Table 3.
Mental health outcomes in COVID-19 survivors.
| Author | Study design | Country | Sample size (N, Male/Female) |
Age (years) Mean (SD) |
Follow-up period month/or days Mean (SD) |
Hospitalization period, days Mean (SD) |
Outcomes (Measurement tools) | Results, Prevalence of outcomes | ||
|---|---|---|---|---|---|---|---|---|---|---|
| Daher et al. [15] | Case series | Germany | 33 22/11 |
64 (3) | 58.49 (17.82) days after discharge |
15 (1.8) | Depression (PHQ-9) Anxiety (GAD-7) Cognitive problems |
Median [IQR] Depression 7 [4–11] Anxiety 4 [1–9] Cognitive problems 6/33 (18%) |
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| Arnold et al. [16] | Prospective cohort study | England | 110 68/42 |
59.64 (20.28) | 88.94 (12.77) days after hospital discharge |
5(4.5) | Mental wellbeing (WEMWBS) Insomnia (NEWS, scored from 1 to 20) |
↑Insomnia (24%) Mental wellbeing in severity of COVID-19 |
||
| Median [IQR] | ||||||||||
| Mild | 52 [44-56] | |||||||||
| Moderate | 53 [42-59] | |||||||||
| Severe | 50 [39-58] | |||||||||
| Mental wellbeing was similar to healthy population norms | ||||||||||
| Garrigues et al. [19] | Cohort study | France | 120 75/45 |
63.2 (15.7) | 110.9 (11.1) days after hospital admission | 11.2 (13.4) | Cognitive and sleep problems (short phone questionnaire) | Attention problem 32/120 (26.7%) Memory loss 41/120 (34.2%) Sleep problems 37/120 (30.8%) |
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| Halpin et al. [21] | Cross-sectional study | England | 100 (19/13 in ICU group, 35/33 in Ward group) |
ICU patients: 58.85 (38.8) Ward patients: 60.61 (55.29) |
48 (10.3) days after hospital discharge | ICU patients: 12.71 (4.65) Ward patients: 8.26 (7.57) |
PTSD symptoms, cognitive problems (COVID-19 rehabilitation telephone screening tool, Likert scale) |
ICU (n=32) | Ward (n=68) | |
| PTSD | 46.9% | 23.5% | ||||||||
| Worsened anxiety/depression | 12 (37.5%) | 11 (16.2%) | ||||||||
| Thoughts of self‐harm | 1 (3.1%) | 1 (1.5%) | ||||||||
| New or worsened concentration problem | 11 (34.4%) | 11 (16.2%) | ||||||||
| New or worsened short‐term memory problem | 6 (18.8%) | 12 (17.6%) | ||||||||
| Mandal et al. [23] | Cross-sectional study | London, United Kingdom | 384 62/38 | 59.9 (16.1) | 53.29 (8.9) days after hospital discharge | 7.1 (5.02) | Sleep quality (11-point scale) | Sleep quality Median [IQR] Maximum intensity 5 [1–5] Intensity at follow up 3 [0–6] 66.2% reported improvement 29.7% reported no change 4.2% reported deterioration at follow-up. Patients graded their overall health recovery as 90% (IQR 75–100%) compared to 100% best health |
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| Kamal et al. [26] | Cross-sectional study | Egypt | 287 103/184 |
32.3 (8.5) | More than 20 days after the last negative test | N/A | Anxiety, depression, obsessive-compulsive disorder, dementia (data collection questionnaire) | Anxiety 38% Depression 28.6% Obsessive-Compulsive disorder 4.9% Dementia 28.6% |
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| Xiong et al. [27] | Prospective cohort study | China | 538 245/293 |
51.64 (15.6) | 98.05 (5.2) days after hospital discharge |
17.4 (10.4) | Psychosocial symptoms, depression, anxiety, dysphoria, feelings of inferiority, sleep problems (small-scale clinical pretrial assessment, telephone follow-up survey) | Psychosocial symptoms 122 (22.7%) † Depression 23 (4.3%) † Anxiety 35 (6.5%) † Dysphoria 9 (1.7%) Feelings of inferiority 3 (0.6%) Sleep problems 95 (17.7%) † Significantly higher than in the comparison group. |
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| Tomasoni et al. [31] | Cross-sectional study | Italy | 105 77/28 |
54.29 (16.53) | 45.64 (3.75) days after virological clearance |
8.35 (3.75) | Anxiety, depression (HADS) Cognitive problems (MMSE) |
Pathological HADS-A/D 30/100 (30%) [Both anxiety and depression 10/30 (33%), only anxiety 19/30 (63%), only depression 1/30 (4%)] Persistent cognitive problems (n = 25) 17.1% 52.4% showed persistent symptoms. |
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| Mendez et al. [33] | Prospective cohort study | Spain | 179 105/74 |
57.7 (13.45) | 2 months after hospital discharge | 13.05 (6.72) | Anxiety (GAD-7) Depression (PHQ-2) PTSD (DTS) Neurocognitive function (standardized instruments) By telephone |
39.1% of patients had psychiatric morbidity Anxiety (29.6%) Depression (26.8%) PTSD (25.1%) 58.7% of patients had neurocognitive impairment in at least one function |
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| Cognitive problems | Moderate | Severe | ||||||||
| Immediate verbal memory | 38% | 11.2% | ||||||||
| Delayed verbal memory | 11.8% | 2.8% | ||||||||
| Working memory | 6.1% | 1.1% | ||||||||
| Semantic verbal fluency | 34.6% | 8.4% | ||||||||
