1
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Weiß M, Gutzeit J, Appel KS, Bahmer T, Beutel M, Deckert J, Fricke J, Hanß S, Hettich-Damm N, Heuschmann PU, Horn A, Jauch-Chara K, Kohls M, Krist L, Lorenz-Depiereux B, Otte C, Pape D, Reese JP, Schreiber S, Störk S, Vehreschild JJ, Hein G. Depression and fatigue six months post-COVID-19 disease are associated with overlapping symptom constellations: A prospective, multi-center, population-based cohort study. J Affect Disord 2024; 352:296-305. [PMID: 38360365 DOI: 10.1016/j.jad.2024.02.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 01/30/2024] [Accepted: 02/12/2024] [Indexed: 02/17/2024]
Abstract
BACKGROUND Depression and fatigue are commonly observed sequelae following viral diseases such as COVID-19. Identifying symptom constellations that differentially classify post-COVID depression and fatigue may be helpful to individualize treatment strategies. Here, we investigated whether self-reported post-COVID depression and post-COVID fatigue are associated with the same or different symptom constellations. METHODS To address this question, we used data from COVIDOM, a population-based cohort study conducted as part of the NAPKON-POP platform. Data were collected in three different German regions (Kiel, Berlin, Würzburg). We analyzed data from >2000 individuals at least six months past a PCR-confirmed COVID-19 disease, using elastic net regression and cluster analysis. The regression model was developed in the Kiel data set, and externally validated using data sets from Berlin and Würzburg. RESULTS Our results revealed that post-COVID depression and fatigue are associated with overlapping symptom constellations consisting of difficulties with daily activities, perceived health-related quality of life, chronic exhaustion, unrestful sleep, and impaired concentration. Confirming the overlap in symptom constellations, a follow-up cluster analysis could categorize individuals as scoring high or low on depression and fatigue but could not differentiate between both dimensions. LIMITATIONS The data presented are cross-sectional, consisting primarily of self-reported questionnaire or medical records rather than biometric data. CONCLUSIONS In summary, our results suggest a strong link between post-COVID depression and fatigue, highlighting the need for integrative treatment approaches.
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Affiliation(s)
- Martin Weiß
- University Hospital Würzburg, Center of Mental Health, Department of Psychiatry, Psychosomatic and Psychotherapy, Margarete-Höppel-Platz 1, 97080 Würzburg, Germany.
| | - Julian Gutzeit
- University Hospital Würzburg, Center of Mental Health, Department of Psychiatry, Psychosomatic and Psychotherapy, Margarete-Höppel-Platz 1, 97080 Würzburg, Germany
| | - Katharina S Appel
- Goethe University Frankfurt, University Hospital, Center for Internal Medicine, Medical Department 2 (Hematology/Oncology and Infectious Diseases), Frankfurt, Germany; University of Cologne, Faculty of Medicine and University Hospital Cologne, Department I for Internal Medicine, Cologne, Germany
| | - Thomas Bahmer
- Department I of Internal Medicine, UKSH Campus Kiel, Arnold-Heller-Straße 3, 24105 Kiel, Germany; Airway Research Center North (ARCN), German Center for Lung Research (DZL), Wöhrendamm 80, 22927 Großhansdorf, Germany
| | - Manfred Beutel
- Department for Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg University Mainz, Untere Zahlbacher Str. 8, 55131 Mainz, Germany
| | - Jürgen Deckert
- University Hospital Würzburg, Center of Mental Health, Department of Psychiatry, Psychosomatic and Psychotherapy, Margarete-Höppel-Platz 1, 97080 Würzburg, Germany
| | - Julia Fricke
- Institute of Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Germany
| | - Sabine Hanß
- Department of Medical Informatics, University Medical Center Göttingen, Göttingen, Germany
| | - Nora Hettich-Damm
- Department for Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg University Mainz, Untere Zahlbacher Str. 8, 55131 Mainz, Germany
| | - Peter U Heuschmann
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, Josef-Schneider-Straße 2, 97080 Würzburg, Germany; Department of Clinical Research & Epidemiology, Comprehensive Heart Failure Center, Department of Internal Medicine I, University Hospital Würzburg, Am Schwarzenberg 15, 97078 Würzburg, Germany; Clinical Trial Center Würzburg (CTC/ZKS), University Hospital Würzburg, Josef-Schneider-Straße 2, 97080 Würzburg, Germany; Institute of Medical Data Science, University Hospital Würzburg, Josef-Schneider-Straße 2, 97080 Würzburg, Germany
| | - Anna Horn
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, Josef-Schneider-Straße 2, 97080 Würzburg, Germany; Institute of Medical Data Science, University Hospital Würzburg, Josef-Schneider-Straße 2, 97080 Würzburg, Germany
| | - Kamila Jauch-Chara
- Department of Psychiatry and Psychotherapy, Christian-Albrechts-Universität zu Kiel, Kiel, Germany
| | - Mirjam Kohls
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, Josef-Schneider-Straße 2, 97080 Würzburg, Germany
| | - Lilian Krist
- Institute of Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Germany
| | | | - Christian Otte
- Charité - Universitätsmedizin Berlin, Department of Psychiatry and Neurosciences, Campus Benjamin Franklin, Berlin, Germany
| | - Daniel Pape
- Department I of Internal Medicine, UKSH Campus Kiel, Arnold-Heller-Straße 3, 24105 Kiel, Germany
| | - Jens-Peter Reese
