Meta-analysis of post-traumatic stress disorder and COVID-19 in patients discharged

Abstract

In this journal, Thor Mertz Schou et al. reported that the severity of Coronavirus disease 2019 (COVID-19) has been highlighted as a risk factor for post-traumatic stress disorder (PTSD);1Schou T.M. Joca S. Wegener G. Bay-Richter C Psychiatric and neuropsychiatric sequelae of COVID-19 - a systematic review.Brain Behav Immun. 2021; 97 ([published Online First: 2021/08/03]): 328-348https://doi.org/10.1016/j.bbi.2021.07.018Google Scholar thus, suggesting that we should focus on long-term mental illness in COVID-19 patients after discharge. PTSD is a serious mental health condition that is triggered by a terrifying event.2Mei Z. Wu X. Zhang X. Zheng X. Li W. Fan R. et al.The occurrence and risk factors associated with post-traumatic stress disorder among discharged COVID-19 patients in Tianjin, China.Brain Behav. 2022; ([published Online First: 2022/01/23]): e2492https://doi.org/10.1002/brb3.2492Google ScholarWe found that many published studies investigated the occurrence and risk factors of PTSD among discharged COVID-19 patients. They may experience psychosocial difficulties while interacting with others after discharge although patients recover physically in the hospital.3Park H.Y. Jung J. Park H.Y. Lee S.H. Kim E.S. Kim H.B. et al.Psychological consequences of survivors of COVID-19 pneumonia 1 month after discharge.J Korean Med Sci. 2020; 35 ([published Online First: 2020/12/09]): e409https://doi.org/10.3346/jkms.2020.35.e409Google Scholar It was showed that PTSD is a common psychological problem in patients after discharge, and they found that age, gender, and smoking history can increase the incidence of PTSD in Tianjin, China.2Mei Z. Wu X. Zhang X. Zheng X. Li W. Fan R. et al.The occurrence and risk factors associated with post-traumatic stress disorder among discharged COVID-19 patients in Tianjin, China.Brain Behav. 2022; ([published Online First: 2022/01/23]): e2492https://doi.org/10.1002/brb3.2492Google ScholarPubMed, Web of Science, Embase, and Cochrane Library databases were extensively searched for all compliant studies published from January 1, 2020, to February 15, 2022. The following keywords were used for the search strategy: “COVID-19,” “2019-nCoV,” “SARS-CoV-2,” “2019 novel coronavirus,” “coronavirus disease 2019,” “severe acute respiratory syndrome coronavirus 2,”“Post-COVID-19,” “post-traumatic stress disorder”, and “PTSD”. Reference lists of the included studies and relevant reviews were searched for additional studies. The inclusion criteria were as follows: (1) adult patients with COVID-19 confirmed by reverse transcriptase–polymerase chain reaction; (2) peer-reviewed original studies in English; (3) individual study populations with at least 100 cases; and (4) key available data of the included studies, four-table data, or effect [95% confidence interval (CI)] clearly stated. Case reports, repeated articles, review papers, and preprints were excluded. After searching the PubMed and other websites, seven eligible studies involving 1426 patients with COVID-19 were included in our meta-analysis. Seven studies reported PTSD symptoms of COVID-19 patients discharged from the hospital. The general information of included studies is summarized in Table 1.2Mei Z. Wu X. Zhang X. Zheng X. Li W. Fan R. et al.The occurrence and risk factors associated with post-traumatic stress disorder among discharged COVID-19 patients in Tianjin, China.Brain Behav. 