of common psychiatric symptoms, and depressive, anxiety, and common mental disorders were compared using the Clinical Interview Scheduled-Revised (CIS-R) and the Depression Anxiety Stress Scale-21 (DASS-21). Multivariable generalized linear models, adjusted by age, gender, educational level, and ethnicity identified variables associated with an elevated risk for mental disorders. Results: In 2117 participants (mean age 62.3 years, 58.2% females), rates of common mental disorders and depressive disorders did not significantly change over time, oscillating from 23.5%- 21.1%, and 3.3%-2.8%, respectively; while anxiety disorders rate significantly decreased (2008-10: 13.8%; 2016-18: 9.8%; 2020: 8%). There was a decrease along 3 Wave-Covid assessments for depression (β=-0.37, 99.5%CI [-0.50,-0.23]), anxiety (β=-0.37, 99.5%CI [-0.48,-0.26]), and stress (β=-0.48, 99.5%CI [-0.64,-0.33]) symptoms (all ps<0.001). Younger age, female sex, lower educational level, non-white ethnicity, and previous psychiatric disorders were associated with increased odds for psychiatric disorders, whereas self-evaluated good health and good quality of relationships with decreased risk. Conclusion: No consistent evidence of pandemic-related worsening psychopathology in our cohort was found. Indeed, psychiatric symptoms slightly decreased along 2020. Risk factors representing socioeconomic disadvantages were associated with increased odds of psychiatric disorders.
Background
Neurological and psychiatric sequelae of COVID-19 have been reported, but more data are needed to adequately assess the effects of COVID-19 on brain health. We aimed to provide robust estimates of incidence rates and relative risks of neurological and psychiatric diagnoses in patients in the 6 months following a COVID-19 diagnosis.
Methods
For this retrospective cohort study and time-to-event analysis, we used data obtained from the TriNetX electronic health records network (with over 81 million patients). Our primary cohort comprised patients who had a COVID-19 diagnosis; one matched control cohort included patients diagnosed with influenza, and the other matched control cohort included patients diagnosed with any respiratory tract infection including influenza in the same period. Patients with a diagnosis of COVID-19 or a positive test for SARS-CoV-2 were excluded from the control cohorts. All cohorts included patients older than 10 years who had an index event on or after Jan 20, 2020, and who were still alive on Dec 13, 2020. We estimated the incidence of 14 neurological and psychiatric outcomes in the 6 months after a confirmed diagnosis of COVID-19: intracranial haemorrhage; ischaemic stroke; parkinsonism; Guillain-Barré syndrome; nerve, nerve root, and plexus disorders; myoneural junction and muscle disease; encephalitis; dementia; psychotic, mood, and anxiety disorders (grouped and separately); substance use disorder; and insomnia. Using a Cox model, we compared incidences with those in propensity score-matched cohorts of patients with influenza or other respiratory tract infections. We investigated how these estimates were affected by COVID-19 severity, as proxied by hospitalisation, intensive therapy unit (ITU) admission, and encephalopathy (delirium and related disorders). We assessed the robustness of the differences in outcomes between cohorts by repeating the analysis in different scenarios. To provide benchmarking for the incidence and risk of neurological and psychiatric sequelae, we compared our primary cohort with four cohorts of patients diagnosed in the same period with additional index events: skin infection, urolithiasis, fracture of a large bone, and pulmonary embolism.
Findings
Among 236 379 patients diagnosed with COVID-19, the estimated incidence of a neurological or psychiatric diagnosis in the following 6 months was 33·62% (95% CI 33·17–34·07), with 12·84% (12·36–13·33) receiving their first such diagnosis. For patients who had been admitted to an ITU, the estimated incidence of a diagnosis was 46·42% (44·78–48·09) and for a first diagnosis was 25·79% (23·50–28·25). Regarding individual diagnoses of the study outcomes, the whole COVID-19 cohort had estimated incidences of 0·56% (0·50–0·63) for intracranial haemorrhage, 2·10% (1·97–2·23) for ischaemic stroke, 0·11% (0·08–0·14) for parkinsonism, 0·67% (0·59–0·75) for dementia, 17·39% (17·04–17·74) for anxiety disorder, and 1·40% (1·30–1·51) for psychotic disorder, among others. In the group with ITU admission, estimated incidences were 2·66% (2·24–3·16) for intracranial haemorrhage, 6·92% (6·17–7·76) for ischaemic stroke, 0·26% (0·15–0·45) for parkinsonism, 1·74% (1·31–2·30) for dementia, 19·15% (17·90–20·48) for anxiety disorder, and 2·77% (2·31–3·33) for psychotic disorder. Most diagnostic categories were more common in patients who had COVID-19 than in those who had influenza (hazard ratio [HR] 1·44, 95% CI 1·40–1·47, for any diagnosis; 1·78, 1·68–1·89, for any first diagnosis) and those who had other respiratory tract infections (1·16, 1·14–1·17, for any diagnosis; 1·32, 1·27–1·36, for any first diagnosis). As with incidences, HRs were higher in patients who had more severe COVID-19 (eg, those admitted to ITU compared with those who were not: 1·58, 1·50–1·67, for any diagnosis; 2·87, 2·45–3·35, for any first diagnosis). Results were robust to various sensitivity analyses and benchmarking against the four additional index health events.
Interpretation
Our study provides evidence for substantial neurological and psychiatric morbidity in the 6 months after COVID-19 infection. Risks were greatest in, but not limited to, patients who had severe COVID-19. This information could help in service planning and identification of research priorities. Complementary study designs, including prospective cohorts, are needed to corroborate and explain these findings.
Funding
National Institute for Health Research (NIHR) Oxford Health Biomedical Research Centre.
Objective: The prognosis of mild and severe patients has prominent differences during the prevalence of COVID-19, and it will be significant to identify patients' potential risk of progressing to severe cases according to their first clinical presentations. Therefore, we aim to review the clinical symptoms of the COVID-19 epidemic systematically.
Methods:We searched PubMed, Embase, Web of Science, and CNKI (Chinese Database) for studies about the clinical features of COVID-19 in China from March 18 to April 18. Then we used REVMAN to conduct a meta-analysis.
Results: After screening, 20 articles including 3,326 COVID-19 confirmed cases were selected from 142 articles we retrieved at the beginning of our research. We divided all the cases into a severe group (including severe and critically severe patients) and a mild group according to the “Diagnosis and Treatment Protocol for Novel Coronavirus Infection-Induced Pneumonia” version 4 (trial). Of all the initial symptoms (including fever, cough, abdominal pain, anorexia, chest tightness, diarrhea, dyspnea, expectoration, fatigue, headache, hemoptysis, myalgia, nausea or vomiting, and pharyngalgia) we studied, we found that cough (odds ratio [OR] = 1.4, 95% confidence interval [CI]: 1.2–1.7; p < 0.001), fever (OR = 1.5, 95% CI: 1.2–1.9; p < 0.001), dyspnea (OR = 6.2, 95% CI: 3.6–10.6; p < 0.001), diarrhea (OR = 2.6, 95% CI: 1.3–4.9; p < 0.001), fatigue (OR = 2.1, 95% CI: 1.3–3.3; p < 0.01), expectoration (OR = 1.7, 95% CI: 1.2–2.6; p < 0.01), myalgia (OR = 1.6, 95% CI: 0.8–3.1; p < 0.001), hemoptysis (OR = 4.0, 95% CI: 1.5–11.3; p < 0.001), abdominal pain (OR = 7.5, 95% CI: 2.4–23.4; p < 0.001), and anorexia (OR = 2.8, 95% CI: 1.5–5.1; p < 0.001) had a different distribution in two groups and were statistically significant (p < 0.05).
Conclusion:COVID-19 patients whose initial manifestation is dyspnea, hemoptysis, anorexia, diarrhea, or fatigue, especially abdominal pain should be closely monitored to prevent disease deterioration.
Introduction
The increasing evidence of SARS‐CoV‐2 impact on the central nervous system (CNS) raises key questions on its impact for risk of later life cognitive decline, Alzheimer's disease (AD), and other dementia.