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, Josef-Schneider-Straße 2, 97080 Würzburg, Germany; Institute of Medical Data Science, University Hospital Würzburg, Josef-Schneider-Straße 2, 97080 Würzburg, Germany
| | - Stefan Schreiber
- Department I of Internal Medicine, UKSH Campus Kiel, Arnold-Heller-Straße 3, 24105 Kiel, Germany
| | - Stefan Störk
- Department of Clinical Research & Epidemiology, Comprehensive Heart Failure Center, Department of Internal Medicine I, University Hospital Würzburg, Am Schwarzenberg 15, 97078 Würzburg, Germany
| | - Jörg Janne Vehreschild
- Goethe University Frankfurt, University Hospital, Center for Internal Medicine, Medical Department 2 (Hematology/Oncology and Infectious Diseases), Frankfurt, Germany; University of Cologne, Faculty of Medicine and University Hospital Cologne, Department I for Internal Medicine, Cologne, Germany; German Centre for Infection Research (DZIF), partner site Bonn-Cologne, Cologne, Germany
| | - Grit Hein
- University Hospital Würzburg, Center of Mental Health, Department of Psychiatry, Psychosomatic and Psychotherapy, Margarete-Höppel-Platz 1, 97080 Würzburg, Germany
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2
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Kuut TA, Müller F, Csorba I, Braamse AMJ, Nieuwkerk P, Rovers CP, Knoop H. Positive Effects of Cognitive-Behavioral Therapy Targeting Severe Fatigue Following COVID-19 Are Sustained Up to 1 Year After Treatment. Clin Infect Dis 2024; 78:1078-1079. [PMID: 37889495 DOI: 10.1093/cid/ciad661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 10/25/2023] [Indexed: 10/28/2023] Open
Affiliation(s)
- Tanja A Kuut
- Department of Medical Psychology, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, the Netherlands
- Amsterdam Public Health, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, the Netherlands
| | - Fabiola Müller
- Department of Medical Psychology, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, the Netherlands
- Amsterdam Public Health, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, the Netherlands
| | - Irene Csorba
- Department of Medical Psychology, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, the Netherlands
- Amsterdam Public Health, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, the Netherlands
| | - Annemarie M J Braamse
- Department of Medical Psychology, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, the Netherlands
- Amsterdam Public Health, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, the Netherlands
| | - Pythia Nieuwkerk
- Department of Medical Psychology, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, the Netherlands
- Amsterdam Public Health, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, the Netherlands
- Amsterdam Institute for Infection and Immunity, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, the Netherlands
| | - Chantal P Rovers
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, 6500 HB Nijmegen, the Netherlands
| | - Hans Knoop
- Department of Medical Psychology, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, the Netherlands
- Amsterdam Public Health, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, the Netherlands
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3
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Deodato M, Qualizza C, Martini M, Mazzari L, Furlanis G, Buoite Stella A, Manganotti P. Efficacy of dual-task augmented reality rehabilitation in non-hospitalized adults with self-reported long COVID fatigue and cognitive impairment: a pilot study. Neurol Sci 2024; 45:1325-1333. [PMID: 38191766 DOI: 10.1007/s10072-023-07268-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 12/12/2023] [Indexed: 01/10/2024]
Abstract
BACKGROUND Cognitive impairment and chronic fatigue represent common characteristics of the long COVID syndrome. Different non-pharmacological treatments have been proposed, and physiotherapy has been proposed to improve the symptoms. This study aimed to evaluate the effects of a dual-task augmented reality rehabilitation protocol in people with long COVID fatigue and cognitive impairment. METHODS AND MATERIALS Ten non-hospitalized adults with reported fatigue and "brain fog" symptoms after COVID (7/10 females, 50 years, range 41-58) who participated in 20 sessions of a 1-h "dual-task" training, were compared to 10 long COVID individuals with similar demographics and symptoms (9/10 females, 56 years, range 43-65), who did not participate to any rehabilitation protocol. Cognitive performance was assessed with the Trail Making Test (TMT-A and -B) and Frontal Assessment Battery (FAB), and cardiovascular and muscular fatigue were assessed with the fatigue severity scale (FSS), six-minute walking test and handgrip endurance. Finally, transcranial magnetic stimulation (TMS) investigated cortical excitability. RESULTS The mixed-factors analysis of variance found a significant interaction effect only in cognitive performance evaluation, suggesting TMT-B execution time decreased (- 15.9 s, 95% CI 7.6-24.1, P = 0.001) and FAB score improved (1.88, 95% CI 2.93-0.82, P = 0.002) only in the physiotherapy group. For the remaining outcomes, no interaction effect was found, and most parameters similarly improved in the two groups. CONCLUSION The preliminary results from this study suggest that dual-task rehabilitation could be a feasible protocol to support cognitive symptoms recovery after COVID-19 and could be helpful in those individuals suffering from persisting and invalidating symptoms.
