[Post-COVID-19 syndrome]. / Syndrome post-COVID-19.

In the aftermath of acute infection with the severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2), a large number of symptoms persist or appear, constituting a real syndrome called "long COVID-19" or "post-COVID- 19" or "post-acute COVID-19 syndrome". Its incidence is very high, half of patients showing at least one symptom at 4-6 months after Coronarovirus infectious disease 2019 (COVID-19). They can affect many organs. The most common symptom is persistent fatigue, similar to that seen after other viral infections. Radiological pulmonary sequelae are relatively rare and not extensive. On the other hand, functional respiratory symptoms, primarily dyspnoea, are much more frequent. Dysfunctional breathing is a significant cause of dyspnoea. Cognitive disorders and psychological symptoms are also very common, with anxiety, depression and post-traumatic stress symptoms being widely described. On the other hand, cardiac, endocrine, cutaneous, digestive or renal sequelae are rarer. The symptoms generally improve after several months, even if their prevalence at two years remains significant. Most of the symptoms are favored by the severity of the initial illness, and the psychic symptoms by the female sex. The pathophysiology of most symptoms is poorly understood. The influence of the treatments used in the acute phase is also important. Vaccination, on the other hand, seems to reduce their incidence. The sheer number of affected patients makes long-term COVID-19 syndrome a public health challenge.

[Burnout, anxiety, insomnia and depressive symptoms among French outpatient physicians in the second wave of COVID-19: Comparison between general practitioners and specialists]. / Santé mentale des médecins libéraux français pendant la deuxième vague de COVID 19.

INTRODUCTION: The 2019 coronavirus (COVID-19) pandemic has caused a public health crisis worldwide. Concerns have been expressed about the rapid deterioration of mental health among primary care physicians among whom burnout already had a high prevalence prior to the pandemic. However, there is little data on private doctors during the pandemic. France experienced a second wave with a second lockdown. We aimed to assess and compare physicians' burnout, anxiety and depression symptoms and insomnia between general practitioners (GP) and all other private specialists during the second Covid-19 wave. METHODS: We conducted an online survey of private practitioners registered on Doctolib® (n=32,655), the interface software most used by private practitioners for booking medical appointments in France. Doctors were invited by email to complete an online survey in November 2020. Inclusions were closed on 1st December. The 2nd lockdown lasted from 30th October to 15th December 2020. We used the Copenhagen Burnout Inventory (CBI) to assess burnout syndrome. A mean score of>50 in at least one subscale defined burnout. The Hospital Anxiety and Depression Scale assessed anxiety and depression symptoms. We used two cut-offs, 8 (>7) and 11 (>10), as both are validated in the ability to find cases. The Insomnia Severity Index (ISI) measures sleep-related complaints among physicians (cut-off >7). To link variations in the psychological scales to the COVID-19 pandemic, one of the items asked explicitly whether participants considered that "the COVID-19 epidemic we are currently experiencing is a source of excess stress, psychological suffering or burnout". Approval for this study was obtained from the local institutional review board of the University of Paris-Saclay, France. The questionnaires were collected anonymously. Statistical significance was tested using the chi-square test and student's t-test to compare the prevalence between GPs and other specialities. Subsequently, logistic regression models were run for statistically significant associations. RESULTS: 1992 physicians replied, a response rate of 12.8% of those who received the invitation email. Among them, 79.4% suffered from psychological distress (symptoms of anxiety or depression or burnout), of which 71.3% suffered from burnout, 26.7% from depressive symptoms, 58.9% from anxiety symptoms and 45.8% from insomnia. There was no difference in gender between GPs and specialists, but there was an age difference (P<0.001). GPs had a higher prevalence of burnout (OR=1.33 CI95 [1.09;1.63]) and took more psychotropic drugs (1.38 CI95 [1.05;1.81]). They were also more likely to perceive their stress as work-related (OR=1.50 CI95 [1.23;1.81]) or COVID-19-related (OR=1.43 CI95 [1.16;1.77]). CONCLUSION: Our study is the first to assess the mental health of private practitioners in the second wave in association with COVID-19 stress. Firstly, GPs who provide primary care have a significantly higher burnout rate than other doctors. Secondly, COVID-19 stress is associated with more significant psychological distress. Thirdly, almost 80% of the private doctors surveyed suffer from psychological pain, and 71% suffer from burnout. This study has strengths and limitations. Firstly, this study assesses mental health and stress related to its COVID-19 association. Second, this is the largest population of private physicians during the COVID-19 pandemic. The low response rate is the main limit of this study. The alarming rates of psychological distress among private doctors and, in particular, GPs should lead to intervention to help doctors reduce stress, burnout and other mental disorders. This study gives a picture of the situation during the second wave and the lock-in, and we need to be cautious with the next waves.