Methods
The Alzheimer's Association and representatives from more than 30 countries—with technical guidance from the World Health Organization—have formed an international consortium to study the short‐and long‐term consequences of SARS‐CoV‐2 on the CNS—including the underlying biology that may contribute to AD and other dementias. This consortium will link teams from around the world covering more than 22 million COVID‐19 cases to enroll two groups of individuals including people with disease, to be evaluated for follow‐up evaluations at 6, 9, and 18 months, and people who are already enrolled in existing international research studies to add additional measures and markers of their underlying biology.
Conclusions
The increasing evidence and understanding of SARS‐CoV‐2's impact on the CNS raises key questions on the impact for risk of later life cognitive decline, AD, and other dementia. This program of studies aims to better understand the long‐term consequences that may impact the brain, cognition, and functioning—including the underlying biology that may contribute to AD and other dementias.
Background
The long-term health consequences of COVID-19 remain largely unclear. The aim of this study was to describe the long-term health consequences of patients with COVID-19 who have been discharged from hospital and investigate the associated risk factors, in particular disease severity.
Methods
We did an ambidirectional cohort study of patients with confirmed COVID-19 who had been discharged from Jin Yin-tan Hospital (Wuhan, China) between Jan 7, 2020, and May 29, 2020. Patients who died before follow-up, patients for whom follow-up would be difficult because of psychotic disorders, dementia, or re-admission to hospital, those who were unable to move freely due to concomitant osteoarthropathy or immobile before or after discharge due to diseases such as stroke or pulmonary embolism, those who declined to participate, those who could not be contacted, and those living outside of Wuhan or in nursing or welfare homes were all excluded. All patients were interviewed with a series of questionnaires for evaluation of symptoms and health-related quality of life, underwent physical examinations and a 6-min walking test, and received blood tests. A stratified sampling procedure was used to sample patients according to their highest seven-category scale during their hospital stay as 3, 4, and 5–6, to receive pulmonary function test, high resolution CT of the chest, and ultrasonography. Enrolled patients who had participated in the Lopinavir Trial for Suppression of SARS-CoV-2 in China received severe acute respiratory syndrome coronavirus 2 antibody tests. Multivariable adjusted linear or logistic regression models were used to evaluate the association between disease severity and long-term health consequences.
Findings
In total, 1733 of 2469 discharged patients with COVID-19 were enrolled after 736 were excluded. Patients had a median age of 57·0 (IQR 47·0–65·0) years and 897 (52%) were men. The follow-up study was done from June 16, to Sept 3, 2020, and the median follow-up time after symptom onset was 186·0 (175·0–199·0) days. Fatigue or muscle weakness (63%, 1038 of 1655) and sleep difficulties (26%, 437 of 1655) were the most common symptoms. Anxiety or depression was reported among 23% (367 of 1617) of patients. The proportions of median 6-min walking distance less than the lower limit of the normal range were 24% for those at severity scale 3, 22% for severity scale 4, and 29% for severity scale 5–6. The corresponding proportions of patients with diffusion impairment were 22% for severity scale 3, 29% for scale 4, and 56% for scale 5–6, and median CT scores were 3·0 (IQR 2·0–5·0) for severity scale 3, 4·0 (3·0–5·0) for scale 4, and 5·0 (4·0–6·0) for scale 5–6. After multivariable adjustment, patients showed an odds ratio (OR) 1·61 (95% CI 0·80–3·25) for scale 4 versus scale 3 and 4·60 (1·85–11·48) for scale 5–6 versus scale 3 for diffusion impairment; OR 0·88 (0·66–1·17) for scale 4 versus scale 3 and OR 1·77 (1·05–2·97) for scale 5–6 versus scale 3 for anxiety or depression, and OR 0·74 (0·58–0·96) for scale 4 versus scale 3 and 2·69 (1·46–4·96) for scale 5–6 versus scale 3 for fatigue or muscle weakness. Of 94 patients with blood antibodies tested at follow-up, the seropositivity (96·2% vs 58·5%) and median titres (19·0 vs 10·0) of the neutralising antibodies were significantly lower compared with at the acute phase. 107 of 822 participants without acute kidney injury and with estimated glomerular filtration rate (eGFR) 90 mL/min per 1·73 m² or more at acute phase had eGFR less than 90 mL/min per 1·73 m² at follow-up.
Interpretation
At 6 months after acute infection, COVID-19 survivors were mainly troubled with fatigue or muscle weakness, sleep difficulties, and anxiety or depression. Patients who were more severely ill during their hospital stay had more severe impaired pulmonary diffusion capacities and abnormal chest imaging manifestations, and are the main target population for intervention of long-term recovery.
Funding
National Natural Science Foundation of China, Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences, National Key Research and Development Program of China, Major Projects of National Science and Technology on New Drug Creation and Development of Pulmonary Tuberculosis, and Peking Union Medical College Foundation.
Introduction:
The increasing evidence of SARS-CoV-2 impact on the central nervous system (CNS) raises key questions on its impact for risk of later life cognitive decline, Alzheimer's disease (AD), and other dementia.
Methods:
The Alzheimer's Association and representatives from more than 30 countries-with technical guidance from the World Health Organization-have formed an international consortium to study the short-and long-term consequences of SARS-CoV-2 on the CNS-including the underlying biology that may contribute to AD and other dementias. This consortium will link teams from around the world covering more than 22 million COVID-19 cases to enroll two groups of individuals including people with disease, to be evaluated for follow-up evaluations at 6, 9, and 18 months, and people who are already enrolled in existing international research studies to add additional measures and markers of their underlying biology.
Conclusions:
The increasing evidence and understanding of SARS-CoV-2's impact on the CNS raises key questions on the impact for risk of later life cognitive decline, AD, and other dementia. This program of studies aims to better understand the long-term consequences that may impact the brain, cognition, and functioning-including the underlying biology that may contribute to AD and other dementias.
Background
The COVID-19 pandemic triggered vast governmental lockdowns. The impact of these lockdowns on mental health is inadequately understood. On the one hand such drastic changes in daily routines could be detrimental to mental health. On the other hand, it might not be experienced negatively, especially because the entire population was affected.
Methods
The aim of this study was to determine mental health outcomes during pandemic induced lockdowns and to examine known predictors of mental health outcomes. We therefore surveyed n = 9,565 people from 78 countries and 18 languages. Outcomes assessed were stress, depression, affect, and wellbeing. Predictors included country, sociodemographic factors, lockdown characteristics, social factors, and psychological factors.
Results
Results indicated that on average about 10% of the sample was languishing from low levels of mental health and about 50% had only moderate mental health. Importantly, three consistent predictors of mental health emerged: social support, education level, and psychologically flexible (vs. rigid) responding. Poorer outcomes were most strongly predicted by a worsening of finances and not having access to basic supplies.
Conclusions
These results suggest that on whole, respondents were moderately mentally healthy at the time of a population-wide lockdown. The highest level of mental health difficulties were found in approximately 10% of the population. Findings suggest that public health initiatives should target people without social support and those whose finances worsen as a result of the lockdown. Interventions that promote psychological flexibility may mitigate the impact of the pandemic.
Background
There is major concern about the impact of the global COVID-19 outbreak on mental health. Several studies suggest that mental health deteriorated in many countries before and during enforced isolation (ie, lockdown), but it remains unknown how mental health has changed week by week over the course of the COVID-19 pandemic. This study aimed to explore the trajectories of anxiety and depression over the 20 weeks after lockdown was announced in England, and compare the growth trajectories by individual characteristics.
Methods
In this prospective longitudinal observational study, we analysed data from the UCL COVID-19 Social Study, a panel study weighted to population proportions, which collects information on anxiety (using the Generalised Anxiety Disorder assessment) and depressive symptoms (using the Patient Health Questionnaire) weekly in the UK since March 21, 2020. We included data from adults living in England who had at least three repeated measures between March 23 and Aug 9, 2020. Analyses were done using latent growth models, which were fitted to account for sociodemographic and health covariates.
Findings
Between March 23, and Aug 9, data from over 70 000 adults were collected in the UCL COVID-19 Social Study. When including participants living in England with three follow-up measures and no missing values, our analytic sample consisted of 36 520 participants. The average depression score was 6·6 (SD=6·0, range 0–27) and the average anxiety score 5·7 (SD=5·6, range 0–21) in week 1. Anxiety and depression levels both declined across the first 20 weeks following the introduction of lockdown in England (b=–1·93, SE=0·26, p<0·0001 for anxiety; b=–2·52, SE=0·28, p<0·0001 for depressive symptoms). The fastest decreases were seen across the strict lockdown period (between weeks 2 and 5), with symptoms plateauing as further lockdown easing measures were introduced (between weeks 16 and 20). Being a woman or younger, having lower educational attainment, lower income, or pre-existing mental health conditions, and living alone or with children were all risk factors for higher levels of anxiety and depression at the start of lockdown. Many of these inequalities in experiences were reduced as lockdown continued, but differences were still evident 20 weeks after the start of lockdown.
