Mid-term Psychiatric Outcomes of Patients Recovered From COVID-19 From an Italian Cohort of Hospitalized Patients

Abstract

Background: Although the usual primary clinical manifestation of Coronavirus disease (COVID-19) is respiratory, several non-respiratory symptoms have been described, including neuropsychiatric ones. The aim of this study was to investigate the mid-term mental health outcomes in patients recovered from COVID-19, 3–4 months after discharge from the University Hospital Maggiore della Carità, Novara, Italy. Furthermore, we investigated the possible association of the mid-term mental health consequences of the COVID-19 infection with patients' clinical current status, persistent physical impairment and severity of acute phase of the disease.Methods: Prospective study involving 238 individuals recovered from COVID-19. In the context of a multi-disciplinary approach, patients' assessment included both a clinical interview performed by an experienced psychiatrist, trained in the use of the Mini-International Neuropsychiatric Interview to assess the presence of anxiety and depressive symptoms and self-administered questionnaires: Beck Anxiety Inventory (BAI), Beck Depression Inventory-II (BDI-II), Resilience Scale for Adults (RSA), Impact of Event Scale (IES).Results: At the psychiatric assessment 32.9 and 29.5% of participants showed anxiety and depressive symptoms, respectively. Changes in appetite and sleep patterns emerged for 15.6 and 31.2% of patients. According to the self-administered questionnaires, 7.1% of participants had moderate-severe anxiety levels (BAI), while 10.5% had mild to severe depression (BDI-II). Twenty-six (11%) participants were referred to further psychiatric consultation. Psychiatric symptoms showed no correlation with acute COVID-19 severity; in our sample patients with depressive symptoms at the clinical interview, as well as those with mild to severe levels of depression according to BDI-II scores, had lower forced expiratory volume in the 1st second (FEV1) values than those without and greater odds for persistent, poor tolerance for physical efforts.Conclusions: As could be expected, an approach including both a psychiatric interview and the use of self-administered questionnaires is likely to capture the psychiatric outcome of patients recovered from COVID-19 better than questionnaires alone. Anxiety and depressive symptoms at follow-up had no correlation with the severity of COVID acute manifestations, but rather with ongoing and persistent physical symptoms. Further studies and longer follow-up duration will allow a better understanding of the complex relationship between residual physical symptoms, quality of life and psychological health.

Psychiatric symptoms in Long-COVID patients: a systematic review

“…Our analyses did not find a significant association between the severity of COVID-19 infection and psychiatric symptoms, except for a potential inverse association with symptoms of cognitive impairment. These findings align with the conclusions drawn from most of the reports included in our systematic review, which examined the relationship between infection severity and psychiatric symptoms ( 6 , 17 , 20 , 23 , 27 , 34 , 40 ). Notably, only one study reported an increased risk of depression and anxiety among individuals with the most severe form of infection ( 8 ).…”

“…As shown in Figure 1 , from 2078 records screened on title and abstract, 114 full texts were analyzed. The review process led to the selection of 33 studies ( 3 , 4 , 6 – 8 , 14 – 41 ). These studies, referring to 33 different samples and involving a total of 282,711 LC participants, were included in the final selection and quantitative synthesis.…”

“…Although progress has been made in the understanding of the clinical and epidemiological features, including the pathogenesis and complications of the acute phase of COVID-19, long-term consequences of the disease remain largely unclear ( 6 ).…”