Mental Health Outcomes and Sleep Status among Patients with Coronavirus Disease 2019
-
Mahsa Nahidi
,
Naghmeh Mokhber
,
Farideh Sinichi
,
Zahra Hatefipour
,
Parvin Zohorian Sadr
,
Maryam Emadzadeh
,
Amir Rezaei Ardani
Abstract
Objective: The immediate impacts of coronavirus disease 2019 (COVID-19) on mental health of affected patients and psychiatric morbidities of these patients has been neglected by researchers. We assessed mental health outcomes and sleep status among inpatients and outpatients with COVID-19 who were initially referred to our COVID-19 clinic in Mashhad, Iran during April-October 2020.
Method: In this ethically approved cross-sectional study, 130 patients with confirmed COVID-19 who were referred to outpatient clinics and wards of a referral hospital in Mashhad, Iran were surveyed during April-October 2020. Demographic data were collected after obtaining informed written consent. Validated Persian versions of insomnia severity index (ISI), 9-item patient health questionnaire (PHQ-9), and 7-item generalized anxiety disorder (GAD-7) and revised impact of event scale (IES-R) were used as main outcome measures (i.e. status of anxiety, depression, insomnia, and event-related distress). Analysis was performed with SPSS using binary logistic regression. P-values < 0.05 were considered significant.
Results: Overall, 65 inpatients and 65 outpatients were surveyed. The two groups did not significantly defer in terms of insomnia and depression severity, but the outpatients showed higher levels of anxiety (52.3% vs. 24.6%, P = 0.005) and distress compared to inpatients (80.0% vs. 64.6%, P < 0.001). Male sex (OR = 0.017, 95%CI = 0.000-0.708, P = 0.032) exhibited independent and inverse association with depression in COVID-19 patients. Being married (OR = 0.102, 95% CI = 0.018-0.567, P = 0.009) was independently and inversely associated with anxiety. Insomnia was independently associated with event-related distress (OR = 7.286, 95%CI = 2.017-26.321, P = 0.002). Only depression was independently associated with insomnia (OR = 49.655, 95%CI = 2.870-859.127, P = 0.007).
Conclusion: We found symptoms of psychological distress and anxiety to be more prevalent among outpatients with COVD-19 than inpatients. Insomnia can be a potential risk factor for adverse mental health outcomes in these patients.
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20. Moradi AR, Herlihy J, Yasseri G, Shahraray M, Turner S, Dalgleish T. Specificity of episodic and semantic aspects of autobiographical memory in relation to symptoms of posttraumatic stress disorder (PTSD). Acta Psychol (Amst). 2008;127(3):645-53.
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22. Naeinian M, Shairi M, Sharifi M, Hadian M. To study reliability and validity for a brief measure for assessing Generalized Anxiety Disorder (GAD-7). Clin Psychol Pers. 2011;3(4):41-50.
23. Vahey GM, McDonald E, Marshall K, Martin SW, Chun H, Herlihy R, et al. Risk factors for hospitalization among persons with COVID-19-Colorado. PLoS One. 2021;16(9):e0256917.
24. Ko JY, Danielson ML, Town M, Derado G, Greenlund KJ, Kirley PD, et al. Risk Factors for Coronavirus Disease 2019 (COVID-19)-Associated Hospitalization: COVID-19-Associated Hospitalization Surveillance Network and Behavioral Risk Factor Surveillance System. Clin Infect Dis. 2021;72(11):e695-e703.
25. Yoshikawa M, Asaba K. Educational Attainment Decreases the Risk of COVID-19 Severity in the European Population: A Two-Sample Mendelian Randomization Study. Front Public Health. 2021;9:673451.
26. Song C-Y, Xu J, He J-Q, Lu Y-Q. COVID-19 early warning score: a multi-parameter screening tool to identify highly suspected patients. MedRxiv. 2020.
27. Klaser K, Thompson EJ, Nguyen LH, Sudre CH, Antonelli M, Murray B, et al. Anxiety and depression symptoms after COVID-19 infection: results from the COVID Symptom Study app. J Neurol Neurosurg Psychiatry. 2021;92(12):1254-8.
