Mental Morbidities and Chronic Fatigue in Severe Acute Respiratory Syndrome Survivors: Long-term Follow-up
Abstract
BACKGROUND: Short-term follow-up studies of severe acute respiratory syndrome (SARS) survivors suggested that their physical conditions continuously improved in the first year but that their mental health did not. We investigated long-term psychiatric morbidities and chronic fatigue among SARS survivors. METHODS: All SARS survivors from the hospitals of a local region in Hong Kong were assessed by a constellation of psychometric questionnaires and a semistructured clinical interview for the Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) to determine the presence of psychiatric disorders and chronic fatigue problems. RESULTS: Of 369 SARS survivors, 233 (63.1%) participated in the study (mean period of time after SARS, 41.3 months). Over 40% of the respondents had active psychiatric illnesses, 40.3% reported a chronic fatigue problem, and 27.1% met the modified 1994 Centers for Disease Control and Prevention criteria for chronic fatigue syndrome. Logistic regression analysis suggested that being a health care worker at the time of SARS infection (odds ratio [OR], 3.24; 95% confidence interval [CI], 1.12- 9.39; P = .03), being unemployed at follow-up (OR, 4.71; 95% CI, 1.50-14.78; P = .008), having a perception of social stigmatization (OR, 3.03; 95% CI, 1.20-7.60; P = .02), and having applied to the SARS survivors' fund (OR, 2.92; 95% CI, 1.18-7.22; P = .02) were associated with an increased risk of psychiatric morbidities at follow-up, whereas application to the SARS survivors' fund (OR, 2.64; 95% CI, 1.07-6.51; P = .04) was associated with increased risk of chronic fatigue problems. CONCLUSIONS: Psychiatric morbidities and chronic fatigue persisted and continued to be clinically significant among the survivors at the 4-year follow-up. Optimization of the treatment of mental health morbidities by a multidisciplinary approach with a view for long-term rehabilitation, especially targeting psychiatric and fatigue problems and functional and occupational rehabilitation, would be needed.
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SARS survivors reported psychiatric symptoms including PTSD, depression, panic disorder, and OCD at 1 to 50 months follow-up.
“SARS survivors reported psychiatric symptoms, including post-traumatic stress disorder (PTSD), depression, panic disorder, and obsessive-compulsive disorder (OCD) at 1 to 50 months follow up (Wu et al., 2020, Cheng et al., 2004, Lam et al., 2009).”
From Anxiety and depression in COVID-19 survivors: role of inflammatory and clinical predictors (2020) · cites this paper as Lam et al., 2009
Viral infections can trigger chronic inflammation and aberrant immune responses, causing long-lasting neuropsychiatric syndromes involving cognitive, affective, and behavioural symptoms over variable periods after infection.
“Current knowledge suggests that viral infections can trigger chronic inflammation and aberrant immune responses, causing long-lasting neuropsychiatric syndromes involving cognitive, affective, and behavioural symptoms, over highly variable periods after infection (from weeks to years following acute infection) (Bechter, 2013, Kepinska et al., 2020, Lam et al., 2009, Rogers et al., 2020).”
