Factors associated with mental health outcomes after COVID-19: A 24-month follow-up longitudinal study

Subjective cognitive, psychiatric, and fatigue symptoms two years after COVID-19: A prospective longitudinal cohort study

Introduction

COVID-19 survivors may present with cognitive and psychiatric symptoms long after the acute phase of SARS-CoV-2 infection.

Objectives

To determine subjective cognitive, psychiatric, and fatigue symptoms two years after COVID-19, and their change from six months to two years.

Methods

We assessed three COVID-19 patient groups of different acute disease severity (ICU-treated, ward-treated, home-isolated) concerning subjective cognitive functioning (AB Neuropsychological Assessment Schedule), anxiety (Generalised Anxiety Disorder 7), depression (Patient Health Questionnaire 9), post-traumatic stress (Impact of Event Scale 6), and fatigue (Multidimensional Fatigue Inventory) with a mailed questionnaire approximately two years after acute COVID-19. We compared the results with those obtained six months after the acute disease. We studied whether any change emerged in the scores of symptomatic patients between six- and 24-month follow-ups.

Results

Two years post-COVID-19, 58 ICU-treated, 35 ward-treated, and 28 home-isolated patients responded to the questionnaire. Subjective cognitive symptoms and fatigue emerged as the most common problems occurring in 30.6 and 35.5% of patients, respectively. In patients with clinically significant symptoms at six months, symptom scores for depression, anxiety, and post-traumatic stress decreased at two years.

Conclusions

Two years after COVID-19, particularly self-reported cognitive symptoms and fatigue remained clinically significant, but also some recovery was evident in depression, anxiety, and post-traumatic stress.

Course of neuropsychological health in post-COVID patients differs 6 and 12 months after inpatient rehabilitation

Background

Rehabilitation is an effective and feasible approach for post-COVID patients to improve mental health and cognitive complaints. However, knowledge regarding the long-term impact of rehabilitation on neuropsychological health of these patients is lacking.

Objective

This study aims to investigate psychological health, fatigue, and cognitive function 6 and 12 months after inpatient post-COVID rehabilitation of patients, who acquired COVID-19 in the workplace. In addition, group differences in these outcome parameters according to sex, age, acute COVID status, socioeconomic status, profession, and pre-existing diseases will be detected.

Methods

This longitudinal observational study examined the changes in mental and cognitive health of 127 patients with COVID-19 as an occupational disease or work accident. Symptoms of depression and anxiety, fatigue severity, somatic symptom severity, trauma-related symptoms, and cognitive functioning were assessed at the beginning as well as six and 12 months after rehabilitation. Group differences concerning sex, age, acute COVID status, socioeconomic status, occupational status, and existing diseases prior to COVID-19 were also analyzed.

Results

The results showed that the improvements direct after rehabilitation in mental health and fatigue severity could not be maintained six and 12 months after rehabilitation discharge. Contrary, patients' cognitive function maintained stable during follow-up. Significant group differences were observed regarding age, sex, acute COVID status, socioeconomic status, occupational status, and pre-existing diseases.

Conclusion

This study highlights the importance of the aftercare process and the implementation of adequate and individualized therapeutic interventions such as psychological support and strengthen self-management skills.The study is registered in the German Clinical Trials Register with the identifier DRKS00022928.

Prevalence, Risk Factors, and Intervention of Long-Term Sleep Disturbance After Intensive Care Unit Discharge: A Scoping Review