2022; ([published Online First: 2022/01/23]): e2492https://doi.org/10.1002/brb3.2492Google Scholar,4Beck K. Vincent A. Becker C. Keller A. Cam H. Schaefert R. et al.Prevalence and factors associated with psychological burden in COVID-19 patients and their relatives: a prospective observational cohort study.PLoS ONE. 2021; 16 ([published Online First: 2021/05/06])e0250590https://doi.org/10.1371/journal.pone.0250590Google Scholar, 5Ju Y. Liu J. Ng R.M.K. Liu B. Wang M. Chen W. et al.Prevalence and predictors of post-traumatic stress disorder in patients with cured coronavirus disease 2019 (COVID-19) one month post-discharge.Eur J Psychotraumatol. 2021; 12 ([published Online First: 2022/01/08])1915576https://doi.org/10.1080/20008198.2021.1915576Google Scholar, 6Méndez R. Balanzá-Martínez V. Luperdi S.C. Estrada I. Latorre A. González-Jiménez P. et al.Short-term neuropsychiatric outcomes and quality of life in COVID-19 survivors.J Intern Med. 2021; 290 ([published Online First: 2021/02/04]): 621-631https://doi.org/10.1111/joim.13262Google Scholar, 7Huang L. Xu X. Zhang L. Zheng D. Liu Y. Feng B. et al.Post-traumatic stress disorder symptoms and quality of life of COVID-19 survivors at 6-month follow-up: a cross-sectional observational study.Front Psychiatry. 2021; 12 ([published Online First: 2022/01/28])782478https://doi.org/10.3389/fpsyt.2021.782478Google Scholar, 8Tarsitani L. Vassalini P. Koukopoulos A. Borrazzo C. Alessi F. Di Nicolantonio C. et al.Post-traumatic stress disorder among COVID-19 survivors at 3-month follow-up after hospital discharge.J Gen Intern Med. 2021; 36 ([published Online First: 2021/03/31]): 1702-1707https://doi.org/10.1007/s11606-021-06731-7Google Scholar, 9De Lorenzo R. Conte C. Lanzani C. Benedetti F. Roveri L. Mazza M.G. et al.Residual clinical damage after COVID-19: a retrospective and prospective observational cohort study.PLoS ONE. 2020; 15 ([published Online First: 2020/10/15])e0239570https://doi.org/10.1371/journal.pone.0239570Google ScholarTable 1The basic information of the included literature. Total: number of patient included in the study.StudyPTSD (n)Total (n)Zaoxian Mei 20222Mei Z. Wu X. Zhang X. Zheng X. Li W. Fan R. et al.The occurrence and risk factors associated with post-traumatic stress disorder among discharged COVID-19 patients in Tianjin, China.Brain Behav. 2022; ([published Online First: 2022/01/23]): e2492https://doi.org/10.1002/brb3.2492Google Scholar23144Katharina Beck 20214Beck K. Vincent A. Becker C. Keller A. Cam H. Schaefert R. et al.Prevalence and factors associated with psychological burden in COVID-19 patients and their relatives: a prospective observational cohort study.PLoS ONE. 2021; 16 ([published Online First: 2021/05/06])e0250590https://doi.org/10.1371/journal.pone.0250590Google Scholar10115Yumeng Ju 20215Ju Y. Liu J. Ng R.M.K. Liu B. Wang M. Chen W. et al.Prevalence and predictors of post-traumatic stress disorder in patients with cured coronavirus disease 2019 (COVID-19) one month post-discharge.Eur J Psychotraumatol. 2021; 12 ([published Online First: 2022/01/08])1915576https://doi.org/10.1080/20008198.2021.1915576Google Scholar41114R. Mendez 20216Méndez R. Balanzá-Martínez V. Luperdi S.C. Estrada I. Latorre A. González-Jiménez P. et al.Short-term neuropsychiatric outcomes and quality of life in COVID-19 survivors.J Intern Med. 2021; 290 ([published Online First: 2021/02/04]): 621-631https://doi.org/10.1111/joim.13262Google Scholar45179Liqun Huang 20217Huang L. Xu X. Zhang L. Zheng D. Liu Y. Feng B. et al.Post-traumatic stress disorder symptoms and quality of life of COVID-19 survivors at 6-month follow-up: a cross-sectional observational study.Front Psychiatry. 