From Persistent psychopathology and neurocognitive impairment in COVID-19 survivors: effect of inflammatory biomarkers at three-month follow-up (2021) · cites this paper as Lam et al., 2009
Cites
Diagnostic and Statistical Manual of Mental Disorders
Williams, J. B. W., & First, M. B. (2013) · Oxford University Press eBooks · doi:10.1093/acrefore/9780199975839.013.104 · Cited by 109,841 · see citing works
The Chronic Fatigue Syndrome: A Comprehensive Approach to Its Definition and Study
Fukuda, K., Straus, S. E., Hickie, I., Sharpe, M. C., Dobbins, J. G., Komaroff, A., & and International Chronic Fatigue Syndrome Study Group. (1994) · Annals of Internal Medicine · doi:10.7326/0003-4819-121-12-199412150-00009 · Cited by 4,969 · see citing works
Development of a fatigue scale
Chalder, T., Berelowitz, G., Pawlikowska, T., Watts, L., Wessely, S., Wright, D., & Wallace, E. P. (1993) · Journal of Psychosomatic Research · doi:10.1016/0022-3999(93)90081-p · Cited by 3,032 · see citing works
Stress and psychological distress among SARS survivors 1 year after the outbreak
Lee, A. M., Wong, J. G., McAlonan, G. M., Cheung, V., Cheung, C., Sham, P. C., Chu, C.-M., Wong, P.-C., Tsang, K. W., & Chua, S. E. (2007) · The Canadian Journal of Psychiatry · doi:10.1177/070674370705200405 · Cited by 1,195 · see citing works
Glial activation: a driving force for pathological pain
Watkins, L. R., Milligan, E. D., & Maier, S. F. (2001) · Trends in Neurosciences · doi:10.1016/s0166-2236(00)01854-3 · Cited by 1,091 · see citing works
Leung, C. M., Wing, Y. K., Kwong, P. K., & Shum, A. L. K. (1999) · Acta Psychiatrica Scandinavica · doi:10.1111/j.1600-0447.1999.tb10897.x · Cited by 407 · see citing works
Lancee, W. J., Maunder, R. G., & Goldbloom, D. S. (2008) · Psychiatric Services · doi:10.1176/ps.2008.59.1.91 · Cited by 391 · see citing works
The experience of SARS-related stigma at Amoy Gardens
Lee, S., Chan, L. Y. Y., Chau, A. M. Y., Kwok, K. P. S., & Kleinman, A. (2005) · Social Science & Medicine · doi:10.1016/j.socscimed.2005.04.010 · Cited by 367 · see citing works
CHENG, S. K. W., WONG, C. W., TSANG, J., & WONG, K. C. (2004) · Psychological Medicine · doi:10.1017/s0033291704002272 · Cited by 347 · see citing works
One-Year Outcomes and Health Care Utilization in Survivors of Severe Acute Respiratory Syndrome
Tansey, C. M. (2007) · Archives of Internal Medicine · doi:10.1001/archinte.167.12.1312 · Cited by 313 · see citing works
Hypocortisolism in survivors of severe acute respiratory syndrome (SARS)
Leow, M. K., Kwek, D. S., Ng, A. W., Ong, K.-C., Kaw, G. J. L., & Lee, L. (2005) · Clinical Endocrinology · doi:10.1111/j.1365-2265.2005.02325.x · Cited by 293 · see citing works
Antonio, G. E., Wong, K. T., Hui, D. S. C., Wu, A. K. L., Lee, N. L. S., Yuen, E. H. Y., Leung, C. B., Rainer, T. H., Cameron, P. A., Chung, S. S. C., et al. (2003) · Radiology · doi:10.1148/radiol.2283030726 · Cited by 290 · see citing works
The development of the Chinese version of Impact of Event Scale - Revised (CIES-R)
Wu, K. K., & Chan, K. S. (2003) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s00127-003-0611-x · Cited by 251 · see citing works
Stress and Psychological Impact on SARS Patients during the Outbreak
Chua, S. E., Cheung, V., McAlonan, G. M., Cheung, C., Wong, J. W., Cheung, E. P., Chan, M. T., Wong, T. K., Choy, K. M., Chu, C. M., et al. (2004) · The Canadian Journal of Psychiatry · doi:10.1177/070674370404900607 · Cited by 250 · see citing works
Posttraumatic Stress after SARS
Wu, K. K., Chan, S. K., & Ma, T. M. (2005) · Emerging infectious diseases · doi:10.3201/eid1108.041083 · Cited by 237 · see citing works
Cheng, S. K.-W., Tsang, J. S.-K., Ku, K.-H., Wong, C.-W., & Ng, Y.-K. (2004) · British Journal of Psychiatry · doi:10.1192/bjp.184.4.359 · Cited by 155 · see citing works
The hypothalamo–pituitary–adrenal axis in chronic fatigue syndrome and fibromyalgia syndrome