Sleep disturbance in the intensive care unit (ICU) is common and often persistent after discharge. Sleep disturbance after ICU discharge, often classified under post-intensive care syndrome (PICS), affects health-related quality of life (HRQOL). The aim of the current review was to map long-term sleep disturbance after ICU discharge, explore related factors, and suggest prevention and treatment measures, including those related to PICS. We searched the PubMed, CINAHL, and CENTRAL databases until June 12, 2024, using keywords related to ICU, sleep disturbance, and recovery. Inclusion criteria were the inclusion of adult patients, analysis of sleep disturbance after ICU, and evaluation of risk factors or interventions. Reviews, case reports, and non-original studies were excluded. A total of 1,786 studies on sleep disturbance after ICU discharge were initially identified, with 52 studies ultimately included after screening. Prevalence of sleep disturbance after ICU discharge was calculated from 42 studies, with rates of 55.0% at less than one month, 49.6% at 1-3 months, 39.2% at 4-6 months, 23.2% at 7-12 months, and 15.0% over one year. Risk factors for sleep disturbance included older age, female sex, pre-hospital sleep disturbance, ICU and hospital lengths of stay, duration of mechanical ventilation, duration of sedation or analgesia, pain, delirium, and poor sleep quality during hospital ward. Long-term sleep disturbance was associated with PICS. Sleep disturbance was associated with physical disability, cognitive impairment, mental dysfunction (especially depression, post-traumatic stress disorder, and anxiety), and HRQOL, assessed at 4-6 months after hospitalization. Two randomized controlled trials (RCTs) examined interventions for sleep disturbance. Psychological counseling and a 12-month nurse-led collaborative care intervention were found effective in improving long-term sleep disturbance. On the other hand, the use of sleep aids such as earplugs and eye masks in the ICU had no such effect. Sleep disturbance after ICU discharge is common, with over half of the patients being affected within one month, and a link to PICS symptoms exists, highlighting the need for further research on comprehensive interventions.

A Two-Year cohort study examining the impact of cytokines and chemokines on cognitive and psychiatric outcomes in Long-COVID-19 patients

This study investigates the relationship between clinical, sociodemographic, and neuropsychological symptoms and serum cytokine concentrations with long-term cognitive and psychiatric outcomes in long-COVID-19 patients. We reassessed 108 adults who survived moderate to severe COVID-19 at two intervals post-discharge (T1, mean 6.9 months; T2, mean 23.5 months). Baseline sociodemographic and clinical data were collected from hospital records, while cognitive and mental health assessments included psychometric tests such as the Hospital Anxiety and Depression Scale (HADS) and Immediate and Delayed Recall Tests from the CERAD Battery. Serum cytokine levels were measured at T1. Generalized Additive Models (GAMs), Elastic Net Regression (NET), and Psychological Network Analysis (PNA) were used to analyze the data. The GAM analysis revealed significant associations between acute COVID-19 severity and Epworth Sleepiness Score with persistent anxiety symptoms at T2. For depression, both WHO severity class and Eotaxin levels were significant predictors. The Anti-inflammatory Index showed a marginally significant relationship with immediate recall, while age was marginally associated with delayed recall performance. In NET, only anxiety was significantly associated with Epworth Sleepiness Score, WHO severity class, and Proinflammatory Index. PNA did not reveal direct connections between cytokines and neuropsychological outcomes in the graphical model. However, centrality measures indicated that the Proinflammatory Index and VEGF were more central within the network, suggesting they might be important components of the overall system. This study provides insights into the complex role of cytokines and inflammation in long-COVID-19 outcomes, potentially aiding in the identification of biomarkers for diagnosis and prognosis.

Prevalence and measurement of post-exertional malaise in post-acute COVID-19 syndrome: A systematic review and meta-analysis

OBJECTIVE

Post-exertional malaise (PEM) is a common and debilitating symptom of post-acute COVID-19 syndrome (PACS), and it is also included in the core outcome set for PACS. Our aims are to determine the prevalence of PEM in patients with PACS, and to review the measurement tools utilized in studies assessing PEM among these patients.

METHODS

A systematic literature search was conducted up to 29 February 2024 across four databases: PubMed, EMBASE, Web of Science, and Cochrane Library. Studies were included if they evaluated PACS individuals who had at least one persistent symptom, with the mean or median follow-up duration of at least 3 months after COVID-19 diagnosis or hospital discharge, and specially reported on PEM or any measurement tools utilized to assess PEM. Data extraction and quality assessment were performed independently by two authors.

RESULTS

After screening 953 articles, 12 studies comprising 2665 patients were included in the meta-analysis, and 16 studies were included in the narrative review. The pooled prevalence of PEM among PACS patients at 3 months or more after COVID-19 diagnosis was 0.55 (95 % CI, 0.38, 0.71). Moreover, narrative review identified seven questionnaires used to assess PEM in PACS individuals, with the DePaul Symptom Questionnaire-Post Exertional Malaise (DSQ-PEM) being the most frequently utilized instrument.

