IMPROVING PATIENT ENGAGEMENT AND EXPERIENCE: LESSONS LEARNED FROM LONG COVID

Background: Long COVID is increasingly recognized as a post-viral syndrome;however general knowledge within the medical field is limited and many with the syndrome continue to face challenges accessing healthcare. The present study examined long COVID patients' perceptions and experiences of medical care. Methods: Participants (N=123) with protracted COVID A-136 symptoms (? 3 months) were recruited via social media and completed online measures of premorbid health, COVID-19 positivity, symptoms, recovery, and perceptions of their healthcare experience. Satisfaction with medical care was rated on a scale of 0 ?very dissatisfied? to 4 ?very satisfied.? Results: Participant satisfaction of long COVID related healthcare ranged from ?dissatisfaction? with their emergency room experience (M=1.45, SD=1.37) to ?neither satisfied nor dissatisfied? for cardiology (M=2.43, SD=1.25). Fifty-six participants (46%) received an anxiety disorder diagnosis by at least one physician despite experiencing symptoms that were not consistent with the diagnosis (e.g. protracted fever, anosmia). As a result, they felt dismissed (84%), unheard (64%), angry (54%), and delayed (29%) or discontinued medical care (25%). Common themes in the open-ended responses included perceiving providers to be dismissive of long COVID medical literature (18%), female patients' belief that clinician response and treatment would have been different if they were male (15%), and a desire for clinicians to recognize limits of their knowledge (11%). Ten percent reported positive experiences, specifically when the relationship felt collaborative and/or the clinician recognized a need to learn more about post-COVID syndromes and complications. Another 5% acknowledged and empathized with challenges faced by the medical community during the pandemic. Discussion: These findings suggest that long COVID patients are generally dissatisfied with their healthcare experiences, and that, in line with research in other populations, engaging the patient's experience, working collaboratively, and recognizing limits of knowledge contribute to a more positive experience. When a formal mental health evaluation supports a psychiatric diagnosis, clinicians can improve patient engagement and treatment compliance by acknowledging symptoms that are inconsistent with such diagnosis and referring to other specialists as appropriate.

CHILDHOOD TRAUMA EXPOSURE INCREASES LONG COVID RISK

Background: While long-term physical and psychological effects of COVID-19 remain unknown, it is clear that a proportion of COVID-19 survivors develop protracted respiratory, cardiovascular, neurologic, dermatologic, and/or gastrointestinal symptoms and complications following acute illness, herein referred to as long COVID (LC) syndrome.Females appear to be at higher risk for LC, and also have higher rates of childhood trauma, which is associated with a heightened inflammatory response to stress. The present study investigated the impact of childhood trauma on COVID-19 illness course and recovery, including mental health outcomes. Methods: Participants (N=244), recruited via social media, Prolific.au, and from a post-COVID clinical treatment trial, completed online self-report measures of premorbid health, COVID-19 positivity, symptoms, and recovery, along with measures of depression, anxiety, post-traumatic stress disorder (PTSD), and childhood (CTE) and recent (RTE) traumatic experiences. Results: Compared to recovered participants (N=110), the LC group (N=158) was older and predominantly female. Those who reported one or more CTE were nearly 3-fold more likely to develop LC (OR=2.87, CI, 0.95 to 8.60) while those who endorsed two or more CTE were 4.5 times more likely (OR=4.56, CI, 1.61 to 12.33). A binary logistic regression analysis revealed that chest pain (p<.001), fatigue (p=.031), burning sensation (p=.002), and olfactory hallucinations (p<.001) during acute COVID, along with sex (p=.001) and age (p<.001) predicted LC. Compared to pre-COVID diagnoses, rates of PTSD (p<.001), depression (p<.001), and generalized anxiety (χ2=12.32, p<.001) increased across the entire sample and current PTSD (p=.001, partial η2=.042), depression (p<.001, partial η2=.048), and anxiety (p=.017, partial η2=.022) severity were higher in the LC group. Discussion: These findings suggest that childhood trauma or early adversity may prove relevant to the development of long COVID via central nervous system changes and dysfunction in the form of central sensitization, somatosensory disruptions, and/or dysautonomia, resulting from a heightened inflammatory response. Psychiatric outcomes should be assessed following acute COVID-19, and future research is needed to determine the unique contributions of COVID-19 and general pandemic stress to post-illness mental health.

INCREASED DEPRESSION AND ANXIETY DURING THE COVID-19 PANDEMIC REGARDLESS OF COVID-19 POSITIVITY

Background: Recent studies have reported increased rates of mood and anxiety disorders in COVID-19 patients after acute illness, possibly resulting from inflammation, which is linked to depression and childhood trauma. Increased rates of anxiety and depression have also been observed at the population level following past viral outbreaks (e.g. SARS-CoV-1, MERS) and pandemic associated stress could also impact mental health. Thus, the present study compared depression, anxiety, and perceived stress scores in university students who tested positive for COVID-19 to those who never contracted the disease, and to scores prior to the pandemic. Methods: University students completed self-report measures of depression, anxiety, and perceived stress before (N=150) and during (N=334) the COVID-19 pandemic. The pandemic sample also completed measures of COVID-19 positivity, symptoms, and recovery. One third of the sample tested positive for COVID-19 (N=109). Three x (pre-pandemic, COVID-19 positive, COVID-19 negative) x two (male, female) ANOVAs examined differences in depression, anxiety, and perceived stress. A two (COVID-19 positive, COVID-19 negative) x two (male, female) ANOVA compared PTSD severity. Results: There were significant group effects for depression (F(1,477)=3.06, p=.048, partial η2=.013), anxiety (F(1,477)=3.03, p=.049, partial η2=.013), and perceived stress (F(1,376)=5.62, p=.004, partial η2=.029). Post-hoc analyses indicated that depression and anxiety were higher in the COVID-19 positive (all p's <.034) and negative (all p's <.042) groups compared to the pre-pandemic sample, but did not differ across the pandemic samples (all p's >.584). In contrast, perceived stress was higher in the pre-pandemic group compared to those who were COVID-19 positive (p=.033) and negative (p=.011). PTSD severity did not differ between the COVID-19 positive and negative groups (p=.645). Females were more depressed (p=.036), anxious (p<.001) and stressed (p=.006) than males but did not differ in PTSD severity (p=.305). Discussion: These results suggest that rates of depression and anxiety have increased during the pandemic regardless of COVID-19 positivity. Reduced stress during the pandemic may reflect reduced extracurricular commitments due to university activity restrictions. Future research should examine if these results generalize beyond university students.