Interpretation
These data suggest that the highest levels of depression and anxiety occurred in the early stages of lockdown but declined fairly rapidly, possibly because individuals adapted to circumstances. Our findings emphasise the importance of supporting individuals in the lead-up to future lockdowns to try to reduce distress, and highlight that groups already at risk for poor mental health before the pandemic have remained at risk throughout lockdown and its aftermath.
Funding
Nuffield Foundation, UK Research and Innovation, Wellcome Trust.
Background
In 2020, to limit the spread of Coronavirus (COVID-19), many countries, including Italy, have issued a lengthy quarantine period for the entire population. For this reason lifestyle has changed, bringing inevitable repercussions to the Quality of Life (QoL). The present study aims to identify which psychosocial variables predict behaviors capable of affecting the QoL during the lockdown period, potentially highlighting factors that might promote well-being and health in the Italian population during the epidemic.
Methods
Between 27 April 2020 and 11 May 2020, we administered a web-survey to a sample of young Italian people (age M = 21.2; SD = 3.5; female = 57.7% of the sample). Employing variance-based structural equation modeling, we attempted to identify whether social connectedness, social support, and loneliness were variables predictive of the QoL of young Italians. We also sought to identify specific psychological factors, such as symbolic threat, realistic threat, and the threat from potentially contaminated objects, was correlated to COVID-19 fear and whether engaging in particular behaviors was likely to improve the QoL.
Results
Our results suggest that social connectedness and loneliness are significant predictors of QoL, while social support did not have a significant effect on QoL. Furthermore, we observed that symbolic and realistic threats and the threat from potentially contaminated objects are significant and positive predictors of COVID-19 fear. Moreover, COVID-19 fear had significant and positive relationships with the carrying out of specific behaviors, such as creative activities during the isolation period and that this related to affirming individuals’ country-specific identity. Finally, COVID-19 fear is a significant predictor of behavioral factors related to the adherence to public health advice in line with national guidance regarding the containment of COVID-19; this factor, however, did not correlate with QoL.
Conclusion
Our results suggest the importance of social context and psychological factors to help devise intervention strategies to improve the QoL during lockdown from epidemic events and, in particular, support the importance of promoting social communication and accurate information about the transmission of the virus.
Background
The COVID-19 pandemic and mitigation measures are likely to have a marked effect on mental health. It is important to use longitudinal data to improve inferences.
Aims
To quantify the prevalence of depression, anxiety and mental well-being before and during the COVID-19 pandemic. Also, to identify groups at risk of depression and/or anxiety during the pandemic.
Method
Data were from the Avon Longitudinal Study of Parents and Children (ALSPAC) index generation ( n = 2850, mean age 28 years) and parent generation ( n = 3720, mean age 59 years), and Generation Scotland ( n = 4233, mean age 59 years). Depression was measured with the Short Mood and Feelings Questionnaire in ALSPAC and the Patient Health Questionnaire-9 in Generation Scotland. Anxiety and mental well-being were measured with the Generalised Anxiety Disorder Assessment-7 and the Short Warwick Edinburgh Mental Wellbeing Scale.
Results
Depression during the pandemic was similar to pre-pandemic levels in the ALSPAC index generation, but those experiencing anxiety had almost doubled, at 24% (95% CI 23–26%) compared with a pre-pandemic level of 13% (95% CI 12–14%). In both studies, anxiety and depression during the pandemic was greater in younger members, women, those with pre-existing mental/physical health conditions and individuals in socioeconomic adversity, even when controlling for pre-pandemic anxiety and depression.
Conclusions
These results provide evidence for increased anxiety in young people that is coincident with the pandemic. Specific groups are at elevated risk of depression and anxiety during the COVID-19 pandemic. This is important for planning current mental health provisions and for long-term impact beyond this pandemic.
Background: Covid-19 remains a pandemic that most countries in the world are still dealing with. This is study aims to report the psychological impact of Covid-19 over time on the Spanish population.
Methods: A longitudinal study (N = 1041) was carried out with two measurements: after 2 and 5 weeks starting from the declaration of the state of emergency in Spain. The presence of depressive symptoms, anxiety, and posttraumatic stress disease (PTSD) was evaluated by means of screening tests. Sociodemographic data, variables about Covid-19, loneliness, spiritual well-being, social support, discrimination, and a sense of belonging were collected.
Results: The data showed how depressive symptomatology increased significantly over time, while anxiety and PTSD did not show statistically significant changes. Spiritual well-being and loneliness were the main predictors of psychological impact. A younger age was a significant predictor of depression and anxiety, while female gender was associated with anxiety and PTSD.
Conclusions: The impact of the pandemic is sustained over time, even increasing in depression, and vulnerable groups that need greater psychological health support could be identified.
Background
The COVID-19 pandemic has created an unprecedented global crisis, necessitating drastic changes to living conditions, social life, personal freedom and economic activity. No study has yet examined the presence of psychiatric symptoms in the UK population under similar conditions.
Aims
We investigated the prevalence of COVID-19-related anxiety, generalised anxiety, depression and trauma symptoms in the UK population during an early phase of the pandemic, and estimated associations with variables likely to influence these symptoms.
Method
Between 23 and 28 March 2020, a quota sample of 2025 UK adults aged 18 years and older, stratified by age, gender and household income, was recruited by online survey company Qualtrics. Participants completed standardised measures of depression, generalised anxiety and trauma symptoms relating to the pandemic. Bivariate and multivariate associations were calculated for demographic and health-related variables.
Results
Higher levels of anxiety, depression and trauma symptoms were reported compared with previous population studies, but not dramatically so. Anxiety or depression and trauma symptoms were predicted by young age, presence of children in the home, and high estimates of personal risk. Anxiety and depression were also predicted by low income, loss of income and pre-existing health conditions in self and others. Specific anxiety about COVID-19 was greater in older participants.
Conclusions
This study showed a modest increase in the prevalence of mental health problems in the early stages of the pandemic, and these problems were predicted by several specific COVID-related variables. Further similar surveys, particularly of those with children at home, are required as the pandemic progresses.
The pandemic caused by Covid-19 has been an unprecedented social and health emergency worldwide. This is the first study in the scientific literature reporting the psychological impact of the Covid-19 outbreak in a sample of the Spanish population. A cross-sectional study was conducted through an online survey of 3480 people. The presence of depression, anxiety and post-traumatic stress disorder (PTSD) was evaluated with screening tests from 14 March. Sociodemographic and Covid-19-related data was collected. Additionally, spiritual well-being, loneliness, social support, discrimination and sense of belonging were assessed. Descriptive analyses were carried out and linear regression models compiled. The 18.7% of the sample revealed depressive, 21.6% anxiety and 15.8% PTSD symptoms. Being in the older age group, having economic stability and the belief that adequate information had been provided about the pandemic were negatively related to depression, anxiety and PTSD. However, female gender, previous diagnoses of mental health problems or neurological disorders, having symptoms associated with the virus, or those with a close relative infected were associated with greater symptomatology in all three variables. Predictive models revealed that the greatest protector for symptomatology was spiritual well-being, while loneliness was the strongest predictor of depression, anxiety and PTSD. The impact on our mental health caused by the pandemic and the measures adopted during the first weeks to deal with it are evident. In addition, it is possible to identify the need of greater psychological support in general and in certain particularly vulnerable groups.
