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Immediate psychological distress in quarantined patients with COVID-19 and its association with peripheral inflammation: A mixed-method study
Open accessAbstract
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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“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]
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“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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Luo, M., Guo, L., Yu, M., Jiang, W., & Wang, H. (2020) · Psychiatry Research · doi:10.1016/j.psychres.2020.113190 · Cited by 1,615
Epidemiology of mental health problems in COVID-19: a review
Hossain, M. M., Tasnim, S., Sultana, A., Faizah, F., Mazumder, H., Zou, L., McKyer, E. L. J., Ahmed, H. U., & Ma, P. (2020) · F1000Research · doi:10.12688/f1000research.24457.1 · Cited by 1,113
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Metadata
- 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)
- 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
- green
- www.ncbi.nlm.nih.gov
- 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 › Clinical 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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