28. Mazza MG, De Lorenzo R, Conte C, Poletti S, Vai B, Bollettini I, et al. Anxiety and depression in COVID-19 survivors: Role of inflammatory and clinical predictors. Brain Behav Immun. 2020;89:594-600.
29. Deng J, Zhou F, Hou W, Silver Z, Wong CY, Chang O, et al. The prevalence of depression, anxiety, and sleep disturbances in COVID-19 patients: a meta-analysis. Ann N Y Acad Sci. 2021;1486(1):90-111.
30. Bo HX, Li W, Yang Y, Wang Y, Zhang Q, Cheung T, et al. Posttraumatic stress symptoms and attitude toward crisis mental health services among clinically stable patients with COVID-19 in China. Psychol Med. 2021;51(6):1052-3.
31. Wang Y, Zhu LY, Ma YF, Bo HX, Deng HB, Cao J, et al. Association of insomnia disorder with sociodemographic factors and poor mental health in COVID-19 inpatients in China. Sleep Med. 2020;75:282-6.
32. Brooks SK, Webster RK, Smith LE, Woodland L, Wessely S, Greenberg N, et al. The psychological impact of quarantine and how to reduce it: rapid review of the evidence. Lancet. 2020;395(10227):912-20.
33. Khawam E, Khouli H, Pozuelo L. Treating acute anxiety in patients with COVID-19. Cleve Clin J Med. 2020.
34. Goodwin GM. The overlap between anxiety, depression, and obsessive-compulsive disorder. Dialogues Clin Neurosci. 2015;17(3):249-60.
35. Fang H, Tu S, Sheng J, Shao A. Depression in sleep disturbance: A review on a bidirectional relationship, mechanisms and treatment. J Cell Mol Med. 2019;23(4):2324-32.
36. Nollet M, Wisden W, Franks NP. Sleep deprivation and stress: a reciprocal relationship. Interface Focus. 2020;10(3):20190092.
37. Tang B, Liu X, Liu Y, Xue C, Zhang L. A meta-analysis of risk factors for depression in adults and children after natural disasters. BMC Public Health. 2014;14:623.
38. Wang C, Pan R, Wan X, Tan Y, Xu L, Ho CS, et al. Immediate Psychological Responses and Associated Factors during the Initial Stage of the 2019 Coronavirus Disease (COVID-19) Epidemic among the General Population in China. Int J Environ Res Public Health. 2020;17(5): 1729.
39. Tanios CY, Abou-Saleh MT, Karam AN, Salamoun MM, Mneimneh ZN, Karam EG. The epidemiology of anxiety disorders in the Arab world: a review. J Anxiety Disord. 2009;23(4):409-19.
40. Wei N, Huang BC, Lu SJ, Hu JB, Zhou XY, Hu CC, et al. Efficacy of internet-based integrated intervention on depression and anxiety symptoms in patients with COVID-19. J Zhejiang Univ Sci B. 2020;21(5):400-4.
2. Günl F, Mecate-Zambrano A, Rehländer S, Hinse S, Ludwig S, Brunotte L. Shooting at a Moving Target-Effectiveness and Emerging Challenges for SARS-CoV-2 Vaccine Development. Vaccines (Basel). 2021;9(10).
3. World Health Organization. Tracking SARS-CoV-2 variants. Geneva: World Health Organization [cited 2021 December 22] 2022. Available from: https://www.who.int/en/activities/tracking-SARS-CoV-2-variants/.
4. Lippi G, Mattiuzzi C, Henry BM. Updated picture of SARS-CoV-2 variants and mutations. Diagnosis (Berl). 2021;9(1):11-7.
5. Obschonka M, Gewirtz AH, Zhu L. Psychological implications of the COVID-19 pandemic around the world: Introduction to the special issue. Int J Psychol. 2021;56(4):493-7.
6. Zhang J, Lu H, Zeng H, Zhang S, Du Q, Jiang T, et al. The differential psychological distress of populations affected by the COVID-19 pandemic. Brain Behav Immun. 2020;87:49-50.
7. Li W, Yang Y, Liu ZH, Zhao YJ, Zhang Q, Zhang L, et al. Progression of Mental Health Services during the COVID-19 Outbreak in China. Int J Biol Sci. 2020;16(10):1732-8.
