School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, the Netherlands; Limburg Brain Injury Center, Maastricht University, Maastricht, the Netherlands.
School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, the Netherlands; Department of Medical Psychology, Maastricht University Medical Center, Maastricht, the Netherlands; Department of Medical Psychology, Radboud University Medical Center, Nijmegen, the Netherlands.
Arch Phys Med Rehabil. 2024 May;105(5):826-834. doi: 10.1016/j.apmr.2023.12.014. Epub 2024 Jan 14.
To evaluate whether psychological and social factors complement biomedical factors in understanding post-COVID-19 fatigue and cognitive complaints. Additionally, to incorporate objective (neuro-cognitive) and subjective (patient-reported) variables in identifying factors related to post-COVID-19 fatigue and cognitive complaints.
Prospective, multicenter cohort study.
Six Dutch hospitals.
205 initially hospitalized (March-June 2020), confirmed patients with SARS-CoV-2, aged ≥18 years, physically able to visit the hospital, without prior cognitive deficit, magnetic resonance imaging (MRI) contraindication, or severe neurologic damage post-hospital discharge (N=205).
Not applicable.
Nine months post-hospital discharge, a 3T MRI scan and cognitive testing were performed and patients completed questionnaires. Medical data were retrieved from medical dossiers. Hierarchical regression analyses were performed on fatigue severity (Fatigue Severity Scale; FSS) and cognitive complaints (Cognitive Consequences after Intensive Care Admission; CLC-IC; dichotomized into CLC-high/low). Variable blocks: (1) Demographic and premorbid factors (sex, age, education, comorbidities), (2) Illness severity (ICU/general ward, PROMIS physical functioning [PROMIS-PF]), (3) Neuro-cognitive factors (self-reported neurological symptoms, MRI abnormalities, cognitive performance), (4) Psychological and social factors (Hospital Anxiety and Depression Scale [HADS], Utrecht Coping List, Social Support List), and (5) Fatigue or cognitive complaints.
The final models explained 60% (FSS) and 48% (CLC-IC) variance, with most blocks (except neuro-cognitive factors for FSS) significantly contributing. Psychological and social factors accounted for 5% (FSS) and 11% (CLC-IC) unique variance. Higher FSS scores were associated with younger age (P=.01), lower PROMIS-PF (P<.001), higher HADS-Depression (P=.03), and CLC-high (P=.04). Greater odds of CLC-high were observed in individuals perceiving more social support (OR=1.07, P<.05).
Results show that psychological and social factors add to biomedical factors in explaining persistent post-COVID-19 fatigue and cognitive complaints. Objective neuro-cognitive factors were not associated with symptoms. Findings highlight the importance of multidomain treatment, including psychosocial care, which may not target biologically-rooted symptoms directly but may reduce associated distress.
评估心理和社会因素是否在理解 COVID-19 后疲劳和认知主诉方面补充了生物医学因素。此外，将客观（神经认知）和主观（患者报告）变量纳入识别与 COVID-19 后疲劳和认知主诉相关的因素。
前瞻性、多中心队列研究。
六家荷兰医院。
205 名最初住院（2020 年 3 月至 6 月）、确诊 SARS-CoV-2 感染、年龄≥18 岁、身体能够就诊于医院、无先前认知缺陷、磁共振成像（MRI）禁忌证或出院后严重神经损伤的患者（N=205）。
不适用。
住院后 9 个月进行 3T MRI 扫描和认知测试，患者完成问卷调查。从病历中检索医疗数据。对疲劳严重程度（疲劳严重程度量表；FSS）和认知主诉（重症监护入院后的认知后果；CLC-IC；分为 CLC-高/低）进行层次回归分析。变量块：（1）人口统计学和发病前因素（性别、年龄、教育、合并症），（2）疾病严重程度（ICU/普通病房、PROMIS 身体机能[PROMIS-PF]），（3）神经认知因素（自我报告的神经系统症状、MRI 异常、认知表现），（4）心理和社会因素（医院焦虑和抑郁量表[HADS]、乌得勒支应对清单、社会支持清单），以及（5）疲劳或认知主诉。
最终模型解释了 60%（FSS）和 48%（CLC-IC）的变异，除了 FSS 的神经认知因素外，大多数块（均）有显著贡献。心理和社会因素分别解释了 5%（FSS）和 11%（CLC-IC）的独特变异。较高的 FSS 评分与较年轻的年龄（P=.01）、较低的 PROMIS-PF（P<.001）、较高的 HADS 抑郁（P=.03）和 CLC-高（P=.04）相关。感知到更多社会支持的个体发生 CLC-高的可能性更大（OR=1.07，P<.05）。
结果表明，心理和社会因素在解释持续的 COVID-19 后疲劳和认知主诉方面补充了生物医学因素。客观的神经认知因素与症状无关。研究结果强调了多领域治疗的重要性，包括心理社会护理，其可能不是直接针对生物学根源的症状，但可能会减轻相关的痛苦。