Syndrome post-COVID-19☆ Post-COVID-19 syndrome

Dans les suites de l'infection aiguë par le severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2), de très nombreux symptômes persistent ou apparaissent, constituant un véritable syndrome appelé « COVID-19 long » ou « syndrome post-COVID-19 » ou « syndrome de COVID-19 post-aigu ». Son incidence est très élevée, la moitié des patients présentant au moins un symptôme à 4–6 mois après le Coronarovirus infectious disease 2019 (COVID-19). Ils peuvent toucher de très nombreux organes. Le symptôme le plus fréquent est une fatigue persistante, semblable à celle rencontrée après d'autres infections virales. Les séquelles pulmonaires radiologiques sont relativement rares et peu étendues. En revanche, les symptômes respiratoires fonctionnels, en premier lieu la dyspnée, sont beaucoup plus fréquents. La respiration dysfonctionnelle est une cause de dyspnée non négligeable. Des troubles cognitifs et des symptômes psychiques sont aussi très fréquents, les symptômes anxieux, dépressifs et de stress post-traumatique étant largement décrits. Les séquelles cardiaques, endocriniennes, cutanées, digestives ou rénales sont en revanche plus rares. Les symptômes vont globalement en s'améliorant au terme de plusieurs mois, même si leur prévalence à deux ans reste non négligeable. La plupart des symptômes sont favorisés par la gravité de la maladie initiale, et les symptômes psychiques par le sexe féminin. La physiopathologie de la plupart des symptômes est mal connue. L'influence des traitements utilisés à la phase aiguë l'est aussi. La vaccination semble en revanche réduire leur incidence. Le nombre total de patients touchés fait du syndrome de COVID-19 long un défi pour la santé publique.

Santé mentale des médecins libéraux français pendant la deuxième vague de COVID 19 Burnout, anxiety, insomnia and depressive symptoms among French outpatient physicians in the second wave of COVID-19: comparison between general practitioners and specialists

Résumé Introduction: La pandémie de COVID-19 a créé une crise sanitaire mondiale ayant entraîné une souffrance psychologique du personnel soignant notamment les médecins hospitaliers. Nous avons montré que les niveaux de souffrance psychologiques étaient aussi élevés parmi les médecins libéraux. Aucune étude n'a à ce jour comparé les médecins généralistes avec les médecins de l'ensemble des autres spécialités libérales pendant la pandémie en France. Cette étude visait à comparer la souffrance psychologique en termes de burn-out, d'anxiété, de symptômes dépressifs et d'insomnie entre les médecins généralistes et les médecins libéraux de toutes les autres spécialités en France durant la deuxième vague épidémique. Méthodes: Il s'agissait d'une étude transversale nationale en ligne adressée aux médecins libéraux utilisateurs de Doctolib. Nous avons utilisé le Copenhagen Burnout Inventory, l'Hospital and Anxiety Depression Scale, l'Insomnia Severity Index, afin d'évaluer burn-out, symptômes anxieux et dépressifs et insomnie. Nous avons évalué l'association entre la pandémie COVID-19, le travail et l'état psychologique. La période d'inclusion était du 1er au 30 novembre 2020 pendant le deuxième confinement. L'étude a été menée selon les critères STROBE. Résultats: 1 992 médecins ont répondu dont 957 généralistes. Parmi les médecins répondants, 79,4 % souffraient de détresse psychologique. Les médecins généralistes rapportaient davantage de stress lié au COVID-19 (OR = 1,43 IC95 [1,16 ;1,77]) et à leur travail (OR= 1,50;I C95[1,23-1,81]) et souffraient plus de burn-out que les médecins d'autres spécialités (OR = 1,33 IC95 [1,09;1,63]). Ils consommaient également davantage de psychotropes (OR=1,38 ;IC95[1,05-1,81]). Discussion: les médecins libéraux déclaraient un niveau élevé de détresse psychologique durant la pandémie covid-19. Les médecins généralistes souffraient de davantage de stress lié à la pandémie et à leur travail en comparaison aux médecins d'autres spécialités.

