Mental health problems among COVID-19 survivors in Wuhan, China.

Abstract

The COVID-19 pandemic is profoundly impacting mental health worldwide1-3. Wuhan, China has been the first city to experience the emergency of COVID-19 and its high hospitalization and casualty rates, as well as the mandatory curfews that were strictly enforced for infection control, with their significant mental health implications4. Although a large number of hospitalized COVID-19 patients recovered and met the clinical criteria for discharge, we hypothesized that mental health problems would occur as major sequelae among COVID-19 survivors. A total of 4,328 hospitalized COVID-19 patients who met relevant clinical criteria5 were discharged between January 18 and March 29, 2020 from five hospitals in Wuhan, China (Wuhan No.1 Hospital, Wuhan Wuchang Hospital, Hubei Provincial Hospital of Traditional Chinese Medicine, Hubei Provincial Hospital of Integrated Chinese and Western Medicine, and Wuhan Pulmonary Hospital). All these COVID-19 survivors (median age: 59 years, interquartile range, IQR: 47-68 years; 54.1% female) were followed up and assessed by mental health care specialists. The evaluation period started on the date of hospital discharge and continued through July 28, 2020. Among the survivors, 156 (3.6%) dropped out at some point of the follow-up. The validated Chinese versions of the Patient Health Questionnaire-9 (PHQ-9)6 and the Generalized Anxiety Disorder-7 (GAD-7)7 were administered to evaluate post-discharge depression and anxiety. As a reference group, 1,500 randomly selected individuals from the general population of Hubei province were assessed using the same instruments during the same time frame. Chi-square tests were used to compare the prevalence of mild-to-severe mental health problems in the two samples. Among COVID-19 survivors with depression or anxiety, logistic regression analysis was applied to test whether several variables (including age, gender, education, income level, comorbid chronic physical diseases, and retesting positive for SARS-CoV-2) influenced the severity of the mental health condition. The study was approved by the institutional ethics board of Tongji Medical College, Huazhong University of Science and Technology. All participants provided their informed consent. The median duration of the follow-up period was 144.0 days (IQR: 135-157). During this period, 615 COVID-19 survivors (14.2%) were found to have clinically defined depression (i.e., a score of at least 5 on the PHQ-9) and 528 (12.2%) to have clinically defined anxiety (i.e., a score of at least 5 on the GAD-7). Four survivors attempted suicide. Compared to the reference group, the risk of both depression and anxiety in COVID-19 survivors was significantly higher (relative risk, RR=1.2, 95% CI: 1.1-1.4, p=0.002; and RR=1.4, 95% CI: 1.2-1.7, p=0.001, respectively). Among the 615 survivors with depression, the risk for a severe condition (i.e., a score of at least 10 on the PHQ-9) was significantly higher in individuals living alone (odds ratio, OR=5.2, 95% CI: 3.6-7.1, p<0.001), in females (OR=3.4, 95% CI: 2.8-5.3, p<0.001), in those with a low income level (OR=2.4, 95% CI: 1.8-3.5, p=0.012), in those with a comorbid chronic physical disease (OR=2.8, 95% CI: 2.1-3.7, p=0.032), and in those who retested positive for SARS-CoV-2 (OR=10.4, 95% CI: 8.3-12.5, p<0.001). Age did not significantly influence the severity of depression. Among the 528 COVID-19 survivors with anxiety, the risk for a severe condition (i.e., a score of at least 10 on the GAD-7) was significantly higher in individuals with a low educational level (OR=3.5, 95% CI: 3.1-4.2, p<0.001), in unmarried subjects (OR=1.7, 95% CI: 1.2-2.8, p=0.025), and in those who retested positive for SARS-CoV-2 (OR=4.7, 95% CI: 3.7-5.8, p<0.001). Age, gender and other social status indices did not influence the severity of anxiety. All the four COVID-19 survivors who attempted suicide were elderly, had retested positive for SARS-CoV-2, and had experienced severe levels of depression and anxiety. In summary, this follow-up study documents that mental health problems among COVID-19 survivors in Wuhan are significantly more common than in the general population of the Hubei province. Risk factors for more severe mental health problems include retesting positive for SARS-CoV-2, living alone, female gender, comorbid chronic physical diseases, and low education and income levels. Clinicians and policy makers should be aware of the risk of mental health sequelae in COVID-19 survivors and implement appropriate preventive and treatment measures.