Lixue Huang and colleagues1 reported that patients discharged from hospital with COVID-19 showed good physical and functional recovery 1 year after symptom onset. Because of several concerns with the methods, we contend that the findings should be interpreted cautiously.
Quality of life (QOL) was measured using the EuroQol five-dimension five-level (EQ-5D-5L) questionnaire. However, the authors did not seem to use the validated Chinese version of the EQ-5D-5L, nor did they cite relevant studies.2 Additionally, the EQ-5D-5L item on anxiety or depression was used on its own as a major health outcome, which is not appropriate since the EQ-5D-5L item on anxiety or depression has not been validated in Chinese populations. Furthermore, depression and anxiety each consist of a cluster of different symptoms that cannot simply be assessed using one EQ-5D-5L item. The study findings on the anxiety or depression risk factors are therefore tentative.
Clinically, depression refers to major depressive disorder, and anxiety refers to anxiety disorder. The investigators did not clarify that the EQ-5D-5L item on anxiety or depression only reflects their symptoms, which is misleading. Strictly speaking, specific methods of measuring anxiety and depression symptoms such as the Generalized Anxiety Disorder 7-item scale and Patient Health Questionnaire-9 should be used. Further, for anxiety disorder and major depressive disorder, structured diagnostic instruments such as the Mini-International Neuropsychiatric Interview or the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders are routinely used.
Moreover, most somatic symptoms reported in the Article1 could be attributed to, or at least be partly explained by, depression or anxiety, or both, since it is widely documented that Chinese populations tend to somatise their mental health problems.3, 4 Most of the somatic symptoms were therefore probably incorrectly assumed to be sequelae symptoms caused by COVID-19. Furthermore, the risk factors of fatigue or muscle weakness were examined using multiple logistic regression analysis; anxiety and depression should have been handled as either major contributing factors or covariates with confounding effects.
Finally, aside from the depression and anxiety symptoms, other notable and common mental health problems in COVID-19 survivors such as post-traumatic stress disorder symptoms and stigma5, 6 were not examined. Such problems could lead to a host of negative health outcomes, including depression and anxiety in the survivors of serious infectious diseases.7, 8
© 2021 Alfredo Estrella/Getty Images
We declare no competing interests. Y-JZ and WB contributed equally.
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