Assessment of mental health of university students faced with different lockdowns during the coronavirus pandemic, a repeated cross-sectional study

Background: Studies have highlighted the impact of the COVID-19 pandemic on the mental health of university students. However, little is known about the psychological impact of successive lockdowns on this population. Objectives: To assess the prevalence of psychological distress in a student population during the first two lockdowns linked to the COVID-19 pandemic, and to stratify them by subgroup. Methods: We used a repeated cross-sectional study of a university student population in France during the first lockdown, the unlockdown, and the second lockdown. We measured rates of depression, anxiety, distress and suicidal ideation. A weighted prevalence was calculated with 95% confidence intervals. Predictors of symptom progression were measured using adjusted logistic regression. Results: 19,150 university students responded to the surveys. Our results suggest a significant decrease in the scores for depression (aOR = 0.64;CI%: 0.59-0.70), anxiety (aOR = 0.81;CI%: 0.74-0.88), and distress symptoms (aOR = 0.47;CI%: 0.43-0.51) between the first lockdown and the lifting of the lockdown. However, a significant increase in symptoms of depression (aOR = 1.53;CI%: 1.43-1.64), anxiety (aOR = 1.56;CI%: 1.45-1.67) and suicidal ideation (aOR = 1.59;CI%: 1.45-1.73) between the first and second lockdown is highlighted. The most impacted students are PhD students, they show a significant increase (aOR = 4.37;CI%: 1.41-13.54) in suicidal ideation. Conclusion: Mental health professionals will need to be vigilant about this population, both to provide care for psychological distress, but also to reduce the risk of PhD students dropping out. (PsycInfo Database Record (c) 2023 APA, all rights reserved) (Chinese) : COVID-19 ,- :COVID-19 , :-, 95% :19,150 -,(aOR = 0.64;CI%:0.59-0.70)(aOR = 0.81;CI%:0.74-0.88)(aOR = 0.47;CI%:0.43-0.51),-(aOR = 1.53;CI%:1.43-1.64)(aOR = 1.56;CI%:1.45-1.67)(aOR = 1.59;CI%:1.45-1.73),(aOR = 4.37;CI%:1.41-13.54) :-,, (PsycInfo Database Record (c) 2023 APA, all rights reserved) (Spanish) Antecedentes: Los estudios han destacado el impacto de la pandemia de COVID-19 en la salud mental de los estudiantes universitarios. Sin embargo, poco se sabe acerca del impacto psicologico de los sucesivos confinamientos en esta poblacion. Objetivos: Evaluar la prevalencia del malestar psicologico en una poblacion estudiantil durante los primeros dos confinamientos vinculados a la pandemia COVID-19 y estratificarlos por subgrupos. Metodos: Utilizamos un estudio transversal repetido de una poblacion de estudiantes universitarios en Francia durante el primer confinamiento, el desbloqueo y el segundo confinamiento. Medimos las tasas de depresion, ansiedad, angustia e ideacion suicida. Se calculo una prevalencia ponderada con intervalos de confianza del 95%. Los predictores de la progresion de los sintomas se midieron mediante regresion logistica ajustada. Resultados: 19.150 estudiantes universitarios respondieron las encuestas. Nuestros resultados sugieren una disminucion significativa en los puntajes de depresion (aOR = 0.64;%IC: 0.59-0.70), ansiedad (aOR = 0.81;%IC: 0.74-0.88) y sintomas de angustia (aOR = 0.47;%IC: 0.43-0.51) entre el primer confinamiento y el levantamiento de este. Sin embargo, se destaca un aumento significativo en los sintomas de depresion (aOR = 1.53;%IC: 1.43-1.64), ansiedad (aOR = 1.56;%IC: 1.45-1.67) e ideacion suicida (aOR = 1.59;%IC: 1.45-1.73) entre el primer y segundo confinamiento. Los estudiantes mas afectados son los doctorandos, ellos muestran un aumento significativo (aOR = 4.37;%IC: 1.41-13.54) de ideacion suicida. Conclusion: Los profesionales de salud mental deberan estar atentos a esta poblacion, tanto para proporcionar cuidado para el malestar psicologico, como tambien para reducir el riesgo de que los estudiantes de doctorado abandonen sus estudios. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Functional respiratory complaints among COVID-19 survivors: a prospective cohort study