Tanrıverdi, F., Karaca, Z., Unluhizarci, K., & Keleştimur, F. (2007) · Stress · doi:10.1080/10253890601130823 · Cited by 153 · see citing works
Kwek, S. K., Chew, W. M., Ong, K.-C., Ng, A. W., Lee, L., Kaw, G. J. L., & Leow, M. K. (2006) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2005.08.020 · Cited by 123 · see citing works
Sheng, B., Wing Cheng, S. K., Lau, K. K., Li, H. L., & Yiu Chan, E. L. (2005) · European Psychiatry · doi:10.1016/j.eurpsy.2004.06.023 · Cited by 117 · see citing works
Avascular necrosis of bone in severe acute respiratory syndrome
Hong, N., & Du, X.-K. (2004) · Clinical Radiology · doi:10.1016/j.crad.2003.12.008 · Cited by 94 · see citing works
Mihaylova, I., DeRuyter, M., Rummens, J., Bosmans, E., & Maes, M. H. J. (2007) · PubMed · Cited by 62 · see citing works
Chronic Stress and Natural Killer Cell Activity After Exposure to Traumatic Death
Delahanty, D. L., Dougall, A. L., Craig, K. J., Jenkins, F. J., & Baum, A. E. (1997) · Psychosomatic Medicine · doi:10.1097/00006842-199709000-00002 · Cited by 46 · see citing works
Mental health of patients infected with SARS
Wing, Y. K., & Ho, M. (2004) · The HKU Scholars Hub (University of Hong Kong) · Cited by 2 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
Nalbandian, A., Sehgal, K., Gupta, A., Madhavan, M. V., McGroder, C., Stevens, J. S., Cook, J. R., Nordvig, A. S., Shalev, D., Sehrawat, T. S., et al. (2021) · Nature Medicine · doi:10.1038/s41591-021-01283-z · Cited by 4,862 · see citing works
Long COVID: major findings, mechanisms and recommendations
Davis, H. E., McCorkell, L., Vogel, J. M., & Topol, E. J. (2023) · Nature Reviews Microbiology · doi:10.1038/s41579-022-00846-2 · Cited by 4,153 · see citing works
RETRACTED: 6-month consequences of COVID-19 in patients discharged from hospital: a cohort study
Huang, C., Huang, L., Wang, Y., Li, X., Ren, L., Gu, X., Kang, L., Guo, L., Liu, M., Zhou, X., et al. (2021) · The Lancet · doi:10.1016/s0140-6736(20)32656-8 · Cited by 4,084 · see citing works
RetractedCOVID-19 pandemic and mental health consequences: Systematic review of the current evidence
Vindegaard, N., & Benros, M. E. (2020) · Brain, Behavior, and Immunity · doi:10.1016/j.bbi.2020.05.048 · Cited by 3,221 · see citing works
Rogers, J. P., Chesney, E., Oliver, D., Pollak, T. A., McGuire, P., Fusar-Poli, P., Zandi, M. S., Lewis, G., & David, A. S. (2020) · The Lancet Psychiatry · doi:10.1016/s2215-0366(20)30203-0 · Cited by 2,407 · see citing works
Anxiety and depression in COVID-19 survivors: role of inflammatory and clinical predictors
Mazza, M. G., De Lorenzo, R., Conte, C., Poletti, S., Vai, B., Bollettini, I., Melloni, E. M. T., Furlan, R., Ciceri, F., Rovere-Querini, P., et al. (2020) · Brain, Behavior, and Immunity · doi:10.1016/j.bbi.2020.07.037 · Cited by 1,804 · see citing works
Chew, N. W. S., Lee, G. K. H., Tan, B. Y. Q., Jing, M., Goh, Y., Ngiam, N. J. H., Yeo, L. L. L., Ahmad, A., Ahmed Khan, F., Napolean Shanmugam, G., et al. (2020) · Brain, Behavior, and Immunity · doi:10.1016/j.bbi.2020.04.049 · Cited by 1,650 · see citing works
“Such psychosomatic symptoms have been reported with increased prevalence during and after the outbreaks, such as the SARS and Ebola virus (Lam et al., 2009; Lee et al., 2005; Marco et al., 2015; Matua and Wal, 2015; Tucker, xxxx; Xiang et al., 2020).”
InfluentialLiu, N., Zhang, F., Wei, C., Jia, Y., Shang, Z., Sun, L., Wu, L., Sun, Z., Zhou, Y., Wang, Y., et al. (2020) · Psychiatry Research · doi:10.1016/j.psychres.2020.112921 · Cited by 1,548 · see citing works
Long COVID or post-COVID-19 syndrome: putative pathophysiology, risk factors, and treatments
Yong, S. J. (2021) · Infectious Diseases · doi:10.1080/23744235.2021.1924397 · Cited by 1,339 · see citing works
1-year outcomes in hospital survivors with COVID-19: a longitudinal cohort study.
