What factors influence mental health burden in patients recovering from Covid-19?

ABSTRACT

Background Respiratory teams should perform a holistic assessment of patients recovering from COVID-19 to identify both physical and psychological needs.1Patients may develop psychological sequelae such as anxiety, dysfunctional breathing, depression and post-traumatic stress disorder (PTSD). We investigated the psychological burden at follow-up in people admitted with COVID-19 and the factors associated with this. Methods SARS-CoV-2 swab-positive patients from two hospital sites had telephone follow-up 8-10 weeks post discharge. We conducted screening questionnaires including the Patient Health Questionnaire 2-item (PHQ-2) for depression and Trauma Screening Questionnaire (TSQ) for PTSD. Demographic, admission, co-morbidity data and symptom burden at follow up (quantified by a numerical rating scale) were also collected. Results 782 patients completed both screening questionnaires. Patients' baseline characteristics are shown in table 1. 71 (9.1%) and 60 (7.7%) patients screened positive for depression and PTSD respectively. Patients with a background of depression and anxiety were more likely to have higher PHQ-2 scores (11.6% and 11.8%, p<0.001);those with anxiety had higher TSQ scores (8.5%, p=0.009). Patients who had a greater symptom burden both at admission and at follow-up were significantly more likely to have positive PHQ-2 and TSQ scores. No difference in scores was found in patients who received positive-airway pressure treatment (5.2%) or who were admitted to ITU (11.8%). Patients who returned to work (53.7%) were less likely to have positive TSQ scores (p=0.006). Discussion In this large cohort, patients with a higher physical symptom burden at admission and follow-up are more likely to also have psychological burden and this may impact their ability to return to work. Current guidelines1 highlight mental health screening only for patients who had more severe disease, but our data suggest any patient may be affected. Whilst more work in this field is required, we suggest clinicians who encounter patients still recovering from COVID-19 should proactively screen for psychological burden and liaise with local psychology services to ensure holistic care is offered.