Background Dyspnoea is a common persistent symptom after COVID-19. Whether it is associated with functional respiratory disorders remains unclear. Methods We assessed the proportion and characteristics of patients with "functional respiratory complaints” (FRCs) (as defined by Nijmegen Questionnaire>22) among 177 post-COVID-19 individuals who benefited from outclinic evaluation in the COMEBAC study (i.e., symptomatic and/or ICU survivors at 4 months). In a distinct explanatory cohort of 21 consecutive individuals with unexplained post-COVID-19 dyspnoea after routine tests, we also analysed the physiological responses to incremental cardio-pulmonary exercise testing (CPET). Findings In the COMEBAC cohort, 37 had significant FRCs (20.9%, IC95: 14.9–26.9). The prevalence of FRCs ranged from 7.2% (ICU patients) to 37.5% (non-ICU patients). The presence of FRCs was significantly associated with more severe dyspnoea, lower 6-minute walk distance, more frequent psychological and neurological symptoms (cognitive complaint, anxiety, depression, insomnia and post-traumatic stress disorders) and poorer quality of life (all p<0.01). In the explanatory cohort, 7/21 patients had significant FRCs. Based on CPET, dysfunctional breathing was identified in 12/21 patients, 5/21 had normal CPET, 3/21 had deconditioning and 1/21 had evidence of uncontrolled cardiovascular disease. Interpretation FRCs are common during post-COVID-19 follow-up, especially among patients with unexplained dyspnoea. Diagnosis of dysfunctional breathing should be considered in those cases. Funding Assistance Publique-Hôpitaux de Paris.

Clinical features and outcomes of COVID-19 patients hospitalized for psychiatric disorders: a French multi-centered prospective observational study.

BACKGROUND: Patients with psychiatric disorders are exposed to high risk of COVID-19 and increased mortality. In this study, we set out to assess the clinical features and outcomes of patients with current psychiatric disorders exposed to COVID-19. METHODS: This multi-center prospective study was conducted in 22 psychiatric wards dedicated to COVID-19 inpatients between 28 February and 30 May 2020. The main outcomes were the number of patients transferred to somatic care units, the number of deaths, and the number of patients developing a confusional state. The risk factors of confusional state and transfer to somatic care units were assessed by a multivariate logistic model. The risk of death was analyzed by a univariate analysis. RESULTS: In total, 350 patients were included in the study. Overall, 24 (7%) were transferred to medicine units, 7 (2%) died, and 51 (15%) patients presented a confusional state. Severe respiratory symptoms predicted the transfer to a medicine unit [odds ratio (OR) 17.1; confidence interval (CI) 4.9-59.3]. Older age, an organic mental disorder, a confusional state, and severe respiratory symptoms predicted mortality in univariate analysis. Age >55 (OR 4.9; CI 2.1-11.4), an affective disorder (OR 4.1; CI 1.6-10.9), and severe respiratory symptoms (OR 4.6; CI 2.2-9.7) predicted a higher risk, whereas smoking (OR 0.3; CI 0.1-0.9) predicted a lower risk of a confusional state. CONCLUSION: COVID-19 patients with severe psychiatric disorders have multiple somatic comorbidities and have a risk of developing a confusional state. These data underline the need for extreme caution given the risks of COVID-19 in patients hospitalized for psychiatric disorders.

