Posttraumatic-stress disorder, and others psychological impairment in COVID-19 surviving patients

Background: The post-COVID syndrome generates physical and respiratory complications that can be accompanied by psychological impairments, which can affect long-term mental and physical health. Objective(s): Know the prevalence and severity of PTSD, anxiety, and depression in surviving COVID-19 patients in a follow-up evaluation. Method(s): A cross-sectional descriptive study was conducted. 227 survivors COVID-19 patients participated, were assessed three months following discharge hospital. The following questionnaires were used: The Brief Davidson Trauma Scale, the General Anxiety Disorder Questionnaire, and the Patient Health Questionnaire. A descriptive and statically analysis was performed using the statistical software SPSS version 26. Result(s): The 64.5% of the patients were men, 60.9% required of invasive mechanical ventilation (IMV) during the hospitalization, the average age was about 48.23+/-14.33 years old. The 40% of the patients showed symptoms associated with PTSD, 38.4% anxiety symptoms, 36.6% depression symptoms. There were statistically significant differences between the type of treatment during hospitalization (IMV vs without IMV), in PTSD (t=2.482, df=223, p=.014, XIMV = 5.21, XWIMV = 6.08) and anxiety (t= -2.006, df=223, p=.046, XIMV = 4.05, XWIMV =5.44). Conclusion(s): Survivors of COVID-19 experience a high prevalence of PTSD, anxiety, and depression even three months after discharge from hospital. Patients who did not require IMV during hospitalization experienced a high prevalence and severity of PTSD and anxiety symptoms. Screening for PTSD and other emotional disturbances should be considered in follow-up evaluations in patients discharged from the hospital.

Sleep disturbances in post-Covid patients as a function of sex

Introduction: Within the post-Covid syndrome, sleep disturbances are one of the most persistent symptoms, in which women are more 50% vulnerable than men to insomnia. Objective(s): To compare the prevalence of sleep disorders in post-Covid patients according to sex. Method(s): A cross-sectional observational study was carried out. The participants were 264 post-Covid patients evaluated 3 months after hospital discharge, divided into men (n=156, G1) and women (n=108, G2). A general sleep habits survey and the Berlin SAOS questionnaire were used for sleep assessment. Statistical analyses were performed using SPSS v25. Result(s): Mean age was G1: 54.16 +/-11.751 and G2: 54.23 +/- 13.319. There were differences (p<0.05) between both sexes in the following disorders (G1 vs G2): snoring (73.1% vs 58.3%), primary snoring (45.6% vs 28.6%), unrefreshing sleep more than 3 times a week (28.2% vs 43.5%), tiredness or fatigue during the day at least 3 times a week (30.1% vs 51.9%), sudden movements in extremities: (37.2% vs 22.2%), onset insomnia: (34.0% vs 53.7%), intermediate insomnia (36.5% vs 58.3%), final insomnia: (39.7% vs 55.6%). No differences (p>0.05) were found in pauses in breathing, teeth grinding, feeling of paralysis and feeling of choking, with a prevalence greater than 20% in all cases. Conclusion(s): In our study, the affectation of most sleep disorders are more frequent in the female sex, with the predominance of different types of insomnia (onset, intermediate and final);which could be related to affective disorders. In men, the most prevalent disorders were snoring and sudden movements, mostly linked to respiratory disorders.

Cognitive alterations in COVID-19 survivors with and without invasive mechanical ventilation during hospital stay

Introduction: Cognitive impairment is observed in patients for Covid-19;derived from both multiple organic dysfunctions due to the disease and its management during hospital stay. Existing literature reports greater cognitive impairment (60-80%) in patients with invasive mechanical ventilation (IMV), compared to those who did not require it (50-70%). Objective(s): To compare cognitive impairment among COVID-19 survivors with and without IMV during hospital stay. Method(s): A cross-sectional observational study was conducted. A total of 211 COVID-19 survivors participated, 64.9% required IMV (G1) and 35.1% did not (G2). The Montreal Cognitive Assessment (MOCA) was used to assess cognitive functions at a 9 month follow-up after hospital discharge. Statistical analyses were performed in SPSS V25. Result(s): Patients presented the following characteristics: male sex (G1: 61.8%, G2: 54.1%), and average age G1: 54.05+/-11.89, G2: 57.21+/-11.90 years. In both groups (G1 vs. G2) no significant differences (p<0.05) were found in the prevalence of probable mild cognitive impairment (72.3% vs. 82.4%), neither in the mean of principal affections reports: attention (4. 70+/-1.23 vs. 4.80+/-1.03) and memory (2.69+/-1.53 vs. 2.86+/-1.59). Orientation (5.60+/-.71 vs. 5.82+/-.41), was the only value that reached statistically significant differences (p=.013), but without clinical significance. Conclusion(s): Both groups have high prevalence of patients with probable mild cognitive impairment yet nine months after discharge, contrasting with the prevalence reported to patients with IMV and to the recovery time (3-6 months). Cognitive sequelae have a greater impact than reported in all patients regardless of treatment.