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Affiliation(s)
- Manuela Deodato
- School of Physiotherapy, Department of Medicine, Surgery and Health Sciences, University of Trieste, Via Pascoli 31, 34100, Trieste, Italy
| | - Caterina Qualizza
- School of Physiotherapy, Department of Medicine, Surgery and Health Sciences, University of Trieste, Via Pascoli 31, 34100, Trieste, Italy
| | - Miriam Martini
- School of Physiotherapy, Department of Medicine, Surgery and Health Sciences, University of Trieste, Via Pascoli 31, 34100, Trieste, Italy
- PhD Program in Personalized Medicine and Innovative Therapies, Department of Medicine, Surgery and Health Sciences, University of Trieste, Strada Di Fiume 447, 34149, Trieste, Italy
| | - Laura Mazzari
- School of Physiotherapy, Department of Medicine, Surgery and Health Sciences, University of Trieste, Via Pascoli 31, 34100, Trieste, Italy
| | - Giovanni Furlanis
- Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, University of Trieste, Strada Di Fiume 447, 34149, Trieste, Italy
| | - Alex Buoite Stella
- School of Physiotherapy, Department of Medicine, Surgery and Health Sciences, University of Trieste, Via Pascoli 31, 34100, Trieste, Italy.
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Strada Di Fiume 447, 34149, Trieste, Italy.
- Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, University of Trieste, Strada Di Fiume 447, 34149, Trieste, Italy.
| | - Paolo Manganotti
- School of Physiotherapy, Department of Medicine, Surgery and Health Sciences, University of Trieste, Via Pascoli 31, 34100, Trieste, Italy
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Strada Di Fiume 447, 34149, Trieste, Italy
- Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, University of Trieste, Strada Di Fiume 447, 34149, Trieste, Italy
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4
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Rauwerda NL, Kuut TA, Braamse AMJ, Csorba I, Nieuwkerk P, van Straten A, Knoop H. Insomnia and sleep characteristics in post COVID-19 fatigue: A cross-sectional case-controlled study. J Psychosom Res 2024; 177:111522. [PMID: 38113796 DOI: 10.1016/j.jpsychores.2023.111522] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 10/07/2023] [Accepted: 10/11/2023] [Indexed: 12/21/2023]
Abstract
OBJECTIVE Following COVID-19 many patients report persistent fatigue and insomnia. Given the overlapping features, insomnia can be underdiagnosed in post-COVID-19 fatigue patients. This study aimed to determine insomnia severity, prevalence of clinical insomnia and sleep characteristics of post-COVID-19 fatigue patients. Data of post-COVID-19 fatigue patients were compared with those of patients with chronic fatigue syndrome (ME/CFS), a condition resembling post-COVID-19 fatigue. METHODS In this cross-sectional case-controlled study, insomnia severity, assessed with the Insomnia Severity Index (ISI), and prevalence of clinical insomnia (ISI score ≥ 10), were determined in patients with post-COVID-19 fatigue (n = 114) and compared with ME/CFS (n = 59) using ANCOVA and logistic regression, respectively. Linear regression analyses were used to evaluate whether mood, concentration problems, pain, fatigue (assessed with questionnaires) and diagnosis were associated with insomnia. Sleep characteristics were determined with a sleep diary and accelerometer in post-COVID-19 fatigue and compared with ME/CFS using ANCOVA. RESULTS In patients with post-COVID-19 fatigue mean (SD) insomnia severity was 11.46 (5.7) and 64% reported clinical insomnia. Insomnia severity was significantly associated with depressive symptoms (ß = 0.49, p = 0.006) and age (ß = 0.08, p = 0.04). The mean (SD) subjective sleep duration was 7.4 (1.0) hours with a sleep efficiency of 82 (11)%. Several subjective sleep characteristics of the post-COVID-19 fatigue patients differed from ME/CFS patients; only sleep duration, being significantly shorter in post-COVID-19 fatigue patients (p = 0.003), seemed clinically relevant (d = 0.58). CONCLUSION Insomnia severity and prevalence of clinical insomnia are high in patients with post-COVID-19 fatigue. Insomnia should be assessed and if present treated with insomnia focused therapy.