Hydroxychloroquine, Interleukin-6 Receptor Antagonists and Corticoid Treatments of Acute COVID-19 Infection: Psychiatric Symptoms and Mental Disorders 4 Months Later.

Objective: Psychiatric symptoms and mental disorders are common after Coronavirus Disease-19 (COVID-19). Some drugs used to treat acute COVID-19 have psychiatric side effects. We assessed the psychiatric symptoms and mental disorders of patients treated for acute COVID-19 with hydroxychloroquine (HCQ), interleukin-6 receptor antagonists (anti-IL-6), and corticoids (CTC). Methods: We evaluated 177 patients in a day hospital 4 months after acute infection. Results: In a multivariate analysis, HCQ was associated with significant anxiety symptoms (odds ratio [OR] = 5.9, 95% confidence interval [95% CI] = 1.8-20.0, p = 0.003) and mental disorders (OR = 4.1, 95% CI = 1.2-13.9, p = 0.02). In a bivariate analysis with propensity matched cohorts, HCQ was associated with significant anxiety symptoms (9 patients [50.0%] with significant symptoms in the HCQ group versus 15 [20.1%] in the control group, OR = 3.8, 95% CI = 1.3-11.3, p = 0.01). Anti-IL-6 and CTC were not associated with significant psychiatric symptoms or mental disorders. Conclusion: We recommend monitoring psychiatric symptoms, especially anxiety, in patients treated with HCQ during COVID-19 infection. Further studies with larger samples and prospective assessments are needed to confirm our results.

Assessment of mental health of university students faced with different lockdowns during the coronavirus pandemic, a repeated cross-sectional study Evaluación de la salud mental de estudiantes universitarios ante diferentes confinamientos durante la pandemia, un estudio transversal repetido 疫情期间面临不同封锁的大学生心理健康评估，一项重复性横断面研究

Background: Studies have highlighted the impact of the COVID-19 pandemic on the mental health of university students. However, little is known about the psychological impact of successive lockdowns on this population. Objectives: To assess the prevalence of psychological distress in a student population during the first two lockdowns linked to the COVID-19 pandemic, and to stratify them by subgroup. Methods: We used a repeated cross-sectional study of a university student population in France during the first lockdown, the unlockdown, and the second lockdown. We measured rates of depression, anxiety, distress and suicidal ideation. A weighted prevalence was calculated with 95% confidence intervals. Predictors of symptom progression were measured using adjusted logistic regression. Results: 19,150 university students responded to the surveys. Our results suggest a significant decrease in the scores for depression (aOR = 0.64;CI%: 0.59–0.70), anxiety (aOR = 0.81;CI%: 0.74–0.88), and distress symptoms (aOR = 0.47;CI%: 0.43–0.51) between the first lockdown and the lifting of the lockdown. However, a significant increase in symptoms of depression (aOR = 1.53;CI%: 1.43-1.64), anxiety (aOR = 1.56;CI%: 1.45–1.67) and suicidal ideation (aOR = 1.59;CI%: 1.45–1.73) between the first and second lockdown is highlighted. The most impacted students are PhD students, they show a significant increase (aOR = 4.37;CI%: 1.41–13.54) in suicidal ideation. Conclusion: Mental health professionals will need to be vigilant about this population, both to provide care for psychological distress, but also to reduce the risk of PhD students dropping out. HIGHLIGHTS Successive lockdowns have a significant impact on the mental health of university students. PhD students have experienced the most significant deterioration in their mental health. The rate of suicidal ideation has increased significantly across the university student population.