Abstract Acute respiratory distress syndrome (ARDS) survivors experience a high prevalence of cognitive impairment with concomitantly impaired functional status and quality of life, often persisting months after hospital discharge. In this review, we explore the pathophysiological mechanisms underlying cognitive impairment following ARDS, the interrelations between mechanisms and risk factors, and interventions that may mitigate the risk of cognitive impairment. Risk factors for cognitive decline following ARDS include pre-existing cognitive impairment, neurological injury, delirium, mechanical ventilation, prolonged exposure to sedating medications, sepsis, systemic inflammation, and environmental factors in the intensive care unit, which can co-occur synergistically in various combinations. Detection and characterization of pre-existing cognitive impairment imparts challenges in clinical management and longitudinal outcome study enrollment. Patients with brain injury who experience ARDS constitute a distinct population with a particular combination of risk factors and pathophysiological mechanisms: considerations raised by brain injury include neurogenic pulmonary edema, differences in sympathetic activation and cholinergic transmission, effects of positive end-expiratory pressure on cerebral microcirculation and intracranial pressure, and sensitivity to vasopressor use and volume status. The blood-brain barrier represents a physiological interface at which multiple mechanisms of cognitive impairment interact, as acute blood-brain barrier weakening from mechanical ventilation and systemic inflammation can compound existing chronic blood-brain barrier dysfunction from Alzheimer’s-type pathophysiology, rendering the brain vulnerable to both amyloid-beta accumulation and cytokine-mediated hippocampal damage. Although some contributory elements, such as the presenting brain injury or pre-existing cognitive impairment, may be irreversible, interventions such as minimizing mechanical ventilation tidal volume, minimizing duration of exposure to sedating medications, maintaining hemodynamic stability, optimizing fluid balance, and implementing bundles to enhance patient care help dramatically to reduce duration of delirium and may help prevent acquisition of long-term cognitive impairment.
Much biomedical research is observational. The reporting of such research is often inadequate, which hampers the assessment of its strengths and weaknesses and of a study's generalisability. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) initiative developed recommendations on what should be included in an accurate and complete report of an observational study. We defined the scope of the recommendations to cover three main study designs: cohort, case-control, and cross-sectional studies. We convened a 2-day workshop in September, 2004, with methodologists, researchers, and journal editors to draft a che-cklist of items. This list was subsequently revised during several meetings of the coordinating group and in e-mail discussions with the larger group of STROBE contributors, taking into account empirical evidence and methodological considerations. The workshop and the subsequent iterative process of consultation and revision resulted in a checklist of 22 items (the STROBE statement) that relate to the title, abstract, introduction, methods, results, and discussion sections of articles. 18 items are common to all three study designs and four are specific for cohort, case-control, or cross-sectional studies. A detailed explanation and elaboration document is published separately and is freely available on the websites of PLoS Medicine, Annals of Internal Medicine, and Epidemiology. We hope that the STROBE statement will contribute to improving the quality of reporting of observational studies.
Objective::
To assess the prevalence of common mental disorders (CMD) and the association of CMD with sociodemographic characteristics in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) cohort.
Methods::
We analyzed data from the cross-sectional baseline assessment of the ELSA-Brasil, a cohort study of 15,105 civil servants from six Brazilian cities. The Clinical Interview Schedule-Revised (CIS-R) was used to investigate the presence of CMD, with a score ≥ 12 indicating a current CMD (last week). Specific diagnostic algorithms for each disorder were based on the ICD-10 diagnostic criteria. Prevalence ratios (PR) of the association between CMD and sociodemographic characteristics were estimated by Poisson regression.
Results::
CMD (CIS-R score ≥ 12) was found in 26.8% (95% confidence intervals [95%CI] 26.1-27.5). The highest burden occurred among women (PR 1.9; 95%CI 1.8-2.0), the youngest (PR 1.7; 95%CI 1.5-1.9), non-white individuals, and those without a university degree. The most frequent diagnostic category was anxiety disorders (16.2%), followed by depressive episodes (4.2%).
Conclusion::
The burden of CMD was high, particularly among the more socially vulnerable groups. These findings highlight the need to strengthen public policies aimed to address health inequities related to mental disorders.
Background: Associations between major depressive disorder (MDD) and coronary heart disease (CHD) have been established, and these associations increase risk of future morbidity and mortality. Prior research has been carried out in high-income countries. Here we examine associations between the mood and anxiety disorders, and CHD in a large cohort at baseline from Brazil, a country facing a variety of challenges that may affect these associations.
Methods: Participants included 15,105 civil servants aged 35 to 74 at baseline (2008–2010) from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). CHD (N = 721) included self-reported angina pectoris (n = 305), myocardial infarction (n = 259) and coronary revascularization (n = 239). Hierarchical logistic regression analyses were conducted to estimate odds ratios and confidence intervals.
Results: Major findings indicate that comorbid MDD and anxiety disorders (n = 434) are associated with a threefold increase in CHD, MDD alone (n = 170) with a twofold increase in CHD, while generalized anxiety disorder alone (n = 1,394) and mixed anxiety and depression disorder (n = 1,844) – symptoms present, but diagnostic threshold not reached – are associated with a 1.5-fold increase in CHD, after full adjustment for covariates.
Conclusion: The association with CHD is greatest in those with psychiatric comorbidity, while associations were also observed in MDD and generalized anxiety disorder without comorbidity. While findings are limited by the cross-sectional design of the study, given the known risks associated with comorbidity of the mood and anxiety disorders with CHD, findings reinforce the importance of comprehensive health assessment in Brazil.
An increased proportion of deaths occur in the intensive care unit (ICU). We performed this prospective study in 41 ICUs to determine the prevalence and determinants of complicated grief after death of a loved one in the ICU. Relatives of 475 adult patients were followed up. Complicated grief was assessed at 6 and 12 months using the Inventory of Complicated Grief (cut-off score >25). Relatives also completed the Hospital Anxiety and Depression Scale at 3 months, and the Revised Impact of Event Scale for post-traumatic stress disorder symptoms at 3, 6 and 12 months. We used a mixed multivariate logistic regression model to identify determinants of complicated grief after 6 months. Among the 475 patients, 282 (59.4%) had a relative evaluated at 6 months. Complicated grief symptoms were identified in 147 (52%) relatives. Independent determinants of complicated grief symptoms were either not amenable to changes (relative of female sex, relative living alone and intensivist board certification before 2009) or potential targets for improvements (refusal of treatment by the patient, patient died while intubated, relatives present at the time of death, relatives did not say goodbye to the patient, and poor communication between physicians and relatives). End-of-life practices, communication and loneliness in bereaved relatives may be amenable to improvements.
Copyright ©ERS 2015.
In prognostic studies, the lasso technique is attractive since it improves the quality of predictions by shrinking regression coefficients, compared to predictions based on a model fitted via unpenalized maximum likelihood. Since some coefficients are set to zero, parsimony is achieved as well. It is unclear whether the performance of a model fitted using the lasso still shows some optimism. Bootstrap methods have been advocated to quantify optimism and generalize model performance to new subjects. It is unclear how resampling should be performed in the presence of multiply imputed data.
The data were based on a cohort of Chronic Obstructive Pulmonary Disease patients. We constructed models to predict Chronic Respiratory Questionnaire dyspnea 6 months ahead. Optimism of the lasso model was investigated by comparing 4 approaches of handling multiply imputed data in the bootstrap procedure, using the study data and simulated data sets. In the first 3 approaches, data sets that had been completed via multiple imputation (MI) were resampled, while the fourth approach resampled the incomplete data set and then performed MI.
The discriminative model performance of the lasso was optimistic. There was suboptimal calibration due to over-shrinkage. The estimate of optimism was sensitive to the choice of handling imputed data in the bootstrap resampling procedure. Resampling the completed data sets underestimates optimism, especially if, within a bootstrap step, selected individuals differ over the imputed data sets. Incorporating the MI procedure in the validation yields estimates of optimism that are closer to the true value, albeit slightly too larger.
Performance of prognostic models constructed using the lasso technique can be optimistic as well. Results of the internal validation are sensitive to how bootstrap resampling is performed.
To identify the cross-national prevalence of psychotic symptoms in the general population and to analyze their impact on health status.
The sample was composed of 256,445 subjects (55.9% women), from nationally representative samples of 52 countries worldwide participating in the World Health Organization's World Health Survey. Standardized and weighted prevalence of psychotic symptoms were calculated in addition to the impact on health status as assessed by functioning in multiple domains.
Overall prevalences for specific symptoms ranged from 4.80% (SE = 0.14) for delusions of control to 8.37% (SE = 0.20) for delusions of reference and persecution. Prevalence figures varied greatly across countries. All symptoms of psychosis produced a significant decline in health status after controlling for potential confounders. There was a clear change in health impact between subjects not reporting any symptom and those reporting at least one symptom (effect size of 0.55).
