Document Type : Original Article
Authors
- . Shabir Ahmad Dar
- . Mohammad Maqbool Dar
- . Shanoo Sheikh 1
- . Inaamul Haq 2
- . Aaliya Mohi Ud Din Azad 3
- . Mehvish Mushtaq 3
- . Naveed Nazir Shah 3
- . Zaid Ahmad Wani
1 Department of Clinical Psychology, College of Health and Rehabilitation, Princess Nourah Abdulrahman University, Riyadh, Saudi Arabia
2 Department of Social and Preventive Medicine, Government Medical College, Srinagar, Jammu and Kashmir, India
3 Department of Respiratory Medicine, Government Medical College, Srinagar, Jammu and Kashmir, India
Abstract
BACKGROUND: The coronavirus disease‑19 (COVID‑19) emerged from China and rapidly spread
to many other countries all over the world. This study aimed to assess the prevalence of anxiety,
depression, posttraumatic stress disorder, and obsessive–compulsive (OC) symptoms among
COVID‑19 survivors after their discharge from the COVID‑19 treatment center.
MATERIALS AND METHODS: This was a cross‑sectional, hospital‑based study performed among
119 COVID‑19 survivors. The Hospital Anxiety and Depression Scale (HADS) was used to measure
anxiety and depression. Posttraumatic Stress Disorder (PTSD)‑Checklist (PCL) and Brief OC Scale
were used to measure PTSD and OC symptoms. Data were analyzed by descriptive and inferential
statistics using the SPSS (IBM Corp. Released 2015 version 23.0).
RESULTS: The mean anxiety, depression, and PTSD scores were, 7.12 ± 0.68, 8.08 ± 0.22, and
19.78 ± 0.88, respectively. Based on cutoff scores, the prevalence of anxiety, depression, and
PTSD among COVID‑19 survivors was n = 53, 44.54%; n = 73, 61.34%; and n = 30, 25.21%,
respectively. Older COVID‑19 survivors (≥50 years) were more likely to show symptoms of
depression and anxiety (P < 0.001) compared to younger ones. Furthermore, COVID‑19 survivors
who were ≥50 years of age experienced a greater level of PTSD compared to younger ones; similar
trends were seen in those experiencing OC symptoms. In the present study, n = 98 (82.4%) were
obsessed with fears of contamination and an equal number had compulsive handwashing.
CONCLUSION: Anxiety, depression, PTSD, and OC symptoms are common among the COVID‑19
survivors and that underscores the need to diagnose and manage mental health morbidities among
these survivors long after their recovery from COVID‑19.
Keywords
- Shigemura J, Ursano RJ, Morganstein JC, Kurosawa M,
BenedekDM. Public responses to the novel 2019 coronavirus (2019‐
nCoV) in Japan: Mental health consequences and target
populations. Psychiatry and clinical neurosciences. 2020 Apr;
74 (4):281.
2. Park HY, Jung J, Park HY, Lee SH, Kim ES, Kim HB, Song KH.
Psychological Consequences of Survivors of COVID‑19
Pneumonia 1 Month after Discharge. Journal of Korean medical
science. 2020 Dec 7;35 (47).
3. Park HY, Park WB, Lee SH, Kim JL, Lee JJ, Lee H, Shin HS.
Posttraumatic stress disorder and depression of survivors 12
months after the outbreak of Middle East respiratory syndrome
in South Korea. BMC public health. 2020 Dec; 20:1‑9.
4. Rogers JP, Chesney E, Oliver D, Pollak TA, McGuire P,
Fusar‑Poli P, Zandi MS, Lewis G, David AS. Psychiatric
and neuropsychiatric presentations associated with severe
coronavirus infections: A systematic review and meta‑analysis
with comparison to the COVID‑19 pandemic. The Lancet
Psychiatry. 2020 Jul 1;7 (7):611‑27.
5. Miao XR, Chen QB, Wei K, Tao KM, Lu ZJ. Posttraumatic
stress disorder: From diagnosis to prevention. Military Medical
Research. 2018 Dec; 5 (1):1‑7.
6. Kucharski AJ, Russell TW, Diamond C, Liu Y, Edmunds J, Funk S,
et al. Early dynamics of transmission and control of COVID‑19:
A mathematical modelling study. Lancet Infect Dis 2020;20:553‑8.