Hospitalization for COVID-19 is associated with a higher risk of subsequent hospitalization for psychiatric disorders: A French nationwide longitudinal study comparing hospitalizations for COVID-19 and for other reasons.

INTRODUCTION: Although COVID-19 has been associated with psychiatric symptoms in patients, no study to date has examined the risk of hospitalization for psychiatric disorders after hospitalization for this disease. OBJECTIVE: We aimed to compare the proportions of hospitalizations for psychiatric disorders in the 12 months following either hospitalization for COVID-19 or hospitalization for another reason in the adult general population in France during the first wave of the current pandemic. METHODS: We conducted a retrospective longitudinal nationwide study based on the national French administrative healthcare database. RESULTS: Among the 2,894,088 adults hospitalized, 96,313 (3.32%) were admitted for COVID-19. The proportion of patients subsequently hospitalized for a psychiatric disorder was higher for COVID-19 patients (11.09 vs. 9.24%, OR = 1.20 95%CI 1.18-1.23). Multivariable analyses provided similar results for a psychiatric disorder of any type and for psychotic and anxiety disorders (respectively, aOR = 1.06 95%CI 1.04-1.09, aOR = 1.09 95%CI 1.02-1.17, and aOR = 1.11 95%CI 1.08-1.14). Initial hospitalization for COVID-19 in intensive care units and psychiatric history were associated with a greater risk of subsequent hospitalization for any psychiatric disorder than initial hospitalization for another reason. DISCUSSION: Compared with hospitalizations for other reasons, hospitalizations for COVID-19 during the first wave of the pandemic in France were associated with a higher risk of hospitalization for a psychiatric disorder during the 12 months following initial discharge. This finding should encourage clinicians to increase the monitoring and assessment of psychiatric symptoms after hospital discharge for COVID-19, and to propose post-hospital care, especially for those treated in intensive care.

Comorbidity of long COVID and psychiatric disorders after a hospitalisation for COVID-19: a cross-sectional study.

OBJECTIVES: Long COVID is a major public health issue. Whether long COVID is comorbid with psychiatric disorders remains unclear. Here, we investigate the association between long COVID, psychiatric symptoms and psychiatric disorders. DESIGN: Cross-sectional. SETTINGS: Bicêtre Hospital, France, secondary care. PARTICIPANTS: One hundred seventy-seven patients admitted in intensive care unit during acute phase and/or reporting long COVID complaints were assessed 4 months after hospitalisation for an acute COVID. MAIN OUTCOME MEASURES: Eight long COVID complaints were investigated: fatigue, respiratory and cognitive complaints, muscle weakness, pain, headache, paraesthesia and anosmia. The number of complaints, the presence/absence of each COVID-19 complaint as well as lung CT scan abnormalities and objective cognitive impairment) were considered. Self-reported psychiatric symptoms were assessed with questionnaires. Experienced psychiatrists assessed Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition-based diagnoses of psychiatric disorders. RESULTS: One hundred and fifteen (65%) patients had at least one long COVID complaint. The number of long COVID complaints was associated with psychiatric symptoms. The number of long COVID complaints was higher in patients with psychiatric disorders (mean (m) (SD)=2.47 (1.30), p<0.05), new-onset psychiatric disorders (m (SD)=2.41 (1.32), p<0.05) and significant suicide risk (m (SD)=2.67 (1.32), p<0.05) than in patients without any psychiatric disorder (m (SD)=1.43 (1.48)). Respiratory complaints were associated with a higher risk of psychiatric disorder and new-onset psychiatric disorder, and cognitive complaints were associated with a higher risk of psychiatric disorder. CONCLUSIONS: Long COVID is associated with psychiatric disorders, new-onset psychiatric disorders and suicide risk. Psychiatric disorders and suicide risk should be systematically assessed in patients with long COVID.