CONCLUSION

Our findings indicate that over half of the PACS individuals experience PEM, and seven questionnaires have been identified for researchers to assess PEM. It is imperative to develop effective intervention strategies to treat and alleviate the burden of PEM.

Four- and sixteen-month clinical status of a cohort of patients following hospitalization for COVID-19

BACKGROUND AND OBJECTIVES

Although many symptoms of post-COVID syndrome have been described, a comprehensive evaluation of their prevalence is lacking. We aimed to describe symptoms at 16 months from hospitalization for COVID-19.

METHODS

A telephone assessment was performed one year later in a cohort of COVID-19 survivors hospitalized between March and May 2020 and already evaluated four months after discharge. Patients with relevant symptoms at 16 months, patients who presented symptoms at four months, and all intensive care unit patients were invited for assessment at an outpatient facility. At telephone consultation, respiratory, cognitive, and functional symptoms were assessed. Patients underwent pulmonary function tests, lung CT scans, and psychometric and cognitive tests at the outpatient facility.

RESULTS

Among 478 patients evaluated four months after discharge, 317 (67 %) were assessed at telephone consultation and 124 at ambulatory assessment. At telephone assessment, ≥1 new symptom was reported by 216 patients (68 %), mainly fatigue (53 %), dyspnea (37 %), and memory difficulties (24 %). Seventy-nine patients (25 %) were asymptomatic at four months but declared ≥1 symptom one year later. In patients evaluated twice, the prevalence of cognitive impairment was 45 % at four months and 40 % at 16 months. Depression and post-traumatic symptoms prevalence remained stable, and the prevalence of anxiety significantly decreased. Dysfunctional breathing was detected in 32 % of patients. At 16 months after discharge, lung CT-scan exhibited abnormalities in 30/80 patients (38 %), compared to 52/85 patients (61 %) at four months.

CONCLUSION

At 16 months after hospitalization for COVID-19, 68 % of patients declared symptoms, including patients whose symptoms appeared between 4 and 16 months.

TRIAL REGISTRATION

ClinicalTrials.gov, NCT04704388.

Mental health status and quality of life among Thai people after the COVID-19 outbreak: a cross-sectional study

The coronavirus disease 2019 (COVID-19) pandemic has had a profound impact on individuals' mental health and well-being worldwide. This study investigated the prevalences of and association between mental health and quality of life (QOL) in Thailand after the COVID-19 outbreak. A cross-sectional study was conducted among Thai individuals aged ≥ 20 years across all regions. Descriptive statistics, chi-square tests, and multiple logistic regression analyses were performed to examine the association between mental health and QOL. A total of 1,133 participants (mean age: 35.1 ± 17.2 years) completed the survey. The prevalence of depression with PHQ-9 instrument was 19.4%. Depression was significantly associated with those who have had family members die from COVID-19 infection (adjusted odds ratio [AOR] 2.27, 95% confidence interval [CI] [1.13-4.52]). The percentages of depression, anxiety, and stress with DASS-21 instrument were 32.4%, 45.4%, and 24.1%, respectively. Smokers and alcohol consumption had approximately 1.5-time higher risk of stress compared with non-smokers and no alcohol consumption (AOR = 1.50, 95% CI [1.01-2.24], AOR = 1.48, 95% CI [1.09-2.02], respectively). An association was observed between socioeconomic factors such as job and income loss and mental health outcomes. Depression, anxiety, and stress were significantly negatively associated with QOL. This study demonstrates a strong association between mental health and QOL among Thai people after the COVID-19 outbreak. The findings underscore the need for interventions targeting lifestyles, including those addressing alcohol consumption and smoking, especially among those who have had family members die from COVID-19 infection and mental health support services that can address depression, anxiety, and stress to improve the overall well-being of the population.

Portrait of mental health identified by people with the post-covid syndrome

OBJECTIVES

This study aimed to produce a patient-centered understanding of mental health symptoms of people with the post-COVID-19 syndrome (PCS).

METHODS

A cross-sectional analysis of 414 participants in a longitudinal study was carried out involving people who self-identified as having symptoms of PCS. People were asked to name their most frequent and most bothersome mental health symptoms affected by PCS using the structure of the Patient Generated Index (PGI). The text threads from the PGI were grouped into topics using BERTopic analysis.

