Claessens Gisela, Gerritzen Iris, van Osch Frits, van den Bergh Joop P, Verberne Daan, Gach Debbie, van Balen Eric, van Heugten Caroline M
Department of Medical Psychology, VieCuri Medical Center, Venlo, Netherlands.
Department of Clinical Epidemiology, VieCuri Medical Center, Venlo, Netherlands.
Front Psychol. 2024 Aug 13;15:1396963. doi: 10.3389/fpsyg.2024.1396963. eCollection 2024.
There is still much uncertainty about why some people develop persistent cognitive and mental health problems after SARS-CoV-2 infection and require additional care while others do not. In this study, we investigated the cognitive and psychological outcomes of non-hospitalized post-COVID-19 patients referred to an outpatient post-COVID-19 clinic for persistent symptoms more than 3 months after infection. Additionally, we aimed to explore the influence of demographic, physical, and personal factors on these outcomes.
This cross-sectional study was conducted at an outpatient post-COVID-19 clinic located at a prominent clinical teaching hospital in the Netherlands. Participants included non-hospitalized patients referred between 2020 and 2022, more than 3 months after SARS-CoV-2 infection, experiencing persistent symptoms. Main outcome measures included levels of anxiety and depression (Hospital Anxiety and Depression Scale), post-traumatic stress symptoms (PTSS) (Post-traumatic Stress Symptoms Checklist 14), and cognitive symptoms (Checklist for Cognitive and Emotional Consequences). Data analysis employed Spearman correlation and hierarchical multiple regression analyses.
A total of 265 patients (61% female; mean age of 51.7 ± 13.7 years) were included in the study, with an average of 7.6 ± 4.5 months following SARS-CoV-2 infection. Among them, 104 patients (40%) reported high levels of anxiety, 111 patients (43%) showed high levels depressive symptoms, and 71 patients (31%) demonstrated high levels of PTSS. Additionally, 200 patients (79%) reported experiencing more than 2 cognitive symptoms. Bivariate analyses indicated associations between psychiatric history and increased cognitive and psychological symptoms. Multivariate analyses revealed positive associations between physical symptoms and cognitive and psychological symptoms, and catastrophizing thoughts were associated with higher anxiety levels ( = 0.217, < 0.001). Conversely, positive refocusing was associated with lower depressive symptoms ( = -0.325, < 0.001), PTSS ( = -0.290, < 0.001), and cognitive symptoms ( = -0.220, < 0.001).
Among non-hospitalized COVID-19 patients seeking care for persistent symptoms, approximately one-third reported high levels of psychological symptoms, and more than three-quarter experienced cognitive symptoms. Physical symptoms, psychiatric history, and a tendency to catastrophize were identified as potential risk factors for persistent psychological and cognitive symptoms. Conversely, positive refocusing demonstrated a protective effect. These findings contribute to the understanding of long-term COVID-19 outcomes and emphasize the importance of integrating a biopsychosocial perspective into treatment approaches.
对于为何有些人在感染新型冠状病毒2（SARS-CoV-2）后会出现持续的认知和心理健康问题并需要额外护理，而另一些人则不会，目前仍存在诸多不确定性。在本研究中，我们调查了感染SARS-CoV-2超过3个月后因持续症状被转诊至新冠门诊的非住院新冠后患者的认知和心理结果。此外，我们旨在探讨人口统计学、身体和个人因素对这些结果的影响。
这项横断面研究在荷兰一家著名临床教学医院的新冠门诊进行。参与者包括2020年至2022年间被转诊的非住院患者，这些患者在感染SARS-CoV-2超过3个月后仍有持续症状。主要结局指标包括焦虑和抑郁水平（医院焦虑抑郁量表）、创伤后应激症状（PTSS）（创伤后应激症状清单14）以及认知症状（认知和情绪后果清单）。数据分析采用斯皮尔曼相关性分析和分层多元回归分析。
本研究共纳入265名患者（61%为女性；平均年龄51.7±13.7岁），感染SARS-CoV-2后平均随访7.6±4.5个月。其中，104名患者（40%）报告焦虑水平较高，111名患者（43%）表现出较高的抑郁症状，71名患者（31%）表现出较高的PTSS水平。此外，200名患者（79%）报告有超过2种认知症状。双变量分析表明精神病史与认知和心理症状增加之间存在关联。多变量分析显示身体症状与认知和心理症状之间存在正相关，灾难化思维与较高的焦虑水平相关（β = 0.217，P < 0.001）。相反，积极的重新聚焦与较低的抑郁症状（β = -0.325，P < 0.001）、PTSS（β = -0.290，P < 0.001）和认知症状（β = -0.220，P < 0.001）相关。
在因持续症状寻求护理的非住院新冠患者中，约三分之一报告有高水平的心理症状，超过四分之三有认知症状。身体症状、精神病史和灾难化倾向被确定为持续心理和认知症状的潜在危险因素。相反，积极的重新聚焦显示出保护作用。这些发现有助于理解新冠的长期后果，并强调将生物心理社会视角纳入治疗方法的重要性。