8. Huang Y, Zhao N. Generalized anxiety disorder, depressive symptoms and sleep quality during COVID-19 outbreak in China: a web-based cross-sectional survey. Psychiatry Res. 2020;288:112954.
9. Holingue C, Badillo-Goicoechea E, Riehm KE, Veldhuis CB, Thrul J, Johnson RM, et al. Mental distress during the COVID-19 pandemic among US adults without a pre-existing mental health condition: Findings from American trend panel survey. Prev Med. 2020;139:106231.
10. Rogers JP, Chesney E, Oliver D, Pollak TA, McGuire P, Fusar-Poli P, et al. Psychiatric and neuropsychiatric presentations associated with severe coronavirus infections: a systematic review and meta-analysis with comparison to the COVID-19 pandemic. Lancet Psychiatry. 2020;7(7):611-27.
11. Troyer EA, Kohn JN, Hong S. Are we facing a crashing wave of neuropsychiatric sequelae of COVID-19? Neuropsychiatric symptoms and potential immunologic mechanisms. Brain Behav Immun. 2020;87:34-9.
12. Pfefferbaum B, North CS. Mental health and the Covid-19 pandemic. N Engl J Med. 2020;383(6):510-2.
13. Taquet M, Luciano S, Geddes JR, Harrison PJ. Bidirectional associations between COVID-19 and psychiatric disorder: retrospective cohort studies of 62 354 COVID-19 cases in the USA. Lancet Psychiatry. 2021;8(2):130-40.
14. Sultana S, Ananthapur V. COVID-19 and its impact on neurological manifestations and mental health: the present scenario. Neurol Sci. 2020;41(11):3015-20.
15. Rehman S, Lela U. Pharmacological treatment during CoViD-19 and mental health issues. Riv Psichiatr. 2021;56(1):53-5.
16. Dragioti E, Li H, Tsitsas G, Lee KH, Choi J, Kim J, et al. A large-scale meta-analytic atlas of mental health problems prevalence during the COVID-19 early pandemic. J Med Virol. 2022;94(5):1935-49.
17. Kong X, Zheng K, Tang M, Kong F, Zhou J, Diao L, et al. Prevalence and factors associated with depression and anxiety of hospitalized patients with COVID-19. medRxiv. 2020.
18. Ministry of Health. COVID-19 Diagnosis and Treatment Flowchart at Outpatient and Inpatient Service Levels. Tehran: Ministry of Health. [cited 2020]. Available from: http://treatment.sbmu.ac.ir/index.jsp?pageid = 63989&p = 1].
19. Dastani M, Jomheri F, Fathi-Ashtiani A, Sadeghniiat K, Someloo S. Effectiveness of drug therapy and behavioral therapy on chronic insomnia. Int J Behav Sci. 2011;5(1):27-32.
20. Moradi AR, Herlihy J, Yasseri G, Shahraray M, Turner S, Dalgleish T. Specificity of episodic and semantic aspects of autobiographical memory in relation to symptoms of posttraumatic stress disorder (PTSD). Acta Psychol (Amst). 2008;127(3):645-53.
21. Majdara E, Talepasand S, Rahimian Boogar I, J Gregory R. The Efficacy of Dynamic Deconstructive Psychotherapy in Treatment of Borderline Personality Disorder: Introducing an Evidence-Based Therapeutic Model. Stud Med Sci. 2018;29(6):1-19.
22. Naeinian M, Shairi M, Sharifi M, Hadian M. To study reliability and validity for a brief measure for assessing Generalized Anxiety Disorder (GAD-7). Clin Psychol Pers. 2011;3(4):41-50.
23. Vahey GM, McDonald E, Marshall K, Martin SW, Chun H, Herlihy R, et al. Risk factors for hospitalization among persons with COVID-19-Colorado. PLoS One. 2021;16(9):e0256917.
24. Ko JY, Danielson ML, Town M, Derado G, Greenlund KJ, Kirley PD, et al. Risk Factors for Coronavirus Disease 2019 (COVID-19)-Associated Hospitalization: COVID-19-Associated Hospitalization Surveillance Network and Behavioral Risk Factor Surveillance System. Clin Infect Dis. 2021;72(11):e695-e703.