Huang, L., Yao, Q., Gu, X., Wang, Q., Ren, L., Wang, Y., Hu, P., Guo, L., Liu, M., Xu, J., et al. (2021) · The Lancet · doi:10.1016/s0140-6736(21)01755-4 · Cited by 1,101 · see citing works
Symptoms, complications and management of long COVID: a review
Aiyegbusi, O. L., Hughes, S. E., Turner, G., Rivera, S. C., McMullan, C., Chandan, J. S., Haroon, S., Price, G., Davies, E. H., Nirantharakumar, K., et al. (2021) · Journal of the Royal Society of Medicine · doi:10.1177/01410768211032850 · Cited by 969 · see citing works
Troyer, E. A., Kohn, J. N., & Hong, S. (2020) · Brain, Behavior, and Immunity · doi:10.1016/j.bbi.2020.04.027 · Cited by 964 · see citing works
Townsend, L., Dyer, A. H., Jones, K., Dunne, J., Mooney, A., Gaffney, F., O'Connor, L., Leavy, D., O'Brien, K., Dowds, J., et al. (2020) · PLOS ONE · doi:10.1371/journal.pone.0240784 · Cited by 911 · see citing works
Clinical sequelae of COVID-19 survivors in Wuhan, China: a single-centre longitudinal study
Xiong, Q., Xu, M., Li, J., Liu, Y., Zhang, J., Xu, Y., & Dong, W. (2021) · Clinical Microbiology and Infection · doi:10.1016/j.cmi.2020.09.023 · Cited by 751 · see citing works
Unexplained post-acute infection syndromes
Choutka, J., Jansari, V., Hornig, M., & Iwasaki, A. (2022) · Nature Medicine · doi:10.1038/s41591-022-01810-6 · Cited by 604 · see citing works
Mazza, M. G., Palladini, M., De Lorenzo, R., Magnaghi, C., Poletti, S., Furlan, R., Ciceri, F., Rovere-Querini, P., & Benedetti, F. (2021) · Brain, Behavior, and Immunity · doi:10.1016/j.bbi.2021.02.021 · Cited by 513 · see citing works
“Current knowledge suggests that viral infections can trigger chronic inflammation and aberrant immune responses, causing longlasting neuropsychiatric syndromes involving cognitive, affective, and behavioural symptoms, over highly variable periods after infection (from weeks to years following acute infection) (Bechter…”
InfluentialThe lasting misery of coronavirus long-haulers
Marshall, M. (2020) · Nature · doi:10.1038/d41586-020-02598-6 · Cited by 282 · see citing works
Spectrum of neuropsychiatric manifestations in COVID-19.
Nalleballe, K., Reddy Onteddu, S., Sharma, R., Dandu, V., Brown, A., Jasti, M., Yadala, S., Veerapaneni, K., Siddamreddy, S., Avula, A., et al. (2020) · Brain, Behavior, and Immunity · doi:10.1016/j.bbi.2020.06.020 · Cited by 235 · see citing works
Addressing the mental health impact of COVID-19 through population health
Boden, M., Zimmerman, L., Azevedo, K. J., Ruzek, J. I., Gala, S., Abdel Magid, H. S., Cohen, N., Walser, R., Mahtani, N. D., Hoggatt, K. J., et al. (2021) · Clinical Psychology Review · doi:10.1016/j.cpr.2021.102006 · Cited by 216 · see citing works
Characterizing long COVID: deep phenotype of a complex condition
Deer, R. R., Rock, M. A., Vasilevsky, N., Carmody, L., Rando, H., Anzalone, A. J., Basson, M. D., Bennett, T. D., Bergquist, T., Boudreau, E. A., et al. (2021) · EBioMedicine · doi:10.1016/j.ebiom.2021.103722 · Cited by 200 · see citing works
Psycho-Neuroendocrine-Immune Interactions in COVID-19: Potential Impacts on Mental Health
Raony, Í., de Figueiredo, C. S., Pandolfo, P., Giestal-de-Araujo, E., Oliveira-Silva Bomfim, P., & Savino, W. (2020) · Frontiers in Immunology · doi:10.3389/fimmu.2020.01170 · Cited by 185 · see citing works
Liu, Z., Qiao, D., Xu, Y., Zhao, W., Yang, Y., Wen, D., Li, X., Nie, X., Dong, Y., Tang, S., et al. (2021) · Journal of Medical Internet Research · doi:10.2196/26883 · Cited by 169 · see citing works
