National Institute of Traditional Chinese Medicine Constitution and Preventive Treatment of Diseases, Beijing University of Chinese Medicine, Beijing, 100029, China.
Department of Public Health, Huangzhou General Hospital, Huanggang, 438000, Hubei, China.
Eur Arch Psychiatry Clin Neurosci. 2023 Mar;273(2):301-310. doi: 10.1007/s00406-022-01484-8. Epub 2022 Oct 3.
This study is aimed to investigate the mental health status of COVID-19 survivors 1 year after discharge from hospital and reveal the related risk factors.
From April 11 to May 11, 2021, 566 COVID-19 survivors in Huanggang city were recruited through their primary doctors. A total of 535 participants (94.5%) admitted to participate in the survey and completed the questionnaires. Five scales were applied including 7-Items Generalized Anxiety Disorder Scale, Patient Health Questionnaire-9, Impact of Event Scale-Revised, Pittsburgh Sleep Quality Index, and Fatigue Scale-14. The chi-square and the Fisher's exact test were used to evaluate the classification data, multivariate logistic regression was used to explore the related factors of sleep quality, fatigue, anxiety, depression, and post-traumatic stress disorder (PTSD).
One year after being discharged, of the 535 COVID-19 survivors, 252 (47.1%) had poor sleep quality; 157 (29.3%) had the symptoms of fatigue; 84 (15.7%),112 (20.9%), and 130 (24.3%) suffered from symptoms of anxiety, depression, and PTSD, respectively. The logistic regression analysis showed that history of chronic disease was risk factor for poor sleep quality (OR 2.501; 95% CI, 1.618-3.866), fatigue (OR 3.284; 95% CI 2.143-5.033), PTSD (OR 2.323; 95% CI 1.431-3.773) and depression (OR 1.950; 95% CI 1.106-3.436) in COVID-19 survivors. Smoking contributed to the poor sleep quality (OR 2.005; 95% CI 1.044-3.850), anxiety (OR 4.491; 95% CI 2.276-8.861) and depression (OR 5.459; 95% CI 2.651-11.239) in survivors. Drinking influenced fatigue (OR 2.783; 95% CI 1.331-5.819) and PTSD (OR 4.419; 95% CI 1.990-9.814) in survivors. Compared with college-educated survivors, survivors with high school education were at higher risk for poor sleep quality (OR 1.828; 95% CI 1.050-3.181) and PTSD (OR 2.521; 95% CI 1.316-4.830), and survivors with junior high school education were at higher risk for PTSD (OR 2.078; 95% CI 1.039-4.155). Compared with overweight survivors (BMI ≥ 23.0), survivors with normal BMI (18.5-22.9) (OR 0.600; 95% CI 0.405-0.889) were at lower risk for fatigue. While being housewife (OR 0.390; 95% CI 0.189-0.803) was protective factor for fatigue and having more family members was protective factor for PTSD (OR 0.404 95% CI 0.250-0.653) in survivors.
One year after infection, poor sleep quality, fatigue, anxiety, depression, and PTSD, still existed in a relatively high proportion of COVID-19 survivors. Chronic disease history was an independent risk factor for poor sleep quality, fatigue, depression, and PTSD. Participants with low education levels were more likely to have mental problems than the others. We should focus on the long-term psychological impact of COVID-19 on survivors, and the government should apply appropriate mental health services to offer psychiatric support.
本研究旨在调查 COVID-19 出院后 1 年幸存者的心理健康状况，并揭示相关风险因素。
2021 年 4 月 11 日至 5 月 11 日，通过其初级医生招募了黄冈市 566 名 COVID-19 幸存者。共有 535 名参与者（94.5%）承认参与调查并完成了问卷。应用了五个量表，包括 7 项广泛性焦虑障碍量表、患者健康问卷-9、事件影响量表修订版、匹兹堡睡眠质量指数和疲劳量表-14。使用卡方检验和 Fisher 确切检验评估分类数据，使用多因素 logistic 回归分析探讨睡眠质量、疲劳、焦虑、抑郁和创伤后应激障碍（PTSD）的相关因素。
出院后 1 年，535 名 COVID-19 幸存者中，252 名（47.1%）睡眠质量较差；157 名（29.3%）出现疲劳症状；84 名（15.7%）、112 名（20.9%）和 130 名（24.3%）分别出现焦虑、抑郁和 PTSD 症状。logistic 回归分析显示，慢性病史是睡眠质量差（OR 2.501；95%CI，1.618-3.866）、疲劳（OR 3.284；95%CI，2.143-5.033）、PTSD（OR 2.323；95%CI，1.431-3.773）和抑郁（OR 1.950；95%CI，1.106-3.436）的危险因素。吸烟导致睡眠质量差（OR 2.005；95%CI，1.044-3.850）、焦虑（OR 4.491；95%CI，2.276-8.861）和抑郁（OR 5.459；95%CI，2.651-11.239）。饮酒影响幸存者的疲劳（OR 2.783；95%CI，1.331-5.819）和 PTSD（OR 4.419；95%CI，1.990-9.814）。与受过高等教育的幸存者相比，高中文化程度的幸存者睡眠质量差（OR 1.828；95%CI，1.050-3.181）和 PTSD（OR 2.521；95%CI，1.316-4.830）的风险更高，而初中文化程度的幸存者 PTSD 的风险更高（OR 2.078；95%CI，1.039-4.155）。与超重幸存者（BMI≥23.0）相比，BMI 正常（18.5-22.9）的幸存者（OR 0.600；95%CI，0.405-0.889）患疲劳的风险较低。而家庭主妇（OR 0.390；95%CI，0.189-0.803）是疲劳的保护因素，家庭成员较多是 PTSD 的保护因素（OR 0.404 95%CI 0.250-0.653）。
感染后 1 年，COVID-19 幸存者中仍存在较高比例的睡眠质量差、疲劳、焦虑、抑郁和 PTSD。慢性病史是睡眠质量差、疲劳、抑郁和 PTSD 的独立危险因素。文化程度较低的参与者比其他人更容易出现心理问题。我们应该关注 COVID-19 对幸存者的长期心理影响，政府应该提供适当的心理健康服务，为精神支持提供帮助。