7. Torales J, O’Higgins M, Castaldelli‑Maia JM, Ventriglio A. The
outbreak of COVID‑19 coronavirus and its impact on global
mental health. Int J Soc Psychiatry 2020;66:317‑20.
8. Liu CH, Zhang E, Wong GT, Hyun S. Factors associated with
depression, anxiety, and PTSD symptomatology during the
COVID‑19 pandemic: Clinical implications for US young adult
mental health. Psychiatry research. 2020 Aug 1;290:113172.
https://doi.org/10.1016/j.psychres. 20200.113172
9. Sun L, Sun Z, Wu L, Zhu Z, Zhang F, Shang Z, Jia Y, Gu J, Zhou Y,
Wang Y, Liu N. Prevalence and risk factors of acute posttraumatic
stress symptoms during the COVID‑19 outbreak in Wuhan, China.
MedRxiv. 2020 Jan 1. https://doi.org/10.1101/2020.03.060.2003
2425
10. Fekih‑Romdhane F, Ghrissi F, Abbassi B, Cherif W, Cheour M.
Prevalence and predictors of PTSD during the COVID‑19
pandemic: Findings from a Tunisian community sample.
Psychiatry Research. 2020 Aug; 290:113131. https://doi.
org/10.1016/j.psychres. 2020.113131
11. ForteG, Favieri F, TambelliR, CasagrandeM. COVID‑19 pandemic
in the Italian population: Validation of a post‑traumatic stress
disorder questionnaire and prevalence of PTSD symptomatology.
International journal of environmental research and public health.
2020 Jan; 17 (11):4151.
12. Xiang YT, Yang Y, Li W, Zhang L, Zhang Q, Cheung T, et al.
Timely mental health care for the 2019 novel coronavirus outbreak
is urgently needed. Lancet Psychiatry 2020;7:228‑9.
13. Brooks SK, Webster RK, Smith LE, Woodland L, Wessely S,
Greenberg N, et al. The psychological impact of quarantine and
how to reduce it: Rapid review of the evidence. The lancet. 2020
Mar 14;395 (10227):912‑20.
14. Greenberg N, Docherty M, Gnanapragasam S, Wessely S.
Managing mental health challenges faced by healthcare workers
during covid‑19 pandemic. bmj. 2020 Mar 26;368. https://doi.
org/10.1136/bmj.m1211
15. Asmundson GJ, Taylor S. Coronaphobia: Fear and the 2019‑nCoV
outbreak. Journal of anxiety disorders. 2020 Mar; 70:102196.
10.1016/j.janxdis. 2020.102196
16. Li S, Wang Y, Xue J, Zhao N, Zhu T. The impact of COVID‑19
epidemic declaration on psychological consequences: A study
on active Weibo users. International journal of environmental
research and public health. 2020 Jan; 17 (6):2032. https://doi.
org/10.3390/ijerph17062032.
17. Rosso G, Albert U, Asinari GF, Bogetto F, Maina G. Stressful
life events and obsessive–compulsive disorder: Clinical
features and symptom dimensions. Psychiatry research. 2012
May 30;197 (3):259‑64. https://doi.org/100.1016/j.psychres.
2011.10.005
18. World Health Organization ( W H O ) . N o v e l
Coronavirus (2019‑nCoV) Situation Reports; 2020. Available
from: https://www.who.int/emergencies/diseases/
novel‑coronavirus‑2019/situation‑reports. [Last accessed on
2020 Jun 09].
19. Djukanovic I, Carlsson J, Årestedt K. Is the Hospital Anxiety and
Depression Scale (HADS) a valid measure in a general population
65‑80 years old? A psychometric evaluation study. Health Qual
Life Outcomes 2017;15:193.
20. Rishi P, Rishi E, Maitray A, Agarwal A, Nair S, Gopalakrishnan S.
Hospital anxiety and depression scale assessment of 100 patients
before and after using low vision care: A prospective study in a
tertiary eye‑care setting. Indian J Ophthalmol 2017;65:1203.