2021; 12 ([published Online First: 2022/01/28])782478https://doi.org/10.3389/fpsyt.2021.782478Google Scholar64574Tarsitani L 20218Tarsitani L. Vassalini P. Koukopoulos A. Borrazzo C. Alessi F. Di Nicolantonio C. et al.Post-traumatic stress disorder among COVID-19 survivors at 3-month follow-up after hospital discharge.J Gen Intern Med. 2021; 36 ([published Online First: 2021/03/31]): 1702-1707https://doi.org/10.1007/s11606-021-06731-7Google Scholar12115De Lorenzo R 20209De Lorenzo R. Conte C. Lanzani C. Benedetti F. Roveri L. Mazza M.G. et al.Residual clinical damage after COVID-19: a retrospective and prospective observational cohort study.PLoS ONE. 2020; 15 ([published Online First: 2020/10/15])e0239570https://doi.org/10.1371/journal.pone.0239570Google Scholar41185 Open table in a new tab The results of seven studies listed in Fig. 1 showed the occurrence of PTSD in 18% of the patients (95% CI, 0.12–0.24; P < 0.01). It indicated that, out of every 100 patients, 18 experienced PTSD due to some reason after discharge. This suggested that these symptoms might indeed be the sequelae after recovery of COVID-19 survivors. The reasons for PTSD and other symptoms may be as follows: Infection with COVID-19 causes great psychological stress in patients. Factors, such as hospitalization, isolation, and restrictions on family member visits, may create a psychological burden on patients and their families.4Beck K. Vincent A. Becker C. Keller A. Cam H. Schaefert R. et al.Prevalence and factors associated with psychological burden in COVID-19 patients and their relatives: a prospective observational cohort study.PLoS ONE. 2021; 16 ([published Online First: 2021/05/06])e0250590https://doi.org/10.1371/journal.pone.0250590Google Scholar Exposure to war, physical or sexual assault, disasters, and vehicle accidents are the most common causes of PTSD. In addition, experience of an acute or critical illness is also considered a potential risk factor for PTSD.8Tarsitani L. Vassalini P. Koukopoulos A. Borrazzo C. Alessi F. Di Nicolantonio C. et al.Post-traumatic stress disorder among COVID-19 survivors at 3-month follow-up after hospital discharge.J Gen Intern Med. 2021; 36 ([published Online First: 2021/03/31]): 1702-1707https://doi.org/10.1007/s11606-021-06731-7Google Scholar Meanwhile, it was showed PTSD during follow-up was associated with persistent respiratory symptoms, sleep difficulty, and a diagnosis of anxiety. Respiratory manifestations are the main symptoms of COVID-19 patients. The association between PTSD and respiratory symptoms and sleep difficulty was bidirectional. Persistent physical symptoms can lead to mental illness, and conversely, increased mental distress can manifest as physical symptoms. In addition, many patients experience difficulty sleeping, and long-term lack of sleep can also lead to mental and psychological disorders. People with anxiety disorders were 15 times more likely to develop PTSD than people without anxiety disorders.7Huang L. Xu X. Zhang L. Zheng D. Liu Y. Feng B. et al.Post-traumatic stress disorder symptoms and quality of life of COVID-19 survivors at 6-month follow-up: a cross-sectional observational study.Front Psychiatry. 2021; 12 ([published Online First: 2022/01/28])782478https://doi.org/10.3389/fpsyt.2021.782478Google Scholar However, further research is needed to confirm the correlation.The results showed that older age, female gender, current smoking status, and the number of involved pulmonary lobes (≥3) are risk factors for PTSD.2Mei Z. Wu X. Zhang X. Zheng X. Li W. Fan R. et al.The occurrence and risk factors associated with post-traumatic stress disorder among discharged COVID-19 patients in Tianjin, China.Brain Behav. 