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Affiliation(s)
- Nynke L Rauwerda
- Department of Medical Psychology, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands; Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam, the Netherlands; Department of Medical Psychology, Hospital Gelderse Vallei, Ede, the Netherlands.
| | - Tanja A Kuut
- Department of Medical Psychology, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands; Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam, the Netherlands
| | - Annemarie M J Braamse
- Department of Medical Psychology, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands; Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam, the Netherlands
| | - Irene Csorba
- Department of Medical Psychology, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands; Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam, the Netherlands
| | - Pythia Nieuwkerk
- Department of Medical Psychology, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands; Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam, the Netherlands; Amsterdam Institute for Infection and Immunity, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands
| | - Annemieke van Straten
- Department of Clinical, Neuro and Developmental Psychology & Amsterdam Public Health Research Institute, VU University, Amsterdam, the Netherlands
| | - Hans Knoop
- Department of Medical Psychology, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands; Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam, the Netherlands
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5
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Müller F, van Dongen S, van Woezik R, Tibosch M, Tuinman MA, Schellekens MPJ, Laurenceau JP, van der Lee M, Hagedoorn M. A Web-Based Mindfulness-Based Cognitive Therapy for Couples Dealing With Chronic Cancer-Related Fatigue: Protocol for a Single-Arm Pilot Trial. JMIR Res Protoc 2023; 12:e48329. [PMID: 37930767 PMCID: PMC10660231 DOI: 10.2196/48329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 08/04/2023] [Accepted: 08/29/2023] [Indexed: 11/07/2023] Open
Abstract
BACKGROUND Chronic fatigue is a common symptom among patients who have been treated for cancer. Current psychosocial interventions typically target the patient alone, despite growing evidence suggesting that a couples' approach can increase and broaden the efficacy of an intervention. Therefore, based on an existing web-based mindfulness-based cognitive therapy for patients, the couple intervention COMPANION was developed. OBJECTIVE The primary objectives of this study are to determine the acceptability of COMPANION and its potential efficacy in reducing fatigue in patients with cancer. Our secondary objectives are to examine the feasibility of the trial procedures and the potential working mechanisms of the couple intervention. METHODS We will conduct a single-arm pilot trial for couples (ie, patients with cancer with chronic fatigue and their partners). All couples are allocated to the web-based couple intervention that consists of psychoeducation, mindfulness, and cognitive-behavioral exercises. The 9 sessions of the intervention are supervised remotely by a trained therapist. Patients and partners will complete questionnaires before starting the intervention (T0), 2 weeks after completing the intervention (T1), and 1 month after T1 (T2). They will also fill out weekly diaries during the intervention period. A subsample of patients (n≈5) and partners (n≈5) as well as all the therapists providing COMPANION will participate in the final focus groups. Benchmark values have been defined to determine the acceptability (ie, ≥60% of couples complete the intervention and/or ≥70% of the participants are satisfied with the intervention) and potential efficacy (ie, a significant improvement in fatigue and/or a clinically relevant improvement in fatigue in 45% of the patients between T0 and T1) of the intervention. The trial procedures are deemed feasible if an average of at least three couples are included per recruiting month and/or adherence to the assessments is at least 65% for T1 and the diaries and 60% for T2. To establish potential working mechanisms, changes in affect, sleep, catastrophizing, partner communication and interactions, self-efficacy, mindfulness, and closeness will be examined. Quantitative outcomes will be interpreted along with the results from the focus groups. RESULTS Data collection is expected to be completed by March 2024. CONCLUSIONS This pilot trial will test the first web-based mindfulness-based cognitive therapy for couples targeting chronic cancer-related fatigue. Findings will indicate whether proceeding with a randomized controlled trial is warranted. TRIAL REGISTRATION ClinicalTrials.gov NCT05636696; https://clinicaltrials.gov/study/NCT05636696. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/48329.
