Psychiatric Outcomes at 3 and 6 Months in Critically Ill SARS-CoV-2 Survivors: Prospective Study in a Portuguese Cohort

Resumo

Introduction: Although mid and long-term psychiatric sequelae are predicted, few studies have focused on critically ill SARS-CoV-2 survivors from Portugal.

We aimed to evaluate mid-term prevalence of psychiatric disease and respective predictors in COVID-19 survivors.

Methods: This is a longitudinal prospective study of critically ill COVID-19 survivors followed up at 3 (T3) and 6 (T6) months after discharge. A set of validated tools, including the GAD-7 for anxiety, PHQ-9 for depression, and PCL-V for PTSD was administered at both visits. Provisional diagnosis of anxiety, depression and PTSD was made if GAD-7≥10, PHQ-9≥10 and PCL-V≥31. Written informed consent was obtained.

Results: A total of 149 patients discharged after COVID-19 hospitalization, were recruited to an outpatient visit at T3 and T6. Of those, 117 completed the test battery. Participants’ age ranged from 25 to 85 years with mean values 64.0±15.5, and 45 (38.5%) were female. Mean age-adjusted Charlson Comorbidity Index was 2.6±2.0 and 51 (43.6%) had at least one comorbidity. Twenty-nine patients (24.8%) presented with psychiatric comorbidities. Regarding education, 56.4% completed primary education, while 8.5% had university or postgraduate qualifications. Twenty patients (17.1%) were single, divorced or widowed.

Prevalence of psychiatric conditions at T3 and T6 was 22.2% vs 12.0% (p= 0.012) for anxiety, 23.1% vs 11.1% (p=0.007) for depression and 7.7% vs 2.6% (p= 0.031) for PTSD, respectively. Significant improvement between evaluations was noted in all mean PCL-V domains. Univariate analysis was conducted for anxiety and depression provisional diagnosis at T6. Female gender [OR 4.86 (CI 95% 1.42-16.60), p= 0.012] and ferritin levels [OR 8.25 (CI 95% 1.04-65.60), p= 0.046] seem to correlate with anxiety. Similarly, mMRC dyspnea scale [OR 1.62 (CI 95% 1.05-2.51), p= 0.031] and psychiatric background [OR 3.44 (CI 95% 1.36-8.66), p= 0.009] were correlated to depression. We did not find association between age, education, marital status, length of stay, do not intubate order, invasive mechanical ventilation and laboratory findings during hospitalization, and anxiety or depression.

Conclusion: Among critically ill SARS-CoV-2 survivors, clinically significant anxiety, depression and PTSD were observed 3 and 6 months after discharge. However substantial improvement over time was perceived. In our study, the risk of anxiety correlated with female gender and the risk of depression with mMRC dyspnea scale and psychiatric background.