2022; ([published Online First: 2022/01/23]): e2492https://doi.org/10.1002/brb3.2492Google Scholar A research suggests that obesity predicted the development of PTSD and reasons for this unexpected association should be further investigated,8Tarsitani L. Vassalini P. Koukopoulos A. Borrazzo C. Alessi F. Di Nicolantonio C. et al.Post-traumatic stress disorder among COVID-19 survivors at 3-month follow-up after hospital discharge.J Gen Intern Med. 2021; 36 ([published Online First: 2021/03/31]): 1702-1707https://doi.org/10.1007/s11606-021-06731-7Google Scholar but De Lorenzo R did not observe any impact of body mass index (BMI) or other comorbidities on the development of PTSD.9De Lorenzo R. Conte C. Lanzani C. Benedetti F. Roveri L. Mazza M.G. et al.Residual clinical damage after COVID-19: a retrospective and prospective observational cohort study.PLoS ONE. 2020; 15 ([published Online First: 2020/10/15])e0239570https://doi.org/10.1371/journal.pone.0239570Google Scholar Therefore, the association between obesity and PTSD needs to be investigated further. Lower age, female gender, and positive psychiatric history were significantly associated with the risk of developing PTSD after COVID-19.9De Lorenzo R. Conte C. Lanzani C. Benedetti F. Roveri L. Mazza M.G. et al.Residual clinical damage after COVID-19: a retrospective and prospective observational cohort study.PLoS ONE. 2020; 15 ([published Online First: 2020/10/15])e0239570https://doi.org/10.1371/journal.pone.0239570Google ScholarAt present, our research has certain limitations. Most of the included studies assessed the mental health status of discharged patients through instruments, such as telephone interviews and questionnaires. Neuropsychological evaluation in patients was inconsistent across studies, and the research results were heterogeneous to a certain extent; hence, more research is needed in the future.In conclusion, our study showed that the occurrence of PTSD was not rare among patients with confirmed COVID-19 infection. This also suggests that we should pay attention to the mental health and social interaction status of patients after discharge, which is very important for disease prognosis and healthy life of patients. PTSD can be treated with medication and psychological intervention.8Tarsitani L. Vassalini P. Koukopoulos A. Borrazzo C. Alessi F. Di Nicolantonio C. et al.Post-traumatic stress disorder among COVID-19 survivors at 3-month follow-up after hospital discharge.J Gen Intern Med. 2021; 36 ([published Online First: 2021/03/31]): 1702-1707https://doi.org/10.1007/s11606-021-06731-7Google Scholar Enhancing emotional support during hospitalization could help prevent PTSD in patients with COVID-19.5Ju Y. Liu J. Ng R.M.K. Liu B. Wang M. Chen W. et al.Prevalence and predictors of post-traumatic stress disorder in patients with cured coronavirus disease 2019 (COVID-19) one month post-discharge.Eur J Psychotraumatol. 2021; 12 ([published Online First: 2022/01/08])1915576https://doi.org/10.1080/20008198.2021.1915576Google Scholar Therefore, clinicians need to pay more attention to the risk predictors of patients' mental health, and develop corresponding diagnosis and treatment measures in a timely manner during treatment.FundingThis study was supported by Hangzhou Science and Technology Bureau fund (Nos. 20191203B96 ; 20191203B105 ; 20191231Y039 ); Youth Fund of Zhejiang Academy of Medical Sciences (No. 2019Y009); Medical and Technology Project of Zhejiang Province (Nos. 2020362651 ; 2021KY890 ; 2022KY970 ); Clinical Research Fund of Zhejiang Medical Association (No. 2020ZYC-A13); Hangzhou Health and Family Planning Technology Plan Key Projects (No. 2017ZD02). Hangzhou Medical and Health Technology Project (No. 0020290592). Zhejiang Traditional Chinese Medicine Scientific Research Fund Project (No. 2022ZB280).Data sharing statementAll the data and materials mentioned in the manuscript are available. In this journal, Thor Mertz Schou et al. reported that the severity of Coronavirus disease 2019 (COVID-19) has been highlighted as a risk factor for post-traumatic stress disorder (PTSD);1Schou T.M. Joca S. Wegener G. Bay-Richter C Psychiatric and neuropsychiatric sequelae