RESULTS

20 topics were identified from 818 text threads referring to PCS mental health symptoms. 35% of threads were identified as relating to anxiety, discussed in terms of five topics: generalized/social anxiety, fear/worry, post-traumatic stress, panic, and nervous. 29% of threads were identified as relating to low mood, represented by five topics: depression, discouragement, emotional distress, sadness, and loneliness. A cognitive domain (22% of threads) was covered by four topics referring to concentration, memory, brain fog, and mental fatigue. Topics related to frustration, anger, irritability. and mood swings (7%) were considered as one domain and there were separate topics related to motivation, insomnia, and isolation.

CONCLUSIONS

This novel method of digital transformation of unstructured text data uncovered different ways in which people think about classical mental health domains. This information could be used to evaluate whether existing measures cover the content identified by people with PCS, to initiate a clinical conversation, or to justify the development of a new measure of the mental health impact of PCS.

Cognitive and psychiatric symptom trajectories 2-3 years after hospital admission for COVID-19: a longitudinal, prospective cohort study in the UK

BACKGROUND

COVID-19 is known to be associated with increased risks of cognitive and psychiatric outcomes after the acute phase of disease. We aimed to assess whether these symptoms can emerge or persist more than 1 year after hospitalisation for COVID-19, to identify which early aspects of COVID-19 illness predict longer-term symptoms, and to establish how these symptoms relate to occupational functioning.

METHODS

The Post-hospitalisation COVID-19 study (PHOSP-COVID) is a prospective, longitudinal cohort study of adults (aged ≥18 years) who were hospitalised with a clinical diagnosis of COVID-19 at participating National Health Service hospitals across the UK. In the C-Fog study, a subset of PHOSP-COVID participants who consented to be recontacted for other research were invited to complete a computerised cognitive assessment and clinical scales between 2 years and 3 years after hospital admission. Participants completed eight cognitive tasks, covering eight cognitive domains, from the Cognitron battery, in addition to the 9-item Patient Health Questionnaire for depression, the Generalised Anxiety Disorder 7-item scale, the Functional Assessment of Chronic Illness Therapy Fatigue Scale, and the 20-item Cognitive Change Index (CCI-20) questionnaire to assess subjective cognitive decline. We evaluated how the absolute risks of symptoms evolved between follow-ups at 6 months, 12 months, and 2-3 years, and whether symptoms at 2-3 years were predicted by earlier aspects of COVID-19 illness. Participants completed an occupation change questionnaire to establish whether their occupation or working status had changed and, if so, why. We assessed which symptoms at 2-3 years were associated with occupation change. People with lived experience were involved in the study.

FINDINGS

2469 PHOSP-COVID participants were invited to participate in the C-Fog study, and 475 participants (191 [40·2%] females and 284 [59·8%] males; mean age 58·26 [SD 11·13] years) who were discharged from one of 83 hospitals provided data at the 2-3-year follow-up. Participants had worse cognitive scores than would be expected on the basis of their sociodemographic characteristics across all cognitive domains tested (average score 0·71 SD below the mean [IQR 0·16-1·04]; p<0·0001). Most participants reported at least mild depression (263 [74·5%] of 353), anxiety (189 [53·5%] of 353), fatigue (220 [62·3%] of 353), or subjective cognitive decline (184 [52·1%] of 353), and more than a fifth reported severe depression (79 [22·4%] of 353), fatigue (87 [24·6%] of 353), or subjective cognitive decline (88 [24·9%] of 353). Depression, anxiety, and fatigue were worse at 2-3 years than at 6 months or 12 months, with evidence of both worsening of existing symptoms and emergence of new symptoms. Symptoms at 2-3 years were not predicted by the severity of acute COVID-19 illness, but were strongly predicted by the degree of recovery at 6 months (explaining 35·0-48·8% of the variance in anxiety, depression, fatigue, and subjective cognitive decline); by a biocognitive profile linking acutely raised D-dimer relative to C-reactive protein with subjective cognitive deficits at 6 months (explaining 7·0-17·2% of the variance in anxiety, depression, fatigue, and subjective cognitive decline); and by anxiety, depression, fatigue, and subjective cognitive deficit at 6 months. Objective cognitive deficits at 2-3 years were not predicted by any of the factors tested, except for cognitive deficits at 6 months, explaining 10·6% of their variance. 95 of 353 participants (26·9% [95% CI 22·6-31·8]) reported occupational change, with poor health being the most common reason for this change. Occupation change was strongly and specifically associated with objective cognitive deficits (odds ratio [OR] 1·51 [95% CI 1·04-2·22] for every SD decrease in overall cognitive score) and subjective cognitive decline (OR 1·54 [1·21-1·98] for every point increase in CCI-20).

