Depression in recovered African Americans with severe COVID-19 infection

ABSTRACT

Introduction The mental health impact of COVID-19 infection on its survivors have been reported. African Americans are disproportionately affected by COVID-19 and more likely to experience severe outcomes relative to other ethnicities. We evaluated the incidence and severity of depression among African American patients within 90 days of recovery from severe COVID-19 infection. Methods We identified African American patients with severe SARS-CoV-2 infection who received invasive mechanical ventilation at the intensive care unit (ICU) of Grady Memorial Hospital, Atlanta, Georgia between May 1, 2020, and June 30, 2020. The patient health questionnaire (PHQ-9), a nine-item questionnaire used to assess depression, and its severity was administered to the patients within 30 to 90 days of hospital discharge. Patients with a history of psychiatric disorders were excluded. We categorized patients into major depressive disorder (MDD) diagnosis or other depression based on their responses. To assess severity, all patients were categorized into none or minimal, mild, moderate, moderately severe, and severe based on a score range of 0-27 on the PHQ-9. We calculated the number of patients on treatment for depression as a percentage of the total eligible for treatment based on their PHQ-9 scores. Data analysis was performed using R version 3.6.3 (R Foundation). Results A total of 73 patients completed the questionnaire. The median age of the participants was 52.5 years [IQR 44-65 years] and 65% were males. 44% of the patients had a diagnosis of MDD. The incidence of MDD was higher among females (69%, n=18/26) compared to males (29%, n=14/47), patients aged 55-74 years (60%, n=18/30), > 75 years (66%, n=4/6) compared to younger patients and patients with multiple co-morbidities (45%, n=28/62) compared to patients with only one or no co-morbidity (36%, n=4/11). 27 patients in the study were eligible for treatment based on a PHQ-9 score of at least 14 (moderate and moderately severe depression). However, only 7 of them were receiving some form of depression treatment. The remaining 74% (n=20/27) had not been screened for depression since hospital discharge (Figure 1). ConclusionOur study showed that at least 4 out of 10 African Americans without prior psychiatric illness, hospitalized in the ICU for severe COVID-19 infection will develop MDD within 90 days of discharge. 74% of treatment eligible patients in our study had not been evaluated by a medical professional and were not on any form of treatment.