Prolonged Fatigue and Mental Health Challenges in Critical COVID-19 Survivors

J Intensive Care Med. 2024 Dec;39(12):1238-1249. doi: 10.1177/08850666241255328. Epub 2024 Jul 23.

Abstract

Background: The aim of this study was to investigate the development of fatigue and mental illness between 3 and 12 months after critical COVID-19 and explore risk factors for long-lasting symptoms. Study Design and Methods: A prospective, multicenter COVID-19 study in southern Sweden, including adult patients (≥18 years) with rtPCR-confirmed COVID-19 requiring intensive care. Survivors were invited to a follow-up at 3 and 12 months, where patient-reported symptoms were assessed using the Modified Fatigue Impact Scale (MFIS), the Hospital Anxiety and Depression Scale (HADS) and the Posttraumatic Stress Disorder Checklist version 5 (PCL-5). The development between 3 and 12 months was described by changes in relation to statistical significance and suggested values for a minimally important difference (MID). Potential risk factors for long-lasting symptoms were analyzed by multivariable logistic regression. Results: At the 3-month follow-up, 262 survivors (87%) participated, 215 (72%) returned at 12 months. Fatigue was reported by 50% versus 40%, with a significant improvement at 12 months (MFIS; median 38 vs. 33, P < .001, MID ≥4). There were no significant differences in symptoms of mental illness between 3 and 12 months, with anxiety present in 33% versus 28%, depression in 30% versus 22%, and posttraumatic stress disorder in 17% versus 13%. A worse functional outcome and less sleep compared to before COVID-19 were risk factors for fatigue and mental illness at 12 months. Conclusions: Fatigue improved between 3 and 12 months but was still common. Symptoms of mental illness remained unchanged with anxiety being the most reported. A worse functional outcome and less sleep compared to before COVID-19 were identified as risk factors for reporting long-lasting symptoms.

Keywords: COVID-19; critical care outcomes; critical illness; fatigue; intensive care; mental illness; patient-reported outcome measures; post-acute COVID-19 syndrome; prolonged fatigue and mental health challenges in critical COVID-19 survivors.

Publication types

  • Multicenter Study

MeSH terms

  • Adult
  • Aged
  • Anxiety* / etiology
  • COVID-19* / complications
  • COVID-19* / epidemiology
  • COVID-19* / psychology
  • Critical Illness / psychology
  • Depression* / etiology
  • Depression* / psychology
  • Fatigue* / etiology
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Mental Health
  • Middle Aged
  • Prospective Studies
  • Risk Factors
  • SARS-CoV-2 / physiology
  • Stress Disorders, Post-Traumatic / epidemiology
  • Stress Disorders, Post-Traumatic / etiology
  • Stress Disorders, Post-Traumatic / psychology
  • Survivors* / psychology
  • Sweden / epidemiology