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Affiliation(s)
- Fabiola Müller
- Department of Health Psychology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Sophie van Dongen
- Scientific Research Department, Helen Dowling Institute, Bilthoven, Netherlands
| | - Rosalie van Woezik
- Scientific Research Department, Helen Dowling Institute, Bilthoven, Netherlands
| | - Marijke Tibosch
- Scientific Research Department, Helen Dowling Institute, Bilthoven, Netherlands
| | - Marrit A Tuinman
- Department of Health Psychology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Melanie P J Schellekens
- Scientific Research Department, Helen Dowling Institute, Bilthoven, Netherlands
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, Netherlands
| | - Jean-Philippe Laurenceau
- Department of Psychological and Brain Sciences, University of Delaware, Newark, DE, United States
| | - Marije van der Lee
- Scientific Research Department, Helen Dowling Institute, Bilthoven, Netherlands
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, Netherlands
| | - Mariët Hagedoorn
- Department of Health Psychology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
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6
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Crawford JS. Issues with Expectation Bias, Absence of Data Relating to Objective Trial Outcome Measures, the Use of Low Quality Trial Design Methods and Choice of Flawed Psychological Model in ReCOVer Trial for Prolonged Fatigue Post Covid-19 Infection. Clin Infect Dis 2023; 77:1073-1074. [PMID: 37390809 DOI: 10.1093/cid/ciad397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 05/18/2023] [Indexed: 07/02/2023] Open
Affiliation(s)
- Joan S Crawford
- Chronic Pain Management Service, Mersey Care National Health Service Foundation Trust, St Helens, Merseyside, United Kingdom
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7
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Kuut TA, Müller F, Csorba I, Braamse A, Aldenkamp A, Appelman B, Assmann-Schuilwerve E, Geerlings SE, Gibney KB, Kanaan RAA, Mooij-Kalverda K, Olde Hartman TC, Pauëlsen D, Prins M, Slieker K, van Vugt M, Keijmel SP, Nieuwkerk P, Rovers CP, Knoop H. Efficacy of Cognitive-Behavioral Therapy Targeting Severe Fatigue Following Coronavirus Disease 2019: Results of a Randomized Controlled Trial. Clin Infect Dis 2023; 77:687-695. [PMID: 37155736 PMCID: PMC10495128 DOI: 10.1093/cid/ciad257] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 04/19/2023] [Accepted: 04/22/2023] [Indexed: 05/10/2023] Open
Abstract
BACKGROUND Severe fatigue following coronavirus disease 2019 (COVID-19) is prevalent and debilitating. This study investigated the efficacy of cognitive-behavioral therapy (CBT) for severe fatigue following COVID-19. METHODS A multicenter, 2-arm randomized controlled trial was conducted in the Netherlands with patients being severely fatigued 3-12 months following COVID-19. Patients (N = 114) were randomly assigned (1:1) to CBT or care as usual (CAU). CBT, targeting perpetuating factors of fatigue, was provided for 17 weeks. The primary outcome was the overall mean difference between CBT and CAU on the fatigue severity subscale of the Checklist Individual Strength, directly post-CBT or CAU (T1), and after 6 months (T2). Secondary outcomes were differences in proportions of patients meeting criteria for severe and/or chronic fatigue, differences in physical and social functioning, somatic symptoms, and problems concentrating between CBT and CAU. RESULTS Patients were mainly nonhospitalized and self-referred. Patients who received CBT were significantly less severely fatigued across follow-up assessments than patients receiving CAU (-8.8 [95% confidence interval {CI}, -11.9 to -5.8]); P < .001), representing a medium Cohen's d effect size (0.69). The between-group difference in fatigue severity was present at T1 (-9.3 [95% CI, -13.3 to -5.3]) and T2 (-8.4 [95% CI, -13.1 to -3.7]). All secondary outcomes favored CBT. Eight adverse events were recorded during CBT, and 20 during CAU. No serious adverse events were recorded. CONCLUSIONS Among patients, who were mainly nonhospitalized and self-referred, CBT was effective in reducing fatigue. The positive effect was sustained at 6-month follow-up. CLINICAL TRIALS REGISTRATION Netherlands Trial Register NL8947.