Heart rate variability in post-COVID-19 patients with different anxiety levels

Introduction: More than 12% of COVID-19 hospitalized patients develop Generalized Anxiety Disorder (GAD) after discharged. High frequency band percentage of heart rate variability (hfHRV) is a reliable indicator of efficient functional coupling between autonomic branches across high-demanding adaptive situations. Objective(s): To compare hfHRV among post-hospitalized COVID-19 survivors by level of GAD. Method(s): We conducted an observational study with 211 post-COVID-19 participants (63.7% males;47.6y +/-14.3), 3 months after discharged. We registered their hfHRV with a computerized biofeedback equipment throughout four conditions: open-eyes (C1);closed-eyes (C2);closed-eyes+natural-relaxation (C3);and closed-eyes+deep-breathing (C4) (2.5 minutes per condition). Participants were classified into 3 categories using General Anxiety Disorder Scale (GAD-7): low anxiety (n=174, 67.5%, 47.2 yo +/-13.4;G1);moderate anxiety (n=24, 66.5%, 47.3 yo +/-15.3;G2) and severe anxiety (n=13, 60.5%, 46.1 yo +/-9;G3). Statistical analysis were performed with SPSS v28. Result(s): hfHRV percentage is higher at C3 in G1 (G1: 29.5 +/-21.1, G2: 21.1 +/-17.1, G3: 20.0 +/-20.4;p = 0.01). G3 display a 30% decrease in hfHRV during this condition in contrast with G1 (p = 0.006). Percentage of hfHRV in G1 (C1: 31 +/-22.6, C2: 29.2 +/-23.6, C4: 24.3 +/-20.7), and G3 (C1: 29.7 +/-22.8;C2: 27.9 +/-17.6;C4: 20 +/-20) didn't show any significant differences. Conclusion(s): C3 involve an adaptive challenge that demands an effective sympathetic-parasympathetic regulation. An increase in hfHRV during C3 in G1, indicates that the group with low anxiety exhibit a more effective psychophysiological adaptive feature than G2 and G3: a potential protective factor from GAD.

Cognitive impairment as a sequel to SARS-CoV-2 infection

Introduction: COVID-19 survivor patients report a complaint subjectively related to memory and attentionconcentration problems when carry out their daily activities. Objective(s): To investigate the presence of cognitive sequelae associated with COVID-19. Method(s): An observational cross-sectional study was conducted. Participated 229 COVID-19 survivor patients, who were evaluated with Montreal Cognitive Assessment (MoCA) and classified into three groups: a) severe cognitive impairment (G1, <13points, n=11), b) mild cognitive impairment (G2, 13-21 points, n=34), and c) without cognitive alterations (G3, 22-30 points, n=184). Statistical analyses were performed in SPSS V25. Result(s): Average age and male sex: G1: 67.36+/-10.71, 63.6%;G2: 58.76+/-11.55, 61.8%;G3: 53.32+/-11.39, 58.7%. G1 presented statistically differences (p <0.001) in all cognitive functions with the other groups (G1, G2, G3): visuospatial/executive ability (0.09+/-0.30, 0.53+/-0.50, 0.83+/-0.38), identification (2.00+/-0.89, 2.82+/-0.38, 2.92+/-0.32), attention (2.45+/-0.82, 3.97+/-1.16, 5.02+/-0.97), repetition (0.18+/-0.40, 0.29+/-0.46, 1.02+/-0.79), fluency (0.18+/-0.40, 0.68+/-0.47, 0.93+/-0.24), abstraction (0.18+/-0.40, 0.68+/-0.72, 1.41+/-0.77), deferred remembering (0.73+/-1.10, 1.44+/-1.37, 3.13+/-1.36) and orientation (4.64+/-0.92, 5.35+/-0.73, 5.79+/-0.49);except in executive ability, identification, repetition, abstraction and deferred remembering with respect to G2 (p<0.05). Conclusion(s): Cognitive alterations were found in patients post- COVID, especially in attention and deferred remembering, which could be related to errors of execution in other areas. In the case of the severe cognitive impairment, age may be a related variable. Necessary integrate this variable in the rehabilitation plan for a better prognosis and quality of life of patients.