21. Bah AJ, James PB, Bah N, Sesay AB, Sevalie S, Kanu JS. Prevalence
of anxiety, depression and post‑traumatic stress disorder among
Ebola survivors in northern Sierra Leone: A cross‑sectional study.
BMC Public Health 2020;20:1391.
22. Turon H, Carey M, Boyes A, Hobden B, Dilworth S,
Sanson‑Fisher R. Agreement between a single‑item measure of
anxiety and depression and the Hospital Anxiety and Depression
Scale: A cross‑sectional study. PLoS One 2019;14:e0210111.
23. Luceño‑Moreno L, Talavera‑Velasco B, García‑Albuerne Y,
Martín‑García J. Symptoms of posttraumatic stress, anxiety,
depression, levels of resilience and burnout in Spanish health
personnel during the COVID‑19 pandemic. Int J Environ Res
Public Health 2020;17:5514.
24. Waterman S, Hunter EC, Cole CL, Evans LJ, Greenberg N,
Rubin GJ, et al. Training peers to treat Ebola centre workers
with anxiety and depression in Sierra Leone. Int J Soc Psychiatry
2018;64:156‑65.
25. Blevins CA, Weathers FW, Davis MT, Witte T, Domino JL. The
posttraumatic stress disorder checklist for DSM‑5 (PCL‑5):
Development and Initial Psychometric Evaluation. J Trauma
Stress 2015;28:489‑98.
26. Ibrahim H, Ertl V, Catani C, Ismail AA, Neuner F. The validity
of posttraumatic stress disorder checklist for DSM‑5 (PCL‑5)
as screening instrument with Kurdish and Arab displaced
populations living in the Kurdistan region of Iraq. BMC Psychiatry
2018;18:259.
27. Bejerot S, Edman G, Anckarsäter H, Berglund G, Gillberg C,
Hofvander B, et al. The Brief Obsessive‑Compulsive Scale (BOCS):
A self‑report scale for OCD and obsessive‑compulsive related
disorders. Nord J Psychiatry 2014;68:549‑59.
28. Bohmwald K, Gálvez NM, Ríos M, Kalergis AM. Neurologic
alterations due to respiratory virus infections. Front Cell Neurosci
2018;12:386.
29. de Medeiros Carvalho PM, Moreira MM, de Oliveira MN,
Landim JM, Neto ML. The psychiatric impact of the novel
coronavirus outbreak. Psychiatry research. 2020 Apr; 286:112902.
https://doi.org/10.1016/j.psychres. 20200.112902
30. Kong X, Zheng K, Tang M, Kong F, Zhou J, Diao L, Wu S, Jiao P,
Su T, Dong Y. Prevalence and factors associated with depression
and anxiety of hospitalized patients with COVID‑19. MedRxiv. - 2020 Jan 1. https://doi.org/10.1101/2020.03.240.20043075
31. Li X, Tian J, Xu Q. The Associated Factors of Anxiety and
Depressive Symptoms in COVID‑19 Patients Hospitalized in
Wuhan, China. Psychiatric Quarterly. 2020 Nov 23:1‑9. https://
doi.org/10.1007/s11126‑020‑09865‑9
32. Wu Y, Xu X, Chen Z, Duan J, Hashimoto K, Yang L, et al. Nervous
system involvement after infection with COVID‑19 and other
coronaviruses. Brain Behav Immun 2020;87:18‑22.
33. Zheng Y, Xiao L, Xie Y, Wang H, Wang G. Prevalence and
Characteristics of Obsessive‑Compulsive Disorder Among Urban
Residents in Wuhan During the Stage of Regular Control of
Coronavirus Disease‑19 Epidemic. Frontiers in psychiatry. 2020
Dec 16;11:1435.
34. Zamanian M, Ahmadi D, Sindarreh S, Aleebrahim F,
Vardanjani HM, Faghihi SH, et al. Fear and rumor associated
with COVID‑19 among Iranian adults, 2020. J Educ Health Promot
2020;9:355.
35. Mazza MG, De Lorenzo R, Conte C, Poletti S, Vai B, Bollettini I,
et al. Anxiety and depression in COVID‑19 survivors: Role
of inflammatory and clinical predictors. Brain Behav Immun
2020;89:594‑600.