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Affiliation(s)
- Tanja A Kuut
- Department of Medical Psychology, Amsterdam UMC location University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
- Amsterdam Public Health, Amsterdam UMC location University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | - Fabiola Müller
- Department of Medical Psychology, Amsterdam UMC location University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
- Amsterdam Public Health, Amsterdam UMC location University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | - Irene Csorba
- Department of Medical Psychology, Amsterdam UMC location University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
- Amsterdam Public Health, Amsterdam UMC location University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | - Annemarie Braamse
- Department of Medical Psychology, Amsterdam UMC location University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
- Amsterdam Public Health, Amsterdam UMC location University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | - Arnoud Aldenkamp
- Department of Lung Medicine, Catharina Hospital, 5623 EJ Eindhoven, The Netherlands
| | - Brent Appelman
- Center for Experimental and Molecular Medicine, Amsterdam UMC location University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | | | - Suzanne E Geerlings
- Amsterdam Public Health, Amsterdam UMC location University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
- Amsterdam Institute for Infection and immunity, Amsterdam UMC location University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | - Katherine B Gibney
- Victorian Infectious Diseases Service, Royal Melbourne Hospital, Melbourne, 3000 Victoria, Australia
- Department of Infectious Diseases, University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Melbourne, 3000 Victoria, Australia
| | - Richard A A Kanaan
- Department of Psychiatry, University of Melbourne, Austin Health, Heidelberg, 3084 Victoria, Australia
| | - Kirsten Mooij-Kalverda
- Department of Pulmonology, Amsterdam UMC location University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | - Tim C Olde Hartman
- Department of Primary and Community Care, Radboud Institute for Health Sciences, 6500 HB Nijmegen, The Netherlands
| | - Dominique Pauëlsen
- Department of Medical Psychology, Amsterdam UMC location University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
- Amsterdam Public Health, Amsterdam UMC location University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | - Maria Prins
- Amsterdam Public Health, Amsterdam UMC location University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
- Amsterdam Institute for Infection and immunity, Amsterdam UMC location University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
- Department of Infectious Diseases, Public Health Service of Amsterdam, 1018 WT Amsterdam, The Netherlands
| | - Kitty Slieker
- Department of Internal Medicine, Bernhoven Hospital, 5406 PT Uden, The Netherlands
| | - Michele van Vugt
- Amsterdam Public Health, Amsterdam UMC location University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
- Amsterdam Institute for Infection and immunity, Amsterdam UMC location University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | - Stephan P Keijmel
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands
| | - Pythia Nieuwkerk
- Department of Medical Psychology, Amsterdam UMC location University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
- Amsterdam Public Health, Amsterdam UMC location University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
- Amsterdam Institute for Infection and immunity, Amsterdam UMC location University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | - Chantal P Rovers
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands
| | - Hans Knoop
- Department of Medical Psychology, Amsterdam UMC location University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
- Amsterdam Public Health, Amsterdam UMC location University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
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8
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Sharma E, Mondal S, Das S, Vrana VG. Scale Development for COVID-19 Vaccine Hesitancy by Integration of Socio-Demographic and Psychological Factors. Vaccines (Basel) 2023; 11:1052. [PMID: 37376441 DOI: 10.3390/vaccines11061052] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 05/27/2023] [Accepted: 05/29/2023] [Indexed: 06/29/2023] Open
Abstract
Vaccination is the most cost-effective way to maintain population health. However, it can only be effective if widespread acceptance is held. The efficacy of COVID-19 vaccines depends on their favor. When countries start to vaccinate their citizens, there is a certain level of skepticism about the effectiveness of the vaccines. The hesitancy study on vaccines has gained momentum following the pandemic. However, few studies have examined the link between the psychological and sociodemographic factors influencing the fit. This paper proposes integrating the concepts of the information systems success and stimulus-organism-response into a cognitive fit theory framework to explore the integration of psychological and sociodemographic factors in the receivers' reactions (n = 1510). This study analyses the factors that influence the hesitancy of vaccines and the public's refusal in Asia and Europe. Receivers' reactions were assessed to various stimuli and we explored the link between psychological and sociodemographic elements and the concept of fit. Two surveys were conducted following the scale development of Mackenzie. The first was to develop the fit scale, while the second was to validate the fit scale. The results of the second survey were analyzed using structural equation modelling. The results indicate that the scale's fit development is valid and reliable. The quality of the vaccine information, the psychological characteristics of the vaccine system, and vaccine receivers' satisfaction are also beneficial factors for emotional and cognitive fit. Maintaining the vaccines' quality and efficiency can help improve the fit between sociodemographic and psychological characteristics. It can also enhance receivers' satisfaction and encourage continued vaccine administration. This study is regarded as one of the first to examine and develop an emotional and cognitive fit scale for practitioners and researchers.
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Affiliation(s)
- Eliza Sharma
- Symbiosis Institute of Business Management Bengaluru, Symbiosis International (Deemed University), Karnataka 560100, India
| | - Subhra Mondal
- The Honors Programme, Department of Marketing, South Star Management Institute, Duy Tan University, Da Nang 550000, Vietnam
| | - Subhankar Das
- The Honors Programme, Department of Marketing, South Star Management Institute, Duy Tan University, Da Nang 550000, Vietnam
| | - Vasiliki G Vrana
- Department of Business Administration, School of Economics and Administration, The Campus of Serres, International Hellenic University, 62124 Serres, Greece
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BARĞI G. COVID-19 Geçirmiş Bireylerde Kinezyofobi, Fiziksel Aktivite, Depresyon, Anksiyete ve Stres Düzeyleri: Kesitsel Bir Çalışma. KOCAELI ÜNIVERSITESI SAĞLIK BILIMLERI DERGISI 2022. [DOI: 10.30934/kusbed.1136101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Objective: Kinesiophobia, inactivity and mood disturbances in post-COVID-19 individuals are poorly investigated. Therefore, the aim of this study was to compare measures of kinesiophobia, physical activity, depression, anxiety and stress in post-COVID-19 individuals and healthy individuals.