Chew, N. W. S., Ngiam, J. N., Tan, B. Y.-Q., Tham, S.-M., Tan, C. Y.-S., Jing, M., Sagayanathan, R., Chen, J. T., Wong, L. Y. H., Ahmad, A., et al. (2020) · BJPsych Open · doi:10.1192/bjo.2020.98 · Cited by 159 · see citing works
Post-COVID syndrome and suicide risk
Sher, L. (2021) · QJM: An International Journal of Medicine · doi:10.1093/qjmed/hcab007 · Cited by 148 · see citing works
Yuan, K., Huang, X.-L., Yan, W., Zhang, Y.-X., Gong, Y.-M., Su, S.-Z., Huang, Y.-T., Zhong, Y., Wang, Y.-J., Yuan, Z., et al. (2022) · Molecular Psychiatry · doi:10.1038/s41380-021-01295-8 · Cited by 148 · see citing works
Hyperactivation of P2X7 receptors as a culprit of COVID-19 neuropathology
Ribeiro, D. E., Oliveira-Giacomelli, Á., Glaser, T., Arnaud-Sampaio, V. F., Andrejew, R., Dieckmann, L., Baranova, J., Lameu, C., Ratajczak, M. Z., & Ulrich, H. (2021) · Molecular Psychiatry · doi:10.1038/s41380-020-00965-3 · Cited by 145 · see citing works
Juan, Y., Yuanyuan, C., Qiuxiang, Y., Cong, L., Xiaofeng, L., Yundong, Z., Jing, C., Peifeng, Q., Yan, L., Xiaojiao, X., et al. (2020) · Comprehensive Psychiatry · doi:10.1016/j.comppsych.2020.152198 · Cited by 92 · see citing works
COVID‑19 and post‑traumatic stress disorder: The perfect ‘storm’ for mental health (Review)
Giannopoulou, I., Galinaki, S., Kollintza, E., Adamaki, M., Kympouropoulos, S., Alevyzakis, E., Tsamakis, K., Tsangaris, I., Spandidos, D., Siafakas, N., et al. (2021) · Experimental and Therapeutic Medicine · doi:10.3892/etm.2021.10596 · Cited by 81 · see citing works
Role of senescence in the chronic health consequences of COVID-19
Wissler Gerdes, E. O., Vanichkachorn, G., Verdoorn, B. P., Hanson, G. J., Joshi, A. Y., Murad, M. H., Rizza, S. A., Hurt, R. T., Tchkonia, T., & Kirkland, J. L. (2022) · Translational Research · doi:10.1016/j.trsl.2021.10.003 · Cited by 38 · see citing works
Chennapragada, L., Sullivan, S. R., Hamerling-Potts, K. K., Tran, H., Szeszko, J., Wrobleski, J., Mitchell, E. L., Walsh, S., & Goodman, M. (2022) · Psychiatry Research · doi:10.1016/j.psychres.2022.114748 · Cited by 13 · see citing works
- Authors
- Lam, M. H.-B.
- Affiliations
- Chinese University of Hong Kong (HK)
- Corresponding author
- Lam, Marco Ho-Bun
- Venue
- Archives of Internal Medicine
- Publisher
- American Medical Association (AMA)
- Published
- 2009-12-14
- Volume
- 169
- Issue
- 22
- Pages
- 2142
- ISSN
- 0003-9926 (ISSN-L)
- OpenAlex
- W2165427892
- Cited by
- 723
- References
- 23
- Citations by year
- 2026: 11 · 2025: 36 · 2024: 59 · 2023: 109 · 2022: 169 · 2021: 226 · 2020: 107 · 2019: 1 · 2014: 2 · 2012: 2
- FWCI
- 0.64
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Archives of Internal Medicine (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Neurology › Long-Term Effects of COVID-19
- Social Sciences › Psychology › Clinical Psychology › COVID-19 and Mental Health
- Health Sciences › Medicine › Infectious Diseases › Infectious Encephalopathies and Encephalitis
- Keywords
- SARS, SARS survivors, psychiatric morbidity, chronic fatigue, chronic fatigue syndrome, long-term follow-up, healthcare workers, unemployment, social stigma, vocational rehabilitation, mental health
- MeSH terms
- Adult, Mental Disorders, Chronic Disease, Fatigue, Female, Follow-Up Studies, Humans, Male, Middle Aged, Time Factors, Cohort Studies, Severe Acute Respiratory Syndrome
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