The prevalence of the presence of at least one psychotic symptom has a wide range worldwide varying as much as from 0.8% to 31.4%. Psychotic symptoms signal a problem of potential public health concern, independent of the presence of a full diagnosis of psychosis, as they are common and are related to a significant decrement in health status. The presence of at least one psychotic symptom is related to a significant poorer health status, with a regular linear decrement in health depending on the number of symptoms.
Background: Acute effects of COVID-19 can be devastating and life-threatening. Alterations in mental health during the active infection have been documented, but the long-term consequences are less clear.
Method: A systematic review was undertaken to investigate the effect of COVID-19 on long-term mental health outcomes. Three databases [PubMed, Medline (Ovid) and Cochrane library] were searched between 1st October 2019 and 29th August 2021 with additional hand searching to identify all published studies reporting symptoms of generalised anxiety, depression, post-traumatic stress disorder (PTSD), or sleep disturbance in participants at least one month after COVID-19 infection. The prevalence and mean symptom score of each were assessed.
Results: Eight hundred and eighty five studies were found, of which 33 were included in the review involving a total of 6743 participants. The studies’ risk of bias were typically fair quality. The median study age of participants was 57.8 years old (IQR 49.3-60.7), with 63.0% male (IQR 57.0%-73.0%). Participants typically experienced no or mild symptoms of long-term anxiety (GAD-7, STAI-S, HADS) and depression (PHQ-9, BDI, PHQ-2, HADS). Prevalence varied depending on the measurement tool. Sleep disturbances (primarily insomnia) were most consistently reported as mild. PTSD prevalence was similar to anxiety and depression.
Conclusion: The overall effect of the pandemic has been linked with worse psychiatric disorder symptoms. However, the long-term effect from direct COVID-19 infection has been associated with no or mild symptoms. Studies exhibited long-term prevalence of anxiety, depression, PTSD, and sleep disturbances were comparable to general population levels.
Background:
Increases in mental health problems have been observed during the COVID-19 pandemic. The objectives were to examine the extent to which mental health symptoms changed during the pandemic in 2020, whether changes were persistent or short lived, and if changes were symptom specific.
Methods:
Systematic review and meta-analysis of longitudinal cohort studies examining changes in mental health among the same group of participants before vs. during the pandemic in 2020.
Results:
Sixty-five studies were included. There was an overall increase in mental health symptoms observed during March-April 2020 (SMC = .102 [95% CI: .026 to .192]) that significantly declined over time and became non-significant (May-July SMC = .067 [95% CI: -.022 to .157]. Compared to measures of anxiety (SMC = 0.13, p = 0.02) and general mental health (SMC = -.03, p = 0.65), increases in depression and mood disorder symptoms tended to be larger and remained significantly elevated in May-July [0.20, 95% CI: .099 to .302]. In primary analyses increases were most pronounced among samples with physical health conditions and there was no evidence of any change in symptoms among samples with a pre-existing mental health condition.
Limitations:
There was a high degree of unexplained heterogeneity observed (I2s > 90%), indicating that change in mental health was highly variable across samples.
Conclusions:
There was a small increase in mental health symptoms soon after the outbreak of the COVID-19 pandemic that decreased and was comparable to pre-pandemic levels by mid-2020 among most population sub-groups and symptom types.
Background
The COVID-19 pandemic represents a public health, economic and mental health crisis. We hypothesized that timely government implementation of stringent measures to reduce viral transmission would benefit mental health, as evidenced by reduced rates of depressive symptoms (i.e., Patient Health Questionnaire [PHQ]-9≥10, PHQ-2≥3).
Methods
The systematic review herein (PROSPERO CRD42020200647) evaluated to what extent differences in government-imposed stringency and timeliness of response to COVID-19 moderate the prevalence of depressive symptoms across 33 countries (k=114, N=640,037). We included data from six lower-middle-income countries, nine upper-middle-income countries, and 18 higher-income countries. Government-imposed stringency and timeliness in response were operationalized using the Oxford COVID-19 Government Response (“Stringency”) Index.
Results
The overall proportion of study participants with clinically significant depressive symptoms was 21.39% (95% CI 19.37–23.47). The prevalence of clinically significant depressive symptoms was significantly lower in countries wherein governments implemented stringent policies promptly. The moderating effect of government response remained significant after including the national frequency of COVID cases at the time of study commencement, Healthcare Access and Quality index, and the inclusion of COVID patients in the study.
Limitations
Factors that may have confounded our results include, for example, differences in lockdown duration, lack of study participant and outcome assessor blinding, and retrospective assessment of depressive symptom severity.
Conclusions
Governments that enacted stringent measures to contain the spread of COVID-19 benefited not only the physical, but also the mental health of their population.
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the pathogen responsible for the coronavirus disease 2019 (COVID-19) pandemic, which has resulted in global healthcare crises and strained health resources. As the population of patients recovering from COVID-19 grows, it is paramount to establish an understanding of the healthcare issues surrounding them. COVID-19 is now recognized as a multi-organ disease with a broad spectrum of manifestations. Similarly to post-acute viral syndromes described in survivors of other virulent coronavirus epidemics, there are increasing reports of persistent and prolonged effects after acute COVID-19. Patient advocacy groups, many members of which identify themselves as long haulers, have helped contribute to the recognition of post-acute COVID-19, a syndrome characterized by persistent symptoms and/or delayed or long-term complications beyond 4 weeks from the onset of symptoms. Here, we provide a comprehensive review of the current literature on post-acute COVID-19, its pathophysiology and its organ-specific sequelae. Finally, we discuss relevant considerations for the multidisciplinary care of COVID-19 survivors and propose a framework for the identification of those at high risk for post-acute COVID-19 and their coordinated management through dedicated COVID-19 clinics.
Early reports and case series suggest cognitive deficits occurs in some patients with COVID-19. We evaluated the frequency, severity, and profile of cognitive dysfunction in patients recovering from prolonged COVID-19 hospitalization who required acute inpatient rehabilitation prior to discharge. We analyzed cross-sectional scores from the Brief Memory and Executive Test (BMET) in a cohort of N = 57 COVID-19 patients undergoing inpatient rehabilitation, calculating the frequency of impairment based on neuropsychologist diagnosis and by age-normed BMET subtests. In total, 43 patients (75%) were male, 35 (61%) were non-white, and mean age was 64.5 (SD = 13.9) years. In total, 48 (84%) were previously living at home independently. Two patients had documented preexisting cognitive dysfunction; none had known dementia. Patients were evaluated at a mean of 43.2 (SD = 19.2) days after initial admission. In total, 50 patients (88%) had documented hypoxemic respiratory failure and 44 (77%) required intubation. Forty-six patients (81%) had cognitive impairment, ranging from mild to severe. Deficits were common in working memory (26/47 [55%] of patients), set-shifting (21/44 [47%]), divided attention (18/39 [46%]), and processing speed (14/35 [40%]). Executive dysfunction was not significantly associated with intubation length or the time from extubation to assessment, psychiatric diagnosis, or preexisting cardiovascular/metabolic disease. Attention and executive functions are frequently impaired in COVID-19 patients who require acute rehabilitation prior to discharge. Though interpretation is limited by lack of a comparator group, these results provide an early benchmark for identifying and characterizing cognitive difficulties after COVID-19. Given the frequency and pattern of impairment, easy-to-disseminate interventions that target attention and executive dysfunctions may be beneficial to this population.
Background
The impact of the COVID-19 pandemic on mental health in people with pre-existing mental health disorders is unclear. In three psychiatry case-control cohorts, we compared the perceived mental health impact and coping and changes in depressive symptoms, anxiety, worry, and loneliness before and during the COVID-19 pandemic between people with and without lifetime depressive, anxiety, or obsessive-compulsive disorders.
Methods
Between April 1 and May 13, 2020, online questionnaires were distributed among the Netherlands Study of Depression and Anxiety, Netherlands Study of Depression in Older Persons, and Netherlands Obsessive Compulsive Disorder Association cohorts, including people with (n=1181) and without (n=336) depressive, anxiety, or obsessive-compulsive disorders. The questionnaire contained questions on perceived mental health impact, fear of COVID-19, coping, and four validated scales assessing depressive symptoms, anxiety, worry, and loneliness used in previous waves during 2006–16. Number and chronicity of disorders were based on diagnoses in previous waves. Linear regression and mixed models were done.