Methods: This cross-sectional study was conducted between 25 November 2021 and 30 December 2021. The individuals were recruited from the general community. Kinesiophobia was assessed with the Tampa Scale of Kinesiophobia, physical activity levels with the International Physical Activity Questionnaire Short-Form, and mood (depression, anxiety, and stress) with the Depression Anxiety Stress-21 Scale in all individuals.
Results: There were 29 volunteer individuals who had COVID-19 with a mean age of 33.41±7.95 years. Healthy controls consisted of 20 volunteers with a mean age of 31.3±7.81 years. Anxiety (55.2% versus 20%) and stress (34.5% versus 5%) were observed more frequently in the post-COVID-19 group. The scores for kinesiophobia and anxiety were significantly higher in post-COVID-19 individuals than healthy individuals (p<0.05). The scores for physical activity, depression and stress were similar between groups (p>0.05). Significant correlations were found among post-COVID-19 individuals for i) the scores for kinesiophobia and stress, and ii) the scores for physical activity, stress, and depression (p<0.05). There was no relationship between kinesiophobia and other outcomes in healthy individuals (p>0.05).
Conclusion: Although a high degree of kinesiophobia is observed in both post-COVID-19 and healthy individuals, kinesiophobia, anxiety and stress measures were higher in people exposed to COVID-19 than others. In post-COVID-19 individuals, kinesiophobia increased as stress increased, and physical activities decreased while stress and depression increased. Hence, exercises, physical activities and psychological counseling should be recommended to individuals exposed to COVID-19.
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Jamoulle M, Kazeneza-Mugisha G, Zayane A. Follow-Up of a Cohort of Patients with Post-Acute COVID-19 Syndrome in a Belgian Family Practice. Viruses 2022; 14:2000. [PMID: 36146806 PMCID: PMC9505954 DOI: 10.3390/v14092000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 08/30/2022] [Accepted: 09/01/2022] [Indexed: 11/18/2022] Open
Abstract
Fifty-five patients who suffered from COVID-19, who were still very ill after several months, with extreme fatigue, effort exhaustion, brain fog, anomia, memory disorder, anosmia, dysgeusia, and other multi-systemic health problems have been followed in a family practice setting between May 2021 and July 2022. Data extracted from the medical records of the 55 patients (40 women), mean age 42.4 (12 to 79 years), and a qualitative study of 6 of them using a semi-open-ended questionnaire allowed to highlight the clinical picture described by WHO as post-acute COVID-19 syndrome (PACS) also known as long COVID. We used brain single-photon emission computed tomography (SPECT-CT) in thirty-two patients with a high severity index and a highly impaired functional status, demonstrating vascular encephalopathy in twenty nine patients and supporting the hypothesis of a persistent cerebral vascular flow disorder in post COVID-19 condition. The patients will benefit from the consortium COVID Human Genetic Effort (covidhge.com) to explore the genetic and immunological basis of their problem, as 23/55 cases don't have immunological certainty of a COVID-19 infection. There is no known verified treatment. Analyzing the data from the first 52 patients, three categories of patients emerged over time: 16 patients made a full recovery after 6-8 months, 15 patients were able to return to life and work after 12-18 months with some sequelae, both groups being considered cured. In the third group, 21 patients are still very ill and unable to resume their work and life after 18 months. The biopsychosocial consequences on patients' lives are severe and family doctors are left out in the cold. It is necessary to test the reproducibility of this description, conducted on a small number of patients. Nevertheless, identifying, monitoring and supporting these patients is a necessity in family medicine.
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Affiliation(s)
- Marc Jamoulle
- HEC Information Sciences, University of Liège, 4000 Liege, Belgium
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Rawlings GH, Beail N. Long-COVID in people with intellectual disabilities: A call for research of a neglected area. BRITISH JOURNAL OF LEARNING DISABILITIES 2022; 51:BLD12499. [PMID: 36247098 PMCID: PMC9538317 DOI: 10.1111/bld.12499] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 07/28/2022] [Accepted: 08/09/2022] [Indexed: 06/16/2023]
Abstract
Background Long-COVID (also known as post-coronavirus-19 syndrome) is a term used to describe symptoms that people experience following their recovery from the COVID-19 virus. The severity of long-COVID is well recognised, with healthcare providers commissioning services to diagnose and treat those affected, as well as funded research into the condition. Methods We performed a systematic search for relevant articles but were unable to find any research on long-COVID in people with intellectual disabilities. Due to the lack of data, we have only been able to make extrapolations from what is known about the condition within the general population. Findings We provide an overview of long-COVID and its potential relevance to people with an intellectual disability. We have focused specifically on symptoms or signs, prevalence, risk factors and treatments of the condition in this group, highlighting areas for clinical practice and future research from a psychosocial perspective. We raise serious questions about our current understanding and the availability of the evidence-based to inform treatments tailored towards this population. Conclusion This is the first report that we are aware of on the topic of long-COVID in people with an intellectual disability. The lack of research is preventing us from gaining a greater understanding of how the condition impacts people with an intellectual disability.
