Olgun Yıldızeli Sehnaz, Kocakaya Derya, Saylan Yüsra Hafza, Tastekin Gözde, Yıldız Sudenur, Akbal Şükran, Özkan Sümeyra, Arıkan Hüseyin, Karakurt Sait
Pulmonary and Critical Care Medicine, Marmara University School of Medicine, Istanbul, TUR.
Cureus. 2023 Jul 29;15(7):e42637. doi: 10.7759/cureus.42637. eCollection 2023 Jul.
Introduction As of December 2019, the COVID-19 infection had spread rapidly across the globe, causing a pandemic. Although the virus primarily affects the respiratory and circulatory systems, neuropsychiatric disorders have been reported in a significant number of infected individuals. The aim of this study is to identify anxiety, depression, and sleep disturbances in the early post-COVID period, as well as potential risk factors. Method Symptomatic cases whose COVID-19 diagnosis was confirmed by polymerase chain reaction (PCR) positivity within the previous three months were evaluated in the COVID-19 follow-up clinic, where they were observed for at least four weeks after the diagnosis. Cases with no suspicious symptoms and no documented PCR positivity were selected as the control group. All participants completed the Hospital Anxiety Depression Scale (HADS) questionnaire and the Pittsburgh sleep quality questionnaire. The laboratory parameters of hospitalized patients with infection were recorded. Results A total of 283 patients were included in the study. While the median age of 144 patients with COVID-19 infection was 44 years, and 104 of them (72.2%) were female, the median age of the controls without COVID-19 infection was 52 years, and 65 of them (46.8%) were female. About 89 (61.8%) of the 144 patients with COVID-19 infections were hospitalized. When the results of the applied HADS questionnaire were analyzed, the median total value of all study participants was 10 points, whereas it was 13 in cases with COVID-19 and nine in those who did not have it (p<0.001). Taking into account the subgroups of the anxiety and depression questionnaires, both results are statistically significantly higher (p<0.001 and p=0.022, respectively) in post-COVID patients. When the hospitalization status of COVID-19 patients was compared, there was no difference in the development of anxiety (p=0.23), but depression(p<0.024) and poor sleep quality(p<0.001) were prevalent in hospitalized patients. The median PSQI score of the entire study population was five points, while it was seven points in cases with COVID-19 infection and four points in cases who did nothave it (p<0.001). Sleep latency (p<0.003), sleep disturbances (p<0.001), and daytime dysfunction (p<0.001) were statistically significantly worse in COVID-19-infected patients. Female gender (p<0.01) and the presence of past anxiety-depression symptoms (p<0.013) were found to be as risk factors in patients with infection. The correlation between the total HADS score, the PSQI, and the results of the complete blood count and biochemical analysis at the time of diagnosis in hospitalized patients was also investigated. CRP (CI 0.26-0.58) p<0.001 vs (CI 0.09-0.45) p=0.004 and ferritin (CI 0.05-0.43) p=0.017 vs (CI 0.01-0.40) p=0.047exhibited a positive correlation. Similarly, lymphocyte count (CI -0.65 to -0.37) p<0.001 vs (CI -0.39 to -0.01) p<0.001 and lymphocyte percentage (-0.57 to -0.24) p=0.001 vs (-0.65 to -0.37) p=0.039 were negatively correlated. Conclusion Early post-infection anxiety, depression, and sleep disturbances increased significantly in COVID-19 patients. Female gender and previous symptoms of anxiety and depression are risk factors, and inpatient treatment increases depression and poor sleep quality. High HADS and poor sleep quality scores are positively correlated with inflammatory parameters and should be evaluated in post-infection in particular.
引言 截至2019年12月,新型冠状病毒肺炎(COVID-19)感染已在全球迅速传播,引发了一场大流行。尽管该病毒主要影响呼吸系统和循环系统,但大量感染个体中已报告出现神经精神障碍。本研究的目的是确定COVID-19感染后早期的焦虑、抑郁和睡眠障碍,以及潜在风险因素。
方法 在COVID-19随访门诊对过去三个月内通过聚合酶链反应(PCR)检测呈阳性确诊为COVID-19的有症状病例进行评估,确诊后对其观察至少四周。选择无可疑症状且无PCR阳性记录的病例作为对照组。所有参与者均完成医院焦虑抑郁量表(HADS)问卷和匹兹堡睡眠质量问卷。记录感染住院患者的实验室参数。
结果 本研究共纳入283例患者。144例COVID-19感染患者的中位年龄为44岁,其中104例(72.2%)为女性,而未感染COVID-19的对照组中位年龄为52岁,其中65例(46.8%)为女性。144例COVID-19感染患者中约89例(61.8%)住院。分析所应用的HADS问卷结果时,所有研究参与者的总得分中位数为10分,而COVID-19患者为13分,未感染患者为9分(p<0.001)。考虑焦虑和抑郁问卷的亚组,COVID-19感染后患者的两项结果在统计学上均显著更高(分别为p<0.001和p=0.022)。比较COVID-19患者的住院状态时,焦虑的发生率无差异(p=0.23),但住院患者中抑郁(p<0.024)和睡眠质量差(p<0.001)更为普遍。整个研究人群的PSQI得分中位数为5分,而COVID-19感染患者为7分,未感染患者为4分(p<0.001)。COVID-19感染患者的睡眠潜伏期(p<0.003)、睡眠障碍(p<0.001)和日间功能障碍(p<0.001)在统计学上显著更差。发现女性(p<0.01)和既往有焦虑抑郁症状(p<0.013)是感染患者的风险因素。还研究了住院患者诊断时HADS总分、PSQI与全血细胞计数及生化分析结果之间的相关性。CRP(CI 0.26 - 0.58)p<0.001与(CI 0.09 - 0.45)p=0.004以及铁蛋白(CI 0.05 - 0.43)p=0.017与(CI 0.01 - 0.40)p=0.047呈正相关。同样,淋巴细胞计数(CI -0.65至-0.37)p<0.001与(CI -0.39至-0.01)p<0.001以及淋巴细胞百分比(-0.57至-0.24)p=0.001与(-0.65至-0.37)p=0.039呈负相关。
结论 COVID-19患者感染后早期焦虑、抑郁和睡眠障碍显著增加。女性性别以及既往焦虑和抑郁症状是风险因素,住院治疗会增加抑郁和睡眠质量差的情况。高HADS得分和睡眠质量差与炎症参数呈正相关,尤其应在感染后进行评估。