INTERPRETATION

Psychiatric and cognitive symptoms appear to increase over the first 2-3 years post-hospitalisation due to both worsening of symptoms already present at 6 months and emergence of new symptoms. New symptoms occur mostly in people with other symptoms already present at 6 months. Early identification and management of symptoms might therefore be an effective strategy to prevent later onset of a complex syndrome. Occupation change is common and associated mainly with objective and subjective cognitive deficits. Interventions to promote cognitive recovery or to prevent cognitive decline are therefore needed to limit the functional and economic impacts of COVID-19.

FUNDING

National Institute for Health and Care Research Oxford Health Biomedical Research Centre, Wolfson Foundation, MQ Mental Health Research, MRC-UK Research and Innovation, and National Institute for Health and Care Research.

Three-Month Follow-Up of the Post-COVID Syndrome after Admission to a Specialised Post-COVID Centre-A Prospective Study Focusing on Mental Health with Patient Reported Outcome Measures (PROMs)

BACKGROUND AND OBJECTIVE

The impairments and duration of PASC (post-acute sequelae of COVID-19) symptoms in mental health have, to date, not been comprehensively examined. Our objective is to provide longitudinal data on the mental health of Post-COVID patients and to identify risk and protective factors associated with a severe or prolonged course.

METHODS

The mental health of 265 Post-COVID patients of the outpatient Post-COVID centre of the University Hospital Erlangen was assessed 17.1 (T0) and 22.5 months after infection (T1). An online survey with validated questionnaires for Post-COVID symptoms (Post-COVID Syndrome Score), depression (Patient Health Questionnaire-9), somatic symptoms (Patient Health Questionnaire-15), anxiety (Generalized Anxiety Disorder-7), fatigue (Fatigue Severity Scale) and Post-Exertional Malaise (PEM) (DePaul Post-Exertional Malaise Screening) was conducted in the home environment.

RESULTS

In total, 80% of patients experienced severe PASC at follow-up. Clinically relevant symptoms of depression, persistent somatic symptoms, anxiety and fatigue were reported by 55.8%, 72.5%, 18.9% and 89.4% of patients, respectively. Depressive, anxiety and somatic symptom severity decreased significantly over time; fatigue and PEM remained at an unchanged high level. The risk factor for higher depression scores was older age; prior psychiatric illness treated with psychotherapy was associated with more severe depressive, somatic, anxiety and PASC symptoms. PEM symptoms were significantly associated with longer duration between acute infection and initial presentation in the Post-COVID centre.

CONCLUSIONS

Our findings align with previous research, claiming severe mental health symptoms in PASC syndrome, lasting for months after infection. In-depth assessment of risk and protective factors for the mental health implications of PASC is needed for the planning of health services and disease prevention.

Social support moderates the relationship between sleep quality and mental health: A Chinese Fangcang shelter hospital-based study in asymptomatic COVID-19 carriers

This study aimed to determine the association between sleep quality and mental health in COVID-19 carriers in China and evaluate the moderating effects of perceived social support. 1283 asymptomatic COVID-19 carriers were enrolled from March 2022 to April 2022 among Ruijin Jiahe Fangcang shelter hospital in Shanghai, China. They were assessed using the Pittsburgh Sleep Quality Index (PSQI), the General Health Questionnaire (GHQ), and the Perceived Social Support Scale (PSSS) respectively. Participants had an average age of 39.64 years and 59.6 % of whom were male. In total, 34.3 % of participants presented with poor sleep quality; 41.1 % showed bad mental health. Sleep quality was positively related to mental health (r = 0.321, P < 0.001, 95 %CI = 0.267, 0.369) and social support was negatively related to mental health (r = -0.414, P < 0.001, 95 %CI = -0.457, -0.367). Meanwhile, social support played a moderating role between sleep quality and mental health (β = 0.066, P < 0.05, 95 %CI = 0.016, 0.117). These findings indicate that mental health resulting from the COVID-19 pandemic are increasingly apparent in China and provide a focus on sleep quality for the early prevention of mental health in asymptomatic carriers. And social support may be beneficial to the improvement of mental health, especially for people in crisis (e.g., COVID-19 pandemic).