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Affiliation(s)
| | - Nigel Beail
- Clinical Psychology UnitUniversity of SheffieldSheffieldUK
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Abstract
Die Weltgesundheitsorganisation (WHO) definiert Post-COVID-19(„coronavirus disease 2019“) als Zustand, der bei Personen mit einer anamnestisch wahrscheinlichen oder bestätigten SARS-CoV-2(„severe acute respiratory syndrome coronavirus type 2“)-Infektion 3 Monate nach Beginn der COVID-19-Symptome und mindestens 2 Monate andauernd vorhanden ist und durch eine alternative Diagnose nicht erklärbar ist. Kernsymptome des Post-COVID-Syndroms umfassen Atemnot, Fatigue und kognitive Dysfunktion, welche das alltägliche Funktionsniveau beeinflussen. Neuropsychiatrische Spätfolgen sind bei COVID-19-Patienten mit Inzidenzraten von über 30 % häufig. Neben den genannten Kernsymptomen zeigen Schlafstörungen, Depression und Angsterkrankungen erhöhte Inzidenzen. Nach gegenwärtiger Meinung werden assoziierte neuropsychiatrische Symptome sowohl unter dem Begriff Post-COVID-Syndrom subsumiert, aber auch als Komorbiditäten interpretiert, welche die Manifestation eines Post-COVID-Syndroms begünstigen können. So zeigt das Kernsymptom Fatigue Symptomüberlappung und Komorbidität mit psychischen Erkrankungen. Bildgebungsstudien deuten auf ein organisches Korrelat der Fatigue bei Post-COVID-Patienten hin, darüber hinaus wurden psychosoziale Aspekte und psychiatrische Komorbiditäten wie Depression und Angsterkrankungen als modulierende und damit potenziell behandelbare Faktoren identifiziert. Die Therapie der Fatigue umfasst neben dem pharmakologischen Management mit u. a. Stimulanzien und Antidepressiva auch nichtpharmakologische Strategien, hier vor allem die kognitive Verhaltenstherapie sowie körper- und bewegungsfokussierte Interventionen. Die Evidenz hierfür erwächst aus Metaanalysen bei tumorassoziierter oder postviraler Fatigue.
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Update of the Potential Treatments for Psychiatric and Neuropsychiatric Symptoms in the Context of the Post-COVID-19 Condition: Still a Lot of Suffering and Many More Things to Learn. TRAUMA CARE 2022. [DOI: 10.3390/traumacare2020011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: The World Health Organization (WHO) has defined a post-COVID-19 condition. Some of these symptoms can be categorized as psychiatric long COVID-19 if they appeared in the aftermath of COVID-19, including depression, anxiety, post-traumatic stress disorder, somatic symptoms disorders such as hyperventilation syndrome, fatigue, cognitive and sleep disorders. Psychiatric and neuropsychiatric post-COVID-19 present mental health specialists with difficult challenges because of its complexity and the multiple ways in which it integrates into a singular somatic context. Methods: We conducted a systematic research paradigm from SARS-CoV-2 using LitCOVID and Web of Science to search management strategies and potential treatments for psychiatric post-COVID-19 symptoms. Results: Management strategies must be based on a multidisciplinary approach to promote the global evaluation of psychiatric and physical symptoms, systematic detection and prevention. Selective serotonin reuptake inhibitors appear to be the best choice to treat post-COVID-19 depression and anxiety disorders, and tofisopam could be helpful for anxiety. Cognitive behavioral therapy techniques adjusted to post-COVID-19 fatigue, functional remediation, extracorporeal apheresis, transcutaneous auricular vagus nerve stimulation, monoclonal antibodies, flavonoids, oxytocin or L-carnitine all represent hypothetical therapeutic avenues that remain to be evaluated in clinical trials. Conclusions: Psychiatric and neuropsychiatric post-COVID-19 symptoms occur frequently and are debilitating. Attention should be paid to this condition and studies undertaken to specify the effective treatments.
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