Anxiety and depression in COVID-19 survivors: Role of inflammatory and clinical predictors

Brain Behav Immun. 2020 Oct:89:594-600. doi: 10.1016/j.bbi.2020.07.037. Epub 2020 Jul 30.

Abstract

Infection-triggered perturbation of the immune system could induce psychopathology, and psychiatric sequelae were observed after previous coronavirus outbreaks. The spreading of the Severe Acute Respiratory Syndrome Coronavirus (COVID-19) pandemic could be associated with psychiatric implications. We investigated the psychopathological impact of COVID-19 in survivors, also considering the effect of clinical and inflammatory predictors. We screened for psychiatric symptoms 402 adults surviving COVID-19 (265 male, mean age 58), at one month follow-up after hospital treatment. A clinical interview and a battery of self-report questionnaires were used to investigate post-traumatic stress disorder (PTSD), depression, anxiety, insomnia, and obsessive-compulsive (OC) symptomatology. We collected sociodemographic information, clinical data, baseline inflammatory markers and follow-up oxygen saturation levels. A significant proportion of patients self-rated in the psychopathological range: 28% for PTSD, 31% for depression, 42% for anxiety, 20% for OC symptoms, and 40% for insomnia. Overall, 56% scored in the pathological range in at least one clinical dimension. Despite significantly lower levels of baseline inflammatory markers, females suffered more for both anxiety and depression. Patients with a positive previous psychiatric diagnosis showed increased scores on most psychopathological measures, with similar baseline inflammation. Baseline systemic immune-inflammation index (SII), which reflects the immune response and systemic inflammation based on peripheral lymphocyte, neutrophil, and platelet counts, positively associated with scores of depression and anxiety at follow-up. PTSD, major depression, and anxiety, are all high-burden non-communicable conditions associated with years of life lived with disability. Considering the alarming impact of COVID-19 infection on mental health, the current insights on inflammation in psychiatry, and the present observation of worse inflammation leading to worse depression, we recommend to assess psychopathology of COVID-19 survivors and to deepen research on inflammatory biomarkers, in order to diagnose and treat emergent psychiatric conditions.

Keywords: Anxiety; COVID-19; COVID-19 survivors; Depression; Inflammation; Insomnia; Mental health; Obsessive-compulsive disorder; PTSD; Psychopathology.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Anxiety / epidemiology
  • Anxiety / immunology
  • Anxiety / psychology
  • Anxiety Disorders / epidemiology*
  • Anxiety Disorders / immunology
  • Anxiety Disorders / psychology
  • Betacoronavirus
  • C-Reactive Protein / immunology
  • COVID-19
  • Coronavirus Infections / epidemiology*
  • Coronavirus Infections / immunology
  • Coronavirus Infections / psychology
  • Depression / epidemiology
  • Depression / immunology
  • Depression / psychology
  • Depressive Disorder / epidemiology
  • Depressive Disorder / immunology
  • Depressive Disorder / psychology
  • Depressive Disorder, Major / epidemiology*
  • Depressive Disorder, Major / immunology
  • Depressive Disorder, Major / psychology
  • Emergency Service, Hospital
  • Female
  • Humans
  • Inflammation
  • Italy / epidemiology
  • Length of Stay / statistics & numerical data
  • Leukocyte Count
  • Lymphocyte Count
  • Male
  • Mental Disorders / epidemiology
  • Mental Disorders / immunology
  • Mental Disorders / psychology
  • Middle Aged
  • Monocytes
  • Neutrophils
  • Obsessive-Compulsive Disorder / epidemiology
  • Obsessive-Compulsive Disorder / immunology
  • Obsessive-Compulsive Disorder / psychology
  • Pandemics
  • Pneumonia, Viral / epidemiology*
  • Pneumonia, Viral / immunology
  • Pneumonia, Viral / psychology
  • SARS-CoV-2
  • Severity of Illness Index
  • Sex Factors
  • Sleep Initiation and Maintenance Disorders / epidemiology
  • Sleep Initiation and Maintenance Disorders / immunology
  • Sleep Initiation and Maintenance Disorders / psychology
  • Stress Disorders, Post-Traumatic / epidemiology
  • Stress Disorders, Post-Traumatic / immunology
  • Stress Disorders, Post-Traumatic / psychology
  • Suicidal Ideation
  • Survivors / psychology
  • Survivors / statistics & numerical data*
  • Young Adult

Substances

  • C-Reactive Protein