Study shows high prevalence of depression, anxiety and post-traumatic stress after Covid-19

In a study carried out with 425 patients who recovered from the moderate and severe forms of Covid-19, researchers from USP (University of São Paulo) observed a high prevalence of cognitive deficits and psychiatric disorders. Assessments were conducted at Hospital das Clínicas between six and nine months after hospital discharge.

More than half (51.1%) of the participants reported having perceived memory decline after infection and another 13.6% developed post-traumatic stress disorder. Generalized anxiety disorder was diagnosed in 15.5% of the volunteers, and in 8.14% of them the problem arose after the disease. The diagnosis of depression was established for 8% of the patients — in 2.5% of them only after hospitalization.

The complete results of the research, which was supported by Fapesp, were published in the journal General Hospital Psychiatry.

“One of the main findings is that none of the cognitive or psychiatric alterations observed in these patients correlates with the severity of the condition. We also did not see an association with the clinical management adopted during the hospitalization period or with socioeconomic factors, such as loss of family members or financial losses during hospitalization. the Covid-19 pandemic”, says Rodolfo Damiano, resident physician at the Institute of Psychiatry of the Faculty of Medicine (FM-USP) and first author of the article.

The study is part of a broader project, coordinated by FM-USP professor Geraldo Busatto Filho, in which a large group of people treated at Hospital das Clínicas between 2020 and 2021 have been accompanied by professionals from different areas, including otorhinolaryngology, physiatry and neurology, in order to assess possible sequelae left by SARS-CoV-2.

“During my doctorate, I coordinated the neuropsychiatric evaluation, whose preliminary results were described in this article”, says Damiano to Agência Fapesp. The work was guided by FM-USP professor Eurípedes Constantino Miguel Filho.

“One of our concerns was to understand whether this virus and the disease caused by it have a long-term impact, producing late manifestations in the central nervous system”, says E. Miguel.

For the researcher, the fact that a clear correlation was not found between the psychiatric condition and the magnitude of the disease in the acute phase or psychosocial factors —including those of a socioeconomic nature or traumatic experiences— corroborates the hypothesis that late changes related to infection by the SARS-CoV-2 (such as inflammatory processes associated with immunological changes, vascular damage associated with coagulopathies or the very presence of the virus in the brain) would play a role in the origin of the disorders.

“The presence of clinical manifestations such as cognitive losses, headaches, anosmia [perda do olfato] and other neurological changes in these patients contribute additional evidence that these psychiatric changes may reflect the action of SARS-CoV-2 in the central system.”

Methodology

All participants underwent a battery of cognitive tests to assess skills such as memory, attention, verbal fluency and spatio-temporal orientation.

“We saw a lot of cognitive loss. In a test that measures processing speed, for example, patients took on average twice as long as expected for their age. [com base em valores médios descritos na literatura científica para a população brasileira]. And this was observed for all ages”, says Damiano. “In addition, more than half subjectively reported a decline in memory.”

Volunteers also underwent a structured interview with a psychiatrist and answered standardized questionnaires used in diagnosing depression, anxiety and post-traumatic stress disorder.

As the authors describe in the article, the prevalence of “common mental disorder” (depressive symptoms, anxiety states, irritability, fatigue, insomnia, memory and concentration difficulties) in the studied group (32.2%) was higher than that reported for the general Brazilian population (26.8%) in epidemiological studies.

In these patients, the prevalence of generalized anxiety disorder (14.1%) was considerably higher than the average for Brazilians (9.9%). The prevalence of depression found (8%) is also higher than that estimated for the general population of the country (between 4% and 5%).

“Patients who progress to the severe form, in general, are more clinically compromised [por problemas cardíacos, renais, diabetes e outras comorbidades] and, consequently, already have more psychiatric symptoms. This was considered in the analysis. Even correcting for this factor, the prevalence observed in the study was very high”, says Damiano.

The worsening of psychiatric symptoms after acute infections is common and expected, comments the researcher. “But with no other viral disease was so much difference and cognitive losses as significant as with Covid-19. One of the possible explanations is the effect of the virus itself on the central nervous system”, he comments. “Whether these losses are recoverable remains to be seen.”

Next steps

Currently, the USP group is studying blood samples collected from volunteers during the period of hospitalization. The objective is to evaluate the profile of cytokines (immune system proteins that regulate the inflammatory response) to find out if there is a correlation between the degree of inflammation during the acute phase of Covid-19 and the development of neuropsychiatric symptoms.

“If there is any correlation, the next step will be to investigate whether interleukin-inhibiting drugs [um dos tipos de citocina] can be used to prevent the onset or worsening of psychiatric symptoms”, he says.

For those who have already been affected, Damiano recommends vaccination and psychiatric follow-up. “There is evidence that physical exercise helps to reverse cognitive changes associated with serious illness and there is also cognitive rehabilitation training that can be done with the follow-up of a qualified neuropsychologist. In addition, I believe that the practice of meditation can be beneficial.”