Anxiety, Post–COVID-19 Syndrome-Related Depression, and Suicidal Thoughts and Behaviors in COVID-19 Survivors: Cross-sectional Study

Abstract

Background Although the mental health impacts of COVID-19 on the general population have been well studied, studies of the long-term impacts of COVID-19 on infected individuals are relatively new. To date, depression, anxiety, and neurological symptoms associated with post–COVID-19 syndrome (PCS) have been observed in the months following COVID-19 recovery. Suicidal thoughts and behavior (STB) have also been preliminarily proposed as sequelae of COVID-19. Objective We asked 3 questions. First, do participants reporting a history of COVID-19 diagnosis or a close relative having severe COVID-19 symptoms score higher on depression (Patient Health Questionnaire-9 [PHQ-9]) or state anxiety (State Trait Anxiety Index) screens than those who do not? Second, do participants reporting a COVID-19 diagnosis score higher on PCS-related PHQ-9 items? Third, do participants reporting a COVID-19 diagnosis or a close relative having severe COVID-19 symptoms score higher in STB before, during, or after the first year of the pandemic? Methods This preliminary study analyzed responses to a COVID-19 and mental health questionnaire obtained from a US population sample, whose data were collected between February 2021 and March 2021. We used the Mann-Whitney U test to detect differences in the medians of the total PHQ-9 scores, PHQ-9 component scores, and several STB scores between participants claiming a past clinician diagnosis of COVID-19 and those denying one, as well as between participants claiming severe COVID-19 symptoms in a close relative and those denying them. Where significant differences existed, we created linear regression models to predict the scores based on COVID-19 response as well as demographics to identify potential confounding factors in the Mann-Whitney relationships. Moreover, for STB scores, which corresponded to 5 questions asking about 3 different time intervals (i.e., past 1 year or more, past 1 month to 1 year, and past 1 month), we developed repeated-measures ANOVAs to determine whether scores tended to vary over time. Results We found greater total depression (PHQ-9) and state anxiety (State Trait Anxiety Index) scores in those with COVID-19 history than those without (Bonferroni P=.001 and Bonferroni P=.004) despite a similar history of diagnosed depression and anxiety. Greater scores were noted for a subset of depression symptoms (PHQ-9 items) that overlapped with the symptoms of PCS (all Bonferroni Ps<.05). Moreover, we found greater overall STB scores in those with COVID-19 history, equally in time windows preceding, during, and proceeding infection (all Bonferroni Ps<.05). Conclusions We confirm previous studies linking depression and anxiety diagnoses to COVID-19 recovery. Moreover, our findings suggest that depression diagnoses associated with COVID-19 history relate to PCS symptoms, and that STB associated with COVID-19 in some cases precede infection.

Prevalence, predictors, and patient-reported outcomes of long COVID in hospitalized and non-hospitalized patients from the city of São Paulo, Brazil

“…Previous studies, including those conducted in low-and middle-income countries, have established a link between female gender and long COVID ( 12 , 13 , 21 – 23 ), However, it has not been previously reported that a positive depression screening at day 30 using a validated questionnaire could be a risk factor for diagnosing long COVID at day 90 ( 24 , 25 ). Additionally, few studies have examined depression as a risk factor for COVID-19 or long COVID ( 26 , 27 ). Taquet et al showed a bidirectional association between COVID-19 and psychiatric disorder.…”

Neuropsychiatric symptoms of post-COVID-19 condition in Mexican healthcare personnel.

“…Existing data reported depressive and anxiety symptoms post-COVID-19 25,26 . However, there is a wide variation of depression and anxiety data between studies (5.8% 4 , 37% 27 , and 91.2% 25 ).…”

“…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 (18-24); 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.…”

Association Between Frequency of Muscle-Strengthening Exercise and Depression Symptoms Among Middle and High School Students: Cross-Sectional Survey Study

“…The estimated number of disability-adjusted life years among adolescents aged 10 to 19 years diagnosed with depression disorders increased worldwide from 3.4 million to 4.3 million between 1990 and 2019 [ 2 ], and in 2019, there were 22.9 million adolescents aged 10 to 19 years with depression disorders worldwide, of whom 1.5 million were in China [ 2 ]. Depression among adolescents may contribute to many negative consequences, including functional impairment, poor cognitive development, poor academic performance, and suicide [ 3 , 4 ]. Depression is also associated with a wide variety of chronic physical disorders, including arthritis, asthma, cancer, cardiovascular disease, diabetes, obesity, hypertension, chronic respiratory disorders, and dementia, acting via multiple mechanisms that are not yet completely clear [ 5 ].…”