Psychological affectation in surviving patients of COVID19, consideration of the use of invasive mechanical ventilation

Introduction: The presence of anxious, depressive and post-traumatic stress (PTSD) symptoms are the most reported psychological sequelae in post-COVID patients. The use of invasive mechanical ventilation (IMV) may contribute to the appearance of these symptoms. Objective(s): To know the differences in anxious, depressive, PTSD and fear of COVID symptoms among surviving COVID-19 patients with or without IMV, 3 months after hospital discharge. Method(s): An observational cross-sectional study was conducted. 239 surviving COVID-19 patients participated: 146 with IMV at hospitalization (67.80% men and 32.20% women) (G1) and 93 without IMV (61.29% men 38.70% women) (G2), who were evaluated with: GAD-7 for anxious symptomatology, PHQ-9 for depressive symptomatology, EMACOVID scale to measure fear of COVID-19, and the brief Davidson scale as screening for EPT. Statistical analyzes were performed in the statistical package SPSS V25. Result(s): Average age: G1= 48.62+/-13.62, G2= 48.49+/-15.43. There was a statistically significant difference in the EPT scores (G1: Md=4 [4.00-6.00];G2: Md=5 [4.00-7.00]). No statistically significant differences were found (P<0.05, G1 vs G2) in depression (Md=3 [0.00-6.00] vs Md=3 [0.00-8.50], anxiety (Md=2 [0.00-6.00] vs Md=3 [1:00-7:50]), nor fear of COVID (Md= 9 [7:00-15:00] vs Md=11.80 [7:00-14:00]), although there were clinical differences. Conclusion(s): Patients without IMV have a conscious experience of their hospitalization, which may lead to a higher level of PTSD compared to sedated patients with IMV.

Prevalence of post-traumatic stress disorder, emotional impairments, and fear in COVID-19 surviving patients

Introduction: Among the different psychological sequelae of post-COVID syndrome are symptoms related to emotional impairment, mostly depression, anxiety, and post-traumatic stress disorder (PTSD). Objective: To describe and compare the prevalence and severity of PTSD, anxiety, depression, and fear of COVID-19 in survivors 3 months after discharge from the hospital. Methods: A cross-sectional descriptive study was conducted, a total of 227 survivors of COVID-19 participated;they were assessed 3 months after being discharged from the hospital. A psychological evaluation focused on anxiety, depression, PTSD, and fear was conducted. Statistical analysis through the t-test for independent samples was performed. Results: Of the patients, 64.5% were men, 60.9% required invasive mechanical ventilation (IMV) during hospitalization, and the average age was about 48.23 ± 14.33 years. Also, 40% showed symptoms associated with PTSD, 38.4% exhibited anxiety, 36.6% depression, and 36.12% exhibited fear of COVID-19. There were statistically significant differences between men and women, in PTSD (t = -3.414, df = 224, p = 0.001, x̅m = 5.10, x̅w = 6.32), depression (t = -4.680, df = 225, p = 0.000, x̅m = 3.64, x̅w = 7.18), anxiety (t = -3.427, df = 152.53, p = 0.001, x̅m = 3.78, x̅w = 6.20), and fear of COVID-19 (t = -3.400, df = 224, p = 0.001, x̅m = 11.88, x̅w = 15.19). Furthermore, there were also statistically significant differences between the type of treatment during hospitalization (IMV vs. without IMV), in PTSD (t = 2.482, df = 223, p = 0.014, x̅IMV = 5.21, x̅WIMV = 6.08) and anxiety (t = -2.006, df = 223, p = 0.046, x̅IMV = 4.05, x̅WIMV = 5.44). Conclusion: Survivors of COVID-19 experience a high prevalence of PTSD, anxiety, depression, and fear, even 3 months after discharge from the hospital. Females and patients who did not require IMV during hospitalization are the most affected population, presenting more severe symptoms of these psychological alterations. More research is required to know and observe the long-term evolution of these psychological alterations in this population. Copyright © 2022 Luna-Rodríguez, Peláez-Hernández, Orea-Tejeda, Ledesma-Ruíz, Casarín-López, Rosas-Trujillo, Domínguez-Trejo and Tepepa-Flores.