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Cited by 406COVID-19 and Mental HealthLong-Term Effects of COVID-19COVID-19 Clinical Research Studies

Immediate psychological distress in quarantined patients with COVID-19 and its association with peripheral inflammation: A mixed-method study

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Guo, Qian, Zheng, Yuchen, Shi, Jia, Wang, Jijun, Li, Guanjun, Li, Chunbo, Fromson, John A., Xu, Yong +13 more·2020·Brain, Behavior, and Immunity
DOI 10.1016/j.bbi.2020.05.038PMC PMC7235603
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Abstract

Since the end of 2019, Corona Virus Disease 2019 (COVID-19) has been the cause of a worldwide pandemic. The mental status of patients with COVID-19 who have been quarantined and the interactions between their psychological distress and physiological levels of inflammation have yet to be analyzed. Using a mixed-method triangulation design (QUAN + QUAL), this study investigated and compared the mental status and inflammatory markers of 103 patients who, while hospitalized with mild symptoms, tested positive with COVID-19 and 103 matched controls that were COVID-19 negative. The severity of depression, anxiety, and post-traumatic stress symptoms (PTSS) was measured via an on-line survey. Using a convenience sampling technique, qualitative data were collected until the point of data saturation. In addition, a semi-structured interview was conducted among five patients with COVID-19. Peripheral inflammatory markers were also collected in patients, both at baseline and within ± three days of completing the on-line survey. Results revealed that COVID-19 patients, when compared to non-COVID controls, manifested higher levels of depression (P < 0.001), anxiety (P < 0.001), and post-traumatic stress symptoms (P < 0.001). A gender effect was observed in the score of "Perceived Helplessness", the subscale of PSS-10, with female patients showing higher scores compared to male patients (Z = 2.56, P = 0.010), female (Z = 2.37, P = 0.018) and male controls (Z = 2.87, P = 0.004). Levels of CRP, a peripheral inflammatory indicator, correlated positively with the PHQ-9 total score (R = 0.37, P = 0.003, Spearman's correlation) of patients who presented symptoms of depression. Moreover, the change of CRP level from baseline inversely correlated with the PHQ-9 total score (R = -0.31, P = 0.002), indicative of improvement of depression symptoms. Qualitative analysis revealed similar results with respect to patient reports of negative feelings, including fear, guilt, and helplessness. Stigma and uncertainty of viral disease progression were two main concerns expressed by COVID-19 patients. Our results indicate that significant psychological distress was experienced by hospitalized COVID-19 patients and that levels of depressive features may be related to the inflammation markers in these patients. Thus, we recommend that necessary measures should be provided to address depression and other psychiatric symptoms for COVID-19 patients and attention should be paid to patient perceived stigma and coping strategies when delivering psychological interventions.

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  • In Shanghai, China, immediately after the outbreak, more than 33.0% of COVID-19 patients reported PTSD, 60.2% depression, and 55.3% anxiety symptoms.

    “Immediately after the outbreak, a considerable proportion of patients with COVID-19 reported post-traumatic stress disorder (PTSD) (more than 33.0%), depression (60.2%), and anxiety (55.3%) symptoms in Shanghai, China [9].”

    From Mindfulness-based online intervention on mental health and quality of life among COVID-19 patients in China: an intervention design (2021) · cites this paper as [9]

    The Results (Demographic and clinical characteristics; page unavailable) report depression symptoms in 60.2% and anxiety symptoms in 55.3% of patients. They report that only 1.0% exceeded the PTSD screening cutoff, not more than 33.0%. The Methods (Design and participants; page unavailable) place recruitment primarily in Shanghai during February 2020. (LLM, conf=0.90)

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  • COVID-19 can cause increased psychological symptoms such as PTSD, depression, and anxiety in patients.

    “Evidence suggests that this disease has psychological consequences on healthcare workers, students, psychiatric patients and general workers, especially for COVID-19 patients [4–13].”

    From Mindfulness-based online intervention on mental health and quality of life among COVID-19 patients in China: an intervention design (2021) · cites this paper as [9]

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  1. Wing, Y., Ho, M., 2004. Mental health of patients infected with SARS, in: In Challenges of Severe Acute Respiratory Syndrome. Elsevier, Hong Kong, pp. 526-546.

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Authors
Guo, Q., Zheng, Y., Shi, J., Wang, J., Li, G., Li, C., Fromson, J. A., Xu, Y., Liu, X., Xu, H., Zhang, T., Lu, Y., Chen, X., Hu, H., Tang, Y., Yang, S., Zhou, H., Wang, X., Chen, H., Wang, Z., & Yang, Z.
Affiliations
  • Shanghai Jiao Tong University (CN)
  • Nanjing University of Chinese Medicine (CN)
  • Brigham and Women's Hospital (US)
  • Fudan University (CN)
Corresponding author
  • Wang, Jijun
  • Chen, Xiaorong
  • Wang, Xiaoliang
  • Chen, Haiying
  • Wang, Zhen
  • Yang, Zongguo
ORCID
Venue
Brain, Behavior, and Immunity
Publisher
Elsevier BV
Published
2020-08
Volume
88
Pages
17-27
ISSN
0889-1591 (ISSN-L)
DOI
10.1016/j.bbi.2020.05.038
PMC
PMC7235603
OpenAlex
W3025479209
Cited by
406
References
58
Citations by year
2026: 4 · 2025: 15 · 2024: 35 · 2023: 70 · 2022: 118 · 2021: 123 · 2020: 40
FWCI
35.06
Type
journal article
Language
en
Open access
Licence
Locations
  • Brain Behavior and Immunity (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Social Sciences › Psychology › Clinical Psychology › COVID-19 and Mental Health
  • Health Sciences › Medicine › Neurology › Long-Term Effects of COVID-19
  • Health Sciences › Medicine › Infectious Diseases › COVID-19 Clinical Research Studies
Keywords
COVID-19 pandemic, psychological distress, quarantine, depression, anxiety, posttraumatic stress symptoms, peripheral inflammation, C-reactive protein, gender differences, helplessness, stigma, fear, guilt, uncertainty, mild COVID-19, hospitalized patients, PHQ-9, PSS-10
MeSH terms
Patient Health Questionnaire, Betacoronavirus, Procalcitonin, Psychological Distress, COVID-19, SARS-CoV-2, Adult, Aged, Anxiety, Blood Sedimentation, C-Reactive Protein, Cross-Sectional Studies, Depression, Female, Hospitalization, Humans, Inflammation, Leukocyte Count, Male, Middle Aged, Pneumonia, Viral, Quarantine, Sex Factors, Stress Disorders, Post-Traumatic, Stress, Psychological, Case-Control Studies, Coronavirus Infections, Pandemics

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