In a recent study published in PLOS ONE Journal, researchers performed a systematic-type review to identify factors that increase the risk of psychiatric symptoms among long coronavirus disease (COVID) or post-COVID 2019 (COVID-19) condition (PCC) patients.

Study: Risk factors for psychiatric symptoms in patients with long COVID: A systematic review. Image Credit: Cryptographer/Shutterstock.com

Background

COVID-19 affects the mental health of affected individuals, primarily due to anxiety, fear, and negative social behaviors, resulting in distressing reactions and health risk behaviors.

Psychiatric-type symptoms have been reported frequently among PCC patients, lasting for weeks or months following recovery. However, the psychiatric PCC symptomatology and associated risk factors are unclear.

Studies have demonstrated that anxiety, depression, post-traumatic stress disorder (PTSD), fatigue, sleep difficulties, and cognitive impairments are common among COVID-19 convalescents.

Other symptoms, such as somatization, sleep difficulties, phobic anxiety, hostility, and obsessive-compulsive disorders, have been observed among severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-positive patients. These symptoms may reportedly persist for long periods following hospital discharge.

About the study

In the present systematic review, researchers analyzed data on psychiatric symptomatology and associated risk factors among PCC patients.

Databases such as EMBASE, PubMed, and SCOPUS were searched on October 24, 2021, for English records published from January 2020 through October 2021, with available full text.

The studies comprised adult and elderly individuals with a confirmed diagnosis of COVID-19, with psychiatric symptomatology persisting >4.0 weeks following the acute SARS-CoV-2 infection, using the National Institute for Health and Care Excellence (NICE) criteria for PCC.

In addition, references listed in the identified records were searched, and citation searching was performed for the included records and previously published relevant reviews. Newcastle-Ottawa scale (NOS) was used to evaluate bias risks for observational-type studies.

The team obtained risk factors and prevalence rates of psychiatric COVID-19 symptoms. Only records with study designs such as cohort-type, case-control-type, cross-sectional-type, or case series type were included.

Reviews and studies comprising children and/or adolescents were excluded. One researcher searched data, and two researchers performed the title-abstract and full-text screening.

Data extracted included author name, year of publication, country of publication, design of the study, sample population, age, male-to-female ratio, the time elapsed since the diagnosis of acute COVID-19, psychiatric symptom prevalence, evaluation tools, risk factors of statistical significance, and their effect sizes (relative risks, odds ratios, hazard ratios, and prevalence ratios).

Results and discussion

In total, 2,218 records were initially obtained, 1,022 duplicate records were eliminated, and 1,131 were removed after the title-abstract screening.

Furthermore, 47 records that did not meet the eligibility criteria were eliminated, and five additional records were included through citation searching. As a result, 23 records were considered for the final analysis.

The majority of included studies used validated but self-documentation questionnaires. The mean NOS score of the included studies was 6.4, indicating moderate evidence quality.

The most frequently documented psychiatric-type symptoms included depression, anxiety, sleep difficulties, PTSD, cognitive impairments, and somatic-type symptoms.

The female sex, prior history of psychiatric disorders, family member loss, self-perceived COVID-19 severity, and persistent symptoms elevated the risk of psychiatric-type symptoms among PCC patients.

Anxiety was documented in 19 out of 23 records, with a prevalence range of 7.0% to 48%. Depression was documented in 17 records, and the prevalence ranged between 4.0% and 36%. PTSD was documented in seven records, with a prevalence range of 13% to 43%. Insomnia and sleep difficulties were documented in 13 records, and their prevalence ranged between 4.0% and 50%.

In addition, the team found associations between neutrophil-lymphocyte ratio (NLR) at hospitalization, elevated interleukin-6 (IL-6), C-reactive protein (CRP), COVID-19-associated hospitalizations, and moderate-intensity SARS-CoV-2 infections.

The follow-up duration was associated with anxiety and PTSD, and obesity was associated with poor sleep quality among PCC patients. Further, marital status, hospital/ intensive care unit (ICU) length of stay, neurological complications, and days elapsed following hospital discharge were associated with cognitive impairments in PCC.

The female sex could increase the risk of psychiatric symptoms among PCC patients due to feminine tendencies toward internalizing disorders in mental well-being. Additionally, females are more habituated to social interactions and support beyond households for preserving mental health.

Thus, the lack of social gatherings due to COVID-19-associated lockdowns could negatively impact females. Further, women tend to be more hyperactive, with negative mood and cognitive disturbances that could result in depression.

Obesity could contribute to sleep difficulties due to associated hyperinflammation, immunological dysfunction, and chronic comorbid conditions. PTSD has been documented during the pandemic because of living with uncertainties, stress, and daily life changes, instead of COVID-19.

Conclusion

Overall, the study findings showed that psychiatric symptoms such as depression, anxiety, PTSD, and sleep difficulties were common among PCC patients, concordant with previous studies.

The female sex and prior history of psychiatric diseases increased the risk of developing most psychiatric PCC symptoms. The findings could aid in developing novel strategies to improve the mental health of PCC patients.

The persistence of psychiatric symptoms in the post-acute phase of COVID-19 could increase the disease burden, warranting long-term monitoring, thorough screening, and early intervention of mental health disorders among PCC patients.

Written by

Pooja Toshniwal Paharia

Dr. based clinical-radiological diagnosis and management of oral lesions and conditions and associated maxillofacial disorders.