25. Yoshikawa M, Asaba K. Educational Attainment Decreases the Risk of COVID-19 Severity in the European Population: A Two-Sample Mendelian Randomization Study. Front Public Health. 2021;9:673451.
26. Song C-Y, Xu J, He J-Q, Lu Y-Q. COVID-19 early warning score: a multi-parameter screening tool to identify highly suspected patients. MedRxiv. 2020.
27. Klaser K, Thompson EJ, Nguyen LH, Sudre CH, Antonelli M, Murray B, et al. Anxiety and depression symptoms after COVID-19 infection: results from the COVID Symptom Study app. J Neurol Neurosurg Psychiatry. 2021;92(12):1254-8.
28. Mazza MG, De Lorenzo R, Conte C, Poletti S, Vai B, Bollettini I, et al. Anxiety and depression in COVID-19 survivors: Role of inflammatory and clinical predictors. Brain Behav Immun. 2020;89:594-600.
29. Deng J, Zhou F, Hou W, Silver Z, Wong CY, Chang O, et al. The prevalence of depression, anxiety, and sleep disturbances in COVID-19 patients: a meta-analysis. Ann N Y Acad Sci. 2021;1486(1):90-111.
30. Bo HX, Li W, Yang Y, Wang Y, Zhang Q, Cheung T, et al. Posttraumatic stress symptoms and attitude toward crisis mental health services among clinically stable patients with COVID-19 in China. Psychol Med. 2021;51(6):1052-3.
31. Wang Y, Zhu LY, Ma YF, Bo HX, Deng HB, Cao J, et al. Association of insomnia disorder with sociodemographic factors and poor mental health in COVID-19 inpatients in China. Sleep Med. 2020;75:282-6.
32. Brooks SK, Webster RK, Smith LE, Woodland L, Wessely S, Greenberg N, et al. The psychological impact of quarantine and how to reduce it: rapid review of the evidence. Lancet. 2020;395(10227):912-20.
33. Khawam E, Khouli H, Pozuelo L. Treating acute anxiety in patients with COVID-19. Cleve Clin J Med. 2020.
34. Goodwin GM. The overlap between anxiety, depression, and obsessive-compulsive disorder. Dialogues Clin Neurosci. 2015;17(3):249-60.
35. Fang H, Tu S, Sheng J, Shao A. Depression in sleep disturbance: A review on a bidirectional relationship, mechanisms and treatment. J Cell Mol Med. 2019;23(4):2324-32.
36. Nollet M, Wisden W, Franks NP. Sleep deprivation and stress: a reciprocal relationship. Interface Focus. 2020;10(3):20190092.
37. Tang B, Liu X, Liu Y, Xue C, Zhang L. A meta-analysis of risk factors for depression in adults and children after natural disasters. BMC Public Health. 2014;14:623.
38. Wang C, Pan R, Wan X, Tan Y, Xu L, Ho CS, et al. Immediate Psychological Responses and Associated Factors during the Initial Stage of the 2019 Coronavirus Disease (COVID-19) Epidemic among the General Population in China. Int J Environ Res Public Health. 2020;17(5): 1729.
39. Tanios CY, Abou-Saleh MT, Karam AN, Salamoun MM, Mneimneh ZN, Karam EG. The epidemiology of anxiety disorders in the Arab world: a review. J Anxiety Disord. 2009;23(4):409-19.
40. Wei N, Huang BC, Lu SJ, Hu JB, Zhou XY, Hu CC, et al. Efficacy of internet-based integrated intervention on depression and anxiety symptoms in patients with COVID-19. J Zhejiang Univ Sci B. 2020;21(5):400-4.
| Files | ||
| Issue | Vol 17 No 3 (2022) | |
| Section | Original Article(s) | |
| DOI | https://doi.org/10.18502/ijps.v17i3.9727 | |
| Keywords | ||
| Anxiety COVID-19 Depression Insomnia Mental Health | ||
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How to Cite
1.
Nahidi M, Mokhber N, Sinichi F, Hatefipour Z, Zohorian Sadr P, Emadzadeh M, Rezaei Ardani A. Mental Health Outcomes and Sleep Status among Patients with Coronavirus Disease 2019. Iran J Psychiatry. 2022;17(3):276-283.