Evolution of Primary Research Studies in Digital Interventions for Mental Well-Being Promotion from 2004 to 2023: A Bibliometric Analysis of Studies on the Web of Science

Research into digital interventions for mental well-being promotion has grown in recent years, fuelled by the need to improve mental health prevention strategies and respond to challenges arising from the coronavirus (COVID-19) pandemic. This bibliometric analysis provides a structured overview of publication trends and themes in primary research studies reporting an array of digital interventions indexed at WoS from 2004 to 2023. Bibliometric data were collected on a sample of 1117 documents and analysed using the Biblioshiny package. Supplemental network visualisation analysis was conducted using VosViewer. The study, based on Web of Science and Scopus databases, indicates a marked increase in publications post-2020. There were seven groups of research themes clustered around "Mindfulness", "Anxiety", "COVID-19", "Acceptance and Commitment Therapy", "Depression", "Web-based", and "Positive Psychology". Further, results demonstrated the growth of specific themes (e.g., mindfulness, mhealth), the defining impact of COVID-19 studies, and the importance of both randomised controlled trials and formative research. Overall, research in the field is still early in its development and is expected to continue to grow. Findings highlight the field's dynamic response to societal and technological changes, suggesting a future trajectory that leans increasingly on digital platforms for mental health promotion and intervention. Finally, study limitations and implications for future studies are discussed.

Impact of COVID-19 on posttraumatic stress disorder in ICU survivors: a prospective observational comparative cohort study

BACKGROUND

Posttraumatic stress disorder (PTSD) after a stay in the intensive care unit (ICU) can affect one in five ICU survivors. At the beginning of the coronavirus disease 2019 (COVID-19) pandemic, admission to the ICU for COVID-19 was stressful due to the severity of this disease. This study assessed whether admission to the ICU for COVID-19 was associated with a higher prevalence of PTSD compared with other causes of ICU admission after adjustment for pre-ICU psychological factors.

METHODS

This prospective observational comparative cohort study included 31 ICUs. Eligible patients were adult ICU survivors hospitalized during the first wave of COVID-19 pandemic in France, regardless of the reason for admission. The prevalence of presumptive diagnosis of PTSD at 6 months was assessed using the PTSD Checklist for DSM-5 (PCL-5). Sociodemographics, clinical data, history of childhood trauma (Childhood Trauma Questionnaire [CTQ]), and exposure to potentially traumatic events (Life Events Checklist for DSM-5 [LEC-5]) were assessed.

RESULTS

Of the 778 ICU survivors included during the first wave of COVID-19 pandemic in France, 417 and 361 were assigned to the COVID-19 and non-COVID-19 cohorts, respectively. Fourteen (4.9%) and 11 (4.9%), respectively, presented with presumptive diagnosis of PTSD at 6 months (p = 0.976). After adjusting for age, sex, severity score at admission, use of invasive mechanical ventilation, ICU duration, CTQ and LEC-5, COVID-19 status was not associated with presumptive diagnosis of PTSD using the PCL-5. Only female sex was associated with presumptive diagnosis of PTSD. However, COVID-19 patients reported significantly more intrusion and avoidance symptoms than non-COVID patients (39% vs. 29%, p = 0.015 and 27% vs. 19%, p = 0.030), respectively. The median PCL-5 score was higher in the COVID-19 than non-COVID-19 cohort (9 [3, 20] vs. 4 [2, 16], p = 0.034).

CONCLUSION

Admission to the ICU for COVID-19 was not associated with a higher prevalence of PTSD compared with admission for another cause during the first wave of the COVID-19 pandemic in France. However, intrusion and avoidance symptoms were more frequent in COVID-19 patients than in non-COVID-19 patients.

TRIAL REGISTRATION

Clinicaltrials.gov Identifier NCT03991611, registered on June 19, 2019.