36. Zhang J, Lu H, Zeng H, Zhang S, Du Q, Jiang T, et al. The
differential psychological distress of populations affected by the
COVID‑19 pandemic. Brain Behav Immun 2020;87:49‑50.
37. Pietrzak RH, Tracy M, Galea S, Kilpatrick DG, Ruggiero KJ,
Hamblen JL, et al. Resilience in the face of disaster: Prevalence
and longitudinal course of mental disorders following hurricane
Ike. PLoS One 2012;7:e38964.
38. Makwana N. Disaster and its impact on mental health: A narrative
review. J Family Med Prim Care 2019;8:3090‑5.
39. Cascella M, Rajnik M, Cuomo A, Dulebohn SC, Di Napoli R.
Features, evaluation and treatment coronavirus (COVID‑19).
Statpearls [internet]. 2020 Mar 8.
40. Qu YM, Kang EM, Cong HY. Positive result of Sars‑Cov‑2 in
sputum from a cured patient with COVID‑19. Travel medicine
and infectious disease. 2020 Mar 1. 10.1016/j.tmaid. 2020.101619
41. Chen D, Xu W, Lei Z, Huang Z, Liu J, Gao Z, et al. Recurrence
of positive SARS‑CoV‑2 RNA in COVID‑19: A case report. Int J
Infect Dis 2020;93:297‑9.
42. Ni MY, Yao XI, Leung KS, Yau C, Leung CM, Lun P, et al.
Depression and post‑traumatic stress during major social unrest
in Hong Kong: A 10‑year prospective cohort study. Lancet
2020;395:273‑84.
43. Achdut N, Refaeli T. Unemployment and psychological
distress among young people during the COVID‑19 pandemic:
Psychological resources and risk factors. Int J Environ Res Public
Health 2020;17:7163.
44. Chang MC, Park D. Incidence of post‑traumatic stress disorder
after coronavirus disease. Healthcare (Basel) 2020;8:373.
45. Mowbray H. In Beijing, coronavirus 2019‑nCOV has created a
siege mentality. BMJ 2020;368:m516.
46. Xiao S, Luo D, Xiao Y. Survivors of COVID‑19 are at high risk of
posttraumatic stress disorder. Glob Health Res Policy 2020;5:29.
47. Fontenelle LF, Cocchi L, Harrison BJ, Miguel EC, Torres AR. Role
of stressful and traumatic life events in obsessive‑compulsive
disorder. Neuropsychiatry 2011;1:61.
48. Abba‑Aji A, Li D, Hrabok M, Shalaby R, Gusnowski A,
Vuong W, et al. COVID‑19 pandemic and mental health:
prevalence and correlates of new‑onset obsessive‑compulsive
symptoms in a Canadian province. Int J Environ Res Public
Health 2020;17:6986.
49. Subramaniam M, Abdin E, VaingankarJA, Chong SA. Obsessive–
compulsive disorder: Prevalence, correlates, help‑seeking and
quality of life in a multiracial Asian population. Soc Psychiatry
Psychiatr Epidemiol 2012;47:2035‑43.
50. Brakoulias V, Starcevic V, Belloch A, Brown C, Ferrao YA,
Fontenelle LF, et al. Comorbidity, age of onset and suicidality
in obsessive‑compulsive disorder (OCD): An international
collaboration. Compr Psychiatry 2017;76:79‑86.
51. Anholt GE, Aderka IM, Van Balkom AJ, Smit JH, Schruers K,
Van Der Wee NJ, et al. Age of onset in obsessive–compulsive
disorder: Admixture analysis with a large sample. Psychol Med
2013;44:185‑94.
52. Wang Y, Di Y, Ye J, Wei W. Study on the public psychological
states and its related factors during the outbreak of coronavirus
disease 2019 (COVID‑19) in some regions of China. Psychology,
health & medicine. 2021 Jan 2;26 (1):13‑22. https://doi.org/10.1
080/135485060.2020.1746817
53. Papaioannou AI, Bartziokas K, Tsikrika S, Karakontaki F,
Kastanakis E, Banya W, et al. The impact of depressive symptoms
on recovery and outcome of hospitalized COPD exacerbations.
Eur Respir J 2013;41:815‑23.
)