ABSTRACT
Objective Rates of anxiety have increased during the coronavirus disease 2019 (COVID-19) pandemic, partially attributable to the experience of COVID-19 related concerns. It remains pivotal to determine the implications of such concerns on the severity of anxiety as they may represent opportune targets for public health preventative or therapeutic efforts. The current study evaluated COVID-19 related concerns as predictors of anxiety symptom severity. It also assessed the relative risk associated with sub-types of COVID-19 concerns, the role of age, sex, and minority status as potential moderators; and the unique contribution of COVID-19 concerns beyond sociodemographics, perceived stress, and self-reported general mental health. Methods The data source was obtained from the publicly available "Crowdsourcing: Impacts of COVID-19 on Canadians-Your Mental Health survey" conducted by Statistics Canada. Participants were Canadians aged 15 and older living in ten provinces or three territories. Only participants that completed the self-reported sociodemographics, COVID-19 concerns, and general anxiety symptoms measures were included (n = 44549). Multivariate linear regression was used to evaluate continuous reports of anxiety symptoms, and the relative risk of meeting anxiety cut-off levels was determined using chi-square non-parametric testing. Results Within the sample, 29.1% met cut-off levels of anxiety. Levels of coping and security (R2 = 0.205, p < 0.001), distal (R2 = 0.043, p < 0.001), and proximal concerns (R2 = 0.122, p < 0.001) were found to predict the severity of anxiety experiences, which was determined to be robust to statistical control for sociodemographics, perceived stress and self-reported general mental health (ΔR2 = 0.0625, p < 0.001). Minority status and sex were significant moderating variables, although the interaction accounted for less than 0.1% of the observed variance. Family stress from confinement, support during and after the crisis and personal health concerns significantly predicted more than a 200% increase in the risk of meeting anxiety cut-off levels. Conclusion The current study represents a novel examination of COVID-19-related concerns as risk factors for the experience of anxiety amongst a sizeable Canadian cohort. Coping and security-related concerns represented robust predictors of anxiety symptom experiences. Participants who experienced concerns relating to their proximal social groups were two times more at risk for meeting cut-off anxiety levels than individuals without such concerns. Longitudinal and evidence synthesis remains essential for identifying therapeutic targets and developing pandemic-related public health prevention and care.
ABSTRACT
BACKGROUND: The prevalence and prognosis of post-acute stage SARS-CoV-2 infection fatigue symptoms remain largely unknown. AIMS: We performed a systematic review to evaluate the prevalence of fatigue in post-recovery from SARS-CoV-2 infection. METHOD: Medline, Embase, PsycINFO, CINAHL, Web of Science, Scopus, trial registries, Cochrane Central Register of Controlled Trials, and Google Scholar were searched for studies on fatigue in samples that recovered from polymerase chain reaction (PCR) diagnosed COVID-19. English, French, and Spanish studies were included. Meta-analyses were conducted separately for each recruitment setting. RESULTS: We identified 41 studies with 9,362 patients that recovered from COVID-19. Post-COVID-19 patients self-report of fatigue was higher compared to healthy controls (risk ratio (RR) = 3.688, 95%CI [2.502, 5.436], p < .001). Over 50% of patients discharged from inpatient care reported symptoms of fatigue during the first (event rate [ER] = 0.517, 95%CI [0.278, 0.749]) and second month following recovery (ER = 0.527, 95%CI [0.337, 0.709]). Ten percent of the community patients reported fatigue in the first-month post-recovery. Patient setting moderated the association between COVID-19 recovery and fatigue symptoms (R2 = 0.11, p < .001). Female patients recovering from COVID-19 had a greater self-report of fatigue (odds ratio [OR] = 1.782, 95%CI [1.531, 2.870]). Patients recruited through social media had fatigue above 90% across multiple time points. Fatigue was highest in studies from Europe. CONCLUSION: Fatigue is a symptom associated with functional challenges which could have economic and social impacts. Developing long-term planning for fatigue management amongst patients beyond the acute stages of SARS-CoV-2 infection is essential to optimizing patient care and public health outcomes. Further studies should examine the impact of sociodemographic, pandemic-related restrictions and pre-existing conditions on fatigue.