Findings
The number and chronicity of disorders showed a positive graded dose–response relation, with greater perceived impact on mental health, fear, and poorer coping. Although people with depressive, anxiety, or obsessive-compulsive disorders scored higher on all four symptom scales than did individuals without these mental health disorders, both before and during the COVID-19 pandemic, they did not report a greater increase in symptoms during the pandemic. In fact, people without depressive, anxiety, or obsessive-compulsive disorders showed a greater increase in symptoms during the COVID-19 pandemic, whereas individuals with the greatest burden on their mental health tended to show a slight symptom decrease.
Interpretation
People with depressive, anxiety, or obsessive-compulsive disorders are experiencing a detrimental impact on their mental health from the COVID-19 pandemic, which requires close monitoring in clinical practice. Yet, the COVID-19 pandemic does not seem to have further increased symptom severity compared with their prepandemic levels.
Funding
Dutch Research Council.
Objective
We conducted a systematic review and meta-analysis to estimate the pooled prevalence of depression, anxiety, insomnia, PTSD, and Psychological distress (PD) related to COVID-19 among affected populations.
Methods
We searched articles in Medline, Embase, APA PsycInfo, CINAHL, Scopus, and Web of Science. Random-effects meta-analyses on the proportions of individuals with symptoms of depression, anxiety, insomnia, PTSD, and PD were generated and between-group differences for gender, healthcare workers (HCWs), and regions where studies were conducted.
Results
A total of 2189 articles were screened, 136 full-text articles were assessed for eligibility. Fifty-five peer-reviewed studies met inclusion criteria for the meta-analysis (N=189,159). The prevalence of depression (k=46) was 15.97% (95%CI, 13.24-19.13). The prevalence of anxiety (k=54) was 15.15% (95%CI, 12.29-18.54). The prevalence of insomnia (k=14) was 23.87% (95%CI, 15.74-34.48). The prevalence of PTSD (k=13) was 21.94% (95%CI, 9.37-43.31). Finally, the prevalence of psychological distress (k=19) was 13.29% (95%CI, 8.80-19.57). Between-group differences were only found in HCWs (z=2.69, p < .05) who had a higher prevalence of insomnia than others.
Conclusions
Findings suggest that the short-term mental health consequences of COVID-19 are equally high across affected countries, and across gender. However, reports of insomnia are significantly higher among HCWs than the general population.
Objective:
The coronavirus class of respiratory viruses - including Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), which causes coronavirus disease 2019 (COVID-19) - has been associated with central nervous system (CNS) disease. In fact, multiple mechanisms of CNS involvement have been proposed, making it difficult to identify a unitary syndrome that can be the focus of clinical work and research. Neuropsychologists need to understand the potential cognitive and psychological sequelae of COVID-19 and the impact of the interventions (e.g., ICU, ventilation) that have been used in treating patients with severe forms of the illness.
Method:
We briefly review the literature regarding the neurological and neuropsychological effects of similar coronaviruses, the limited information that has been published to date on COVID-19, and the literature regarding the long-term cognitive and psychological effects of undergoing treatment in the intensive care unit (ICU).
Results:
We discuss the roles that neuropsychologists can play in assessing and treating the cognitive difficulties and psychiatric symptoms described.
Conclusions:
At this time, the mechanisms, correlates, and effects of COVID-19 are poorly understood, but information gleaned from the literature on similar viruses and utilized interventions should help inform neuropsychologists as they begin to work with this population.
Infection-triggered perturbation of the immune system could induce psychopathology, and psychiatric sequelae were observed after previous coronavirus outbreaks. The spreading of the Severe Acute Respiratory Syndrome Coronavirus (COVID-19) pandemic could be associated with psychiatric implications. We investigated the psychopathological impact of COVID-19 in survivors, also considering the effect of clinical and inflammatory predictors.
We screened for psychiatric symptoms 402 adults surviving COVID-19 (265male,meanage58), at one month follow-up after hospital treatment. A clinical interview and a battery of self-report questionnaires were used to investigate post-traumatic stress disorder (PTSD), depression, anxiety, insomnia, and obsessive-compulsive (OC) symptomatology. We collected sociodemographic information, clinical data, baseline inflammatory markers and follow-up oxygen saturation levels.
A significant proportion of patients self-rated in the psychopathological range: 28% for PTSD, 31% for depression, 42% for anxiety, 20% for OC symptoms, and 40% for insomnia. Overall, 56% scored in the pathological range in at least one clinical dimension. Despite significantly lower levels of baseline inflammatory markers, females suffered more for both anxiety and depression. Patients with a positive previous psychiatric diagnosis showed increased scores on most psychopathological measures, with similar baseline inflammation. Baseline systemic immune-inflammation index (SII), which reflects the immune response and systemic inflammation based on peripheral lymphocyte, neutrophil and platelet counts, positively associated with scores of depression and anxiety at follow-up.
PTSD, major depression, and anxiety, are all high-burden non-communicable conditions associated with years of life lived with disability. Considering the alarming impact of COVID-19 infection on mental health, the current insights on inflammation in psychiatry, and the present obervation of worse inflammation leading to worse depression, we recommend to assess psychopathology of COVID-19 survivors and to deepen research on inflammatory biomarkers, in order to diagnose and treat emergent psychiatric conditions.
Background
The potential impact of the COVID-19 pandemic on population mental health is of increasing global concern. We examine changes in adult mental health in the UK population before and during the lockdown.
Methods
In this secondary analysis of a national, longitudinal cohort study, households that took part in Waves 8 or 9 of the UK Household Longitudinal Study (UKHLS) panel, including all members aged 16 or older in April, 2020, were invited to complete the COVID-19 web survey on April 23–30, 2020. Participants who were unable to make an informed decision as a result of incapacity, or who had unknown postal addresses or addresses abroad were excluded. Mental health was assessed using the 12-item General Health Questionnaire (GHQ-12). Repeated cross-sectional analyses were done to examine temporal trends. Fixed-effects regression models were fitted to identify within-person change compared with preceding trends.
Findings
Waves 6–9 of the UKHLS had 53 351 participants. Eligible participants for the COVID-19 web survey were from households that took part in Waves 8 or 9, and 17 452 (41·2%) of 42 330 eligible people participated in the web survey. Population prevalence of clinically significant levels of mental distress rose from 18·9% (95% CI 17·8–20·0) in 2018–19 to 27·3% (26·3–28·2) in April, 2020, one month into UK lockdown. Mean GHQ-12 score also increased over this time, from 11·5 (95% CI 11·3–11·6) in 2018–19, to 12·6 (12·5–12·8) in April, 2020. This was 0·48 (95% CI 0·07–0·90) points higher than expected when accounting for previous upward trends between 2014 and 2018. Comparing GHQ-12 scores within individuals, adjusting for time trends and significant predictors of change, increases were greatest in 18–24-year-olds (2·69 points, 95% CI 1·89–3·48), 25–34-year-olds (1·57, 0·96–2·18), women (0·92, 0·50–1·35), and people living with young children (1·45, 0·79–2·12). People employed before the pandemic also averaged a notable increase in GHQ-12 score (0·63, 95% CI 0·20–1·06).
Interpretation
By late April, 2020, mental health in the UK had deteriorated compared with pre-COVID-19 trends. Policies emphasising the needs of women, young people, and those with preschool aged children are likely to play an important part in preventing future mental illness.
Funding
None.
This study aims to evaluate the impacts of COVID-19 on cognitive functions in recovered patients and its relationship with inflammatory profiles. Twenty-nine patients recovered from COVID-19 as confirmed by negative nucleic tests for two consecutive times were recruited. A total of 29 age-, gender- and education-matched healthy controls were also recruited. The cognitive functions of all subjects were evaluated by the iPad-based online neuropsychological tests, including the Trail Making Test (TMT), Sign Coding Test (SCT), Continuous Performance Test (CPT), and Digital Span Test (DST). Blood samples from all patients were collected for examining inflammatory profiles, including interleukin-2 (IL-2), IL-4, IL-6, IL-10, tumor necrosis factor-α (TNF-α), interferon-γ (IFN-γ), and C-reactive protein (CRP). The relationship between cognitive functions and inflammatory profiles were analyzed by Pearson correlation. In results, although no significant differences were found in TMT, SCT, and DST between the two groups, patients with COVID-19 scored lower in the correct number of the second and third parts of CPT, they also scored higher in the missing number of the third part of CPT (all P < 0.05). In patients with COVID-19, there was a trend of significant difference for lower reaction time in the first and second parts of CPT (P = 0.050, and 0.051, respectively), as well as the lower correct number of the second part of CPT (P = 0.050). Correlation analysis showed that the reaction time for the first and second parts of CPT was positively correlated with the CRP levels (r = 0.557 and 0.410, P < 0.05). In conclusion, our findings indicated that cognitive impairments exist even in patients recovered from COVID-19, and might be possibly linked to the underlying inflammatory processes.
Background
Concerns regarding potential neurological complications of COVID-19 are being increasingly reported, primarily in small series. Larger studies have been limited by both geography and specialty. Comprehensive characterisation of clinical syndromes is crucial to allow rational selection and evaluation of potential therapies. The aim of this study was to investigate the breadth of complications of COVID-19 across the UK that affected the brain.
Methods
During the exponential phase of the pandemic, we developed an online network of secure rapid-response case report notification portals across the spectrum of major UK neuroscience bodies, comprising the Association of British Neurologists (ABN), the British Association of Stroke Physicians (BASP), and the Royal College of Psychiatrists (RCPsych), and representing neurology, stroke, psychiatry, and intensive care. Broad clinical syndromes associated with COVID-19 were classified as a cerebrovascular event (defined as an acute ischaemic, haemorrhagic, or thrombotic vascular event involving the brain parenchyma or subarachnoid space), altered mental status (defined as an acute alteration in personality, behaviour, cognition, or consciousness), peripheral neurology (defined as involving nerve roots, peripheral nerves, neuromuscular junction, or muscle), or other (with free text boxes for those not meeting these syndromic presentations). Physicians were encouraged to report cases prospectively and we permitted recent cases to be notified retrospectively when assigned a confirmed date of admission or initial clinical assessment, allowing identification of cases that occurred before notification portals were available. Data collected were compared with the geographical, demographic, and temporal presentation of overall cases of COVID-19 as reported by UK Government public health bodies.
Findings
The ABN portal was launched on April 2, 2020, the BASP portal on April 3, 2020, and the RCPsych portal on April 21, 2020. Data lock for this report was on April 26, 2020. During this period, the platforms received notification of 153 unique cases that met the clinical case definitions by clinicians in the UK, with an exponential growth in reported cases that was similar to overall COVID-19 data from UK Government public health bodies. Median patient age was 71 years (range 23–94; IQR 58–79). Complete clinical datasets were available for 125 (82%) of 153 patients. 77 (62%) of 125 patients presented with a cerebrovascular event, of whom 57 (74%) had an ischaemic stroke, nine (12%) an intracerebral haemorrhage, and one (1%) CNS vasculitis. 39 (31%) of 125 patients presented with altered mental status, comprising nine (23%) patients with unspecified encephalopathy and seven (18%) patients with encephalitis. The remaining 23 (59%) patients with altered mental status fulfilled the clinical case definitions for psychiatric diagnoses as classified by the notifying psychiatrist or neuropsychiatrist, and 21 (92%) of these were new diagnoses. Ten (43%) of 23 patients with neuropsychiatric disorders had new-onset psychosis, six (26%) had a neurocognitive (dementia-like) syndrome, and four (17%) had an affective disorder. 18 (49%) of 37 patients with altered mental status were younger than 60 years and 19 (51%) were older than 60 years, whereas 13 (18%) of 74 patients with cerebrovascular events were younger than 60 years versus 61 (82%) patients older than 60 years.
Interpretation
To our knowledge, this is the first nationwide, cross-specialty surveillance study of acute neurological and psychiatric complications of COVID-19. Altered mental status was the second most common presentation, comprising encephalopathy or encephalitis and primary psychiatric diagnoses, often occurring in younger patients. This study provides valuable and timely data that are urgently needed by clinicians, researchers, and funders to inform immediate steps in COVID-19 neuroscience research and health policy.
Funding
None.
Background
Depression is a main source of disability worldwide. Identifying risk factors associated with incident and persistent episodes could inform clinical practice and hence mitigate their burden. However, previous research has focused on populations from developed countries. Thus, we evaluated sociodemographic risk factors and psychiatric comorbidities associated with incident and persistent depression in a large Brazilian occupational cohort.
Methods
We examined baseline (2008-2010, n=15,105) and follow-up (2012-2014) data from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). Based on the presence of depression diagnosis at two timepoints, we diagnosed persistent and incident depression. Simple and multiple logistic regression analyses were employed to explore risk factors associated with incident and persistent depression. As gender is associated with the exposure and outcome variables, analyses stratified by gender were also conducted.
Results
Presence of any anxiety disorder, obsessive-compulsive disorder, and female gender were significant (p<0.001) risk factors for depression incidence (odds ratios of 2.59, 3.6, and 1.82, respectively) and persistence (odds ratios of 6.94, 14.37, and 2.85, respectively) in multiple models, whereas having university degree decreased the odds of depression incidence (0.74) and persistence (0.45). In stratified analyses, the effects of low education were only evident in women.
Limitations
Brief depressive episodes could not be measured by our assessments.
Conclusion
In this occupational cohort, female gender, low education and psychiatric comorbidities were associated with unfavorable depression courses. Interventions targeting comorbidities could prevent depression incidence and persistence.
Background:
Delirium during critical illness results from numerous insults, which might be interconnected and yet individually contribute to long-term cognitive impairment. We sought to describe the prevalence and duration of clinical phenotypes of delirium (ie, phenotypes defined by clinical risk factors) and to understand associations between these clinical phenotypes and severity of subsequent long-term cognitive impairment.
Methods:
In this multicentre, prospective cohort study, we included adult (≥18 years) medical or surgical ICU patients with respiratory failure, shock, or both as part of two parallel studies: the Bringing to Light the Risk Factors and Incidence of Neuropsychological Dysfunction in ICU Survivors (BRAIN-ICU) study, and the Delirium and Dementia in Veterans Surviving ICU Care (MIND-ICU) study. We assessed patients at least once a day for delirium using the Confusion Assessment Method-ICU and identified a priori-defined, non-mutually exclusive phenotypes of delirium per the presence of hypoxia, sepsis, sedative exposure, or metabolic (eg, renal or hepatic) dysfunction. We considered delirium in the absence of hypoxia, sepsis, sedation, and metabolic dysfunction to be unclassified. 3 and 12 months after discharge, we assessed cognition with the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). We used multiple linear regression to separately analyse associations between the duration of each phenotype of delirium and RBANS global cognition scores at 3-month and 12-month follow-up, adjusting for potential confounders.
Findings:
Between March 14, 2007, and May 27, 2010, 1048 participants were enrolled, eight of whom could not be analysed. Of 1040 participants, 708 survived to 3 months of follow-up and 628 to 12 months. Delirium was common, affecting 740 (71%) of 1040 participants at some point during the study and occurring on 4187 (31%) of all 13 434 participant-days. A single delirium phenotype was present on only 1355 (32%) of all 4187 participant-delirium days, whereas two or more phenotypes were present during 2832 (68%) delirium days. Sedative-associated delirium was most common (present during 2634 [63%] delirium days), and a longer duration of sedative-associated delirium predicted a worse RBANS global cognition score 12 months later, after adjusting for covariates (difference in score comparing 3 days vs 0 days: -4·03, 95% CI -7·80 to -0·26). Similarly, longer durations of hypoxic delirium (-3·76, 95% CI -7·16 to -0·37), septic delirium (-3·67, -7·13 to -0·22), and unclassified delirium (-4·70, -7·16 to -2·25) also predicted worse cognitive function at 12 months, whereas duration of metabolic delirium did not (1·14, -0·12 to 3·01).
Interpretation:
Our findings suggest that clinicians should consider sedative-associated, hypoxic, and septic delirium, which often co-occur, as distinct indicators of acute brain injury and seek to identify all potential risk factors that may impact on long-term cognitive impairment, especially those that are iatrogenic and potentially modifiable such as sedation.
Funding:
National Institutes of Health and the Department of Veterans Affairs.
Purpose:
We aimed to characterize anxiety, depression, and posttraumatic stress disorder (PTSD) symptoms over 5-year follow-up after acute respiratory distress syndrome (ARDS) and determine risk factors for prolonged psychiatric morbidity.
Methods:
This prospective cohort study enrolled patients from 13 medical and surgical intensive care units in four hospitals, with follow-up at 3, 6, 12, 24, 36, 48, and 60 months post-ARDS. Trained research staff administered the Hospital Anxiety and Depression Scale (HADS) (scores ≥ 8 on anxiety and depression subscales indicating substantial symptoms) and the Impact of Event Scale-Revised (IES-R, scores ≥ 1.6 indicating substantial PTSD symptoms) at each follow-up visit.
Results:
Of 196 consenting survivors, 186 (95%) completed HADS and IES-R assessments; 96 (52%) had any continuous or recurring (prolonged) symptoms, and 71 (38%), 59 (32%), and 43 (23%) had prolonged anxiety, depression, and PTSD symptoms, respectively (median total durations 33-39 months, 71-100% of observed follow-up time). Prolonged psychiatric symptoms tended to co-occur across domains; the most common morbidity pattern involved substantial symptoms in all three domains. Worse pre-ARDS mental health, including prior depression and psychological distress in the period immediately preceding ARDS, was strongly associated with prolonged post-ARDS psychiatric morbidity across symptom domains.
Conclusions:
Clinically significant and long-lasting symptoms of anxiety, depression, and PTSD are common in the first 5 years after ARDS. In-hospital screening of psychiatric history, including recent anxiety and depression symptoms, may be useful for long-term mental health treatment planning after ARDS.
Data-driven soft sensors have been widely used in both academic research and industrial applications for predicting hard-to-measure variables or replacing physical sensors to reduce cost. It has been shown that the performance of these data-driven soft sensors could be greatly improved by selecting only the vital variables that strongly affect the primary variables, rather than using all the available process variables. In this work, a comprehensive evaluation of different variable selection methods for PLS-based soft sensor development is presented, and a new metric is proposed to assess the performance of different variable selection methods. The following seven variable selection methods are compared: stepwise regression (SR), partial least squares with regression coefficients (PLS-BETA), PLS with variable importance in projection (PLS-VIP), uninformative variable elimination with PLS (UVE-PLS), genetic algorithm with PLS (GA-PLS), least absolute shrinkage and selection operator (Lasso), and competitive adaptive reweighted sampling with PLS (CARS-PLS). Their strengths and limitations for soft sensor development are demonstrated by a simulated case study and an industrial case study.
Critical illness is associated with cognitive impairment, but mental health and functional disabilities in survivors of intensive care are inadequately characterised. We aimed to assess associations of age and duration of delirium with mental health and functional disabilities in this group.
In this prospective, multicentre cohort study, we enrolled patients with respiratory failure or shock who were undergoing treatment in medical or surgical ICUs in Nashville, TN, USA. We obtained data for baseline demographics and in-hospital variables, and assessed survivors at 3 months and 12 months with measures of depression (Beck Depression Inventory II), post-traumatic stress disorder (PTSD, Post-Traumatic Stress Disorder Checklist-Event Specific Version), and functional disability (activities of daily living scales, Pfeffer Functional Activities Questionnaire, and Katz Activities of Daily Living Scale). We used linear and proportional odds logistic regression to assess the independent associations between age and duration of delirium with mental health and functional disabilities. This study is registered with ClinicalTrials.gov, number NCT00392795.
We enrolled 821 patients with a median age of 61 years (IQR 51-71), assessing 448 patients at 3 months and 382 patients at 12 months after discharge. At 3 months, 149 (37%) of 406 patients with available data reported at least mild depression, as did 116 (33%) of 347 patients at 12 months; this depression was mainly due to somatic rather than cognitive-affective symptoms. Depressive symptoms were common even among individuals without a history of depression (as reported by a proxy), occurring in 76 (30%) of 255 patients with data at 3 months and 62 (29%) of 217 individuals at 12 months. Only 7% of patients (27 of 415 at 3 months and 24 of 361 at 12 months) had symptoms consistent with post-traumatic distress disorder. Disabilities in basic activities of daily living (ADL) were present in 139 (32%) of 428 patients at 3 months and 102 (27%) of 374 at 12 months, as were disabilities in instrumental ADL in 108 (26%) of 422 individuals at 3 months and 87 (23%) of 372 at 12 months. Mental health and functional difficulties were prevalent in patients of all ages. Although old age was frequently associated with mental health problems and functional disabilities, we observed no consistent association between the presence of delirium and these outcomes.
Poor mental health and functional disability is common in patients treated in intensive-care units. Depression is five times more common than is post-traumatic distress disorder after critical illness and is driven by somatic symptoms, suggesting approaches targeting physical rather than cognitive causes could benefit patients leaving critical care.
National Institutes of Health AG027472 and the Geriatric Research, Education and Clinical Center (GRECC), Department of Veterans Affairs Medical Center, Tennessee Valley Healthcare System.
Background:
The psychosis-proneness-persistence-impairment model of psychotic disorder incorporates notions of both phenomenological and temporal continuity (persistence) of psychotic experiences (PE), but not structural continuity. Specific testable propositions of phenomenological continuity and persistence are identified. Method Propositions are tested by systematic reviews of the epidemiology of PE, persistence of PE and disorder outcomes, and meta-analyses (including Monte Carlo permutation sampling, MCPS) of reported rates and odds ratios (ORs).
Results:
Estimates of the incidence and prevalence of PE obtained from 61 cohorts revealed a median annual incidence of 2.5% and a prevalence of 7.2%. Meta-analysis of risk factors identified age, minority or migrant status, income, education, employment, marital status, alcohol use, cannabis use, stress, urbanicity and family history of mental illness as important predictors of PE. The mode of assessment accounted for significant variance in the observed rates. Across cohorts, the probability of persistence was very strongly related to the rate of PE at baseline. Of those who report PE, ∼20% go on to experience persistent PE whereas for ∼80%, PE remit over time. Of those with baseline PE, 7.4% develop a psychotic disorder outcome.
Conclusions:
Compelling support is found for the phenomenological and temporal continuity between PE and psychotic disorder and for the fundamental proposition that this relationship is probabilistic. However, imprecision in epidemiological research design, measurement limitations and the epiphenomenological nature of PE invite further robust scrutiny of the continuity theory.
the goal of this study was to determine the relationship between health status, including self-rated health status and chronic disease, and risk for depression among the elderly. Method: MEDLINE, EMBASE and The Cochrane Library Database were used to identify potential studies. The studies were classified into cross-sectional and longitudinal subsets. For each study, the numbers of the total participants, cases (for cross-sectional study) or incident cases (for longitudinal study) of depression in each health status group were extracted and entered into Review Manager 4.2. The quantitative meta-analysis of cross-sectional studies and that of longitudinal studies were performed, respectively. For prevalence and incidence rates of depression, odds risk and relative risk (RR) were calculated, respectively.
the quantitative meta-analysis showed that, compared with the elderly without chronic disease, those with chronic disease had higher risk for depression (RR: 1.53, 95% confidence intervals (CI): 1.20-1.97). Compared with the elderly with good self-rated health, those with poor self-rated health had higher risk for depression (RR: 2.40, 95% CI: 1.94-2.97).
despite the methodological limitations of this meta-analysis, both poor self-rated health status and the presence of chronic disease are risk factors for depression among the elderly. In the elderly, poor self-reported health status appears to be more strongly associated with depression than the presence of chronic disease.
In a controlled study, the authors determined the risk of developing major mental illness after catastrophic financial loss. Seventy-two adults who lost their retirement savings in a bank fraud were interviewed using the Diagnostic Interview Schedule. Major depression by DSM-III criteria was present in 29% of the victims during the first 20 months after their loss as compared with 2% of 66 age, gender, and residential area-matched control subjects (p less than .0001). Generalized anxiety disorder as defined by DSM-III criteria was experienced by 27% of victims after the loss as compared with 10% of control subjects (p = .03). After the loss, victims had lower subjective health ratings, more functional somatic complaints, and higher tranquilizer usage than control subjects. There was no difference between depressed and nondepressed in types of coping responses or use of social supports and confidants. Only four of 21 victims who suffered major depression sought help from a mental health professional. We conclude that catastrophic financial loss may result in the onset of major depressive disorder and generalized anxiety disorder.