| Mazza et al. [35] | Prospective cohort study | Italy | 402 [admitted patients (n = 300), managed at home (n = 102)] 265/137 |
57.80 (13.33) | 31.29 (15.7) days after hospital discharge | 15.31 (10.32) for admitted patients | Anxiety (STAI-Y) Depression (ZSDS and BDI-13) PTSD (PCL-5, IES-R) Sleep problem (MOS-SS) Obsessive-Compulsive (OCI) |
Anxiety 42% Depression 31% PTSD 28% Obsessive-Compulsive symptoms 20% Sleep problem 40% 55.7% presented at least 1 mental disorder |
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| De Lorenzo et al. [36] | Retrospective and prospective cohort study |
Italy | 185 123/62 |
57.35 (14.19) | 24.05 (6.72) days after hospital discharge |
10.2 (6.72) | PTSD (IES-R) Anxiety (STAI-Y, Pain (VAS) Insomnia (WHIIRS) Cognitive impairment (MoCA score) |
Cognitive impairment 47/185 (25.4%) Insomnia 51/185 (27.6%) Anxiety 55/185 (29.7%) PTSD 41/185 (22.2%) VAS pain 77.5 [IQR 75–90] Anxiety and PTSD were significantly more frequent in discharged vs. hospitalized patients. |
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| Wu et al. [37] | Case series | China | 370 203/167 |
50.5 (13.1) | 24.1(7.44) days after hospital discharge |
11.64 (3.72) | Anxiety (GAD-7) Depression (PHQ-9) Sleep problem (single question) |
Anxiety 50 (13.5%) Depression 40 (10.8%) Both anxiety and depression 23 (6.2%) Sleep problem 109 (29.5%) |
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| Yuan et al. [38] | Retrospective cohort study | China | 96 (27/27 in normal group, 20/22 in self-reported depression group) | Normal group = 45.2 (13.2), Self-reported depression group = 49.6 (13.2) | 14 days after discharge | Normal group = 24.4 (6.7) Self-reported depression group = 24.8 (6.5) |
Zung self-rating depression scale | Depression 42/96 (43%) Significantly increased immune response in individuals with depression . |
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| Liu et al. [60] | Cross-sectional survey study | China | 675 317/358 |
53.94 (18.57) | 36.75 days after hospital discharge |
27.87 | Anxiety (GAD-7) Depression (PHQ-9) PTSD symptoms (PCL-5) Sleep difficulties (item analysis for PTSD, depression) |
PTSD 84/675 (12.4%) Anxiety 70/675 (10.4%) Depression 128/675 (19%) PCL-5 12 [IQR 4–16] GAD-7 4 [IQR 2–6] PHQ-9 5 [IQR 3–8] Sleep difficulty was the most frequently reported symptom. Perceived discrimination was a central predictor of mental illness. |
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| Ismael et al. [74] | Retrospective cohort study | Brazil | 895 354/541 |
40.79 (0.45) | 56.6 days after treatment | N/A | Depression (PHQ-9) Anxiety (GAD-7) PTSD (PCL-C) (online assessment, website or phone) |
Depression (n = 235) 26.26% Anxiety (n = 201) 22.46% PTSD (n = 155) 17.32% |
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| Weerahandi et al. [75] | Prospective cohort study | New York, USA | 152 95/57 |
59.54 (12.72) | 36.64 (9.72) days after hospital discharge |
19.75 (15.71) | Overall and mental health status (PROMIS Global Health-10 instrument) Survey completed by phone or online |
During follow-up: Mean (SD) ↓Mental health 47.3 (9.3) * Indicating worse mental health after COVID-19 compared to baseline |
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| Chang et al. [76] | Cross-sectional study | Korea | 64 28/36 |
54.7 (16.6) | 75.7 (20.0) days after hospital discharge | 31.2 (18.1) | PTSD (PCL-5) By telephone interview | PTSD 13/64 (20.3%) PCL-5 score in PTSD group vs. Non-PTSD group 46 (SD 11.9) vs. 9.6 (SD 7.6) |
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| Wu et al. [77] | Case series | China | 14 7/7 |
39 (10) | 44.7 (13.5) days out of clinical services | 12.1 (8.7) | Anxiety/fear (valid questionnaires, website) | Persistent mild to severe anxiety/fear 13/14 (92.9%) | ||
MOS-SS: Medical Outcomes Study Sleep Scale, WHIIRS: Women's Health Initiative Insomnia Rating Scale, MMSE: Mini Mental State Examination, STAI-Y: State-Trait Anxiety Inventory form Y, ZSDS: Zung Self-Rating Depression Scale, BDI-13: 13-item Beck's Depression Inventory, PTSD: posttraumatic stress disorder, PCL-5: PTSD Checklist-5, HADS: Hospital Anxiety and Depression Scale, GAD-7: Generalized Anxiety Disorder Screener, OCI: Obsessive-Compulsive Inventory, PHQ-9: Patient Health Questionnaire-9, PROMIS: Patient-Reported Outcomes Measurement Information System, NEWS: National Early Warning Score, IES-R: Impact of Events Scale-Revised, VAS: visual analog scale, DTS: Davidson Trauma Scale, WEMWBS: Warwick-Edinburgh Mental Well-Being Scale, PTSD-SS: Post-traumatic Stress Disorder Self-rating Scale, GHQ-12: General Health Questionnaire-12, SAS: Zung Self-Rating Anxiety Scale, SDS: Zung Self-Rating Depression Scale, PCL—C: PTSD Checklist-Civilian version, MoCA: Montreal Cognitive Assessment, N/A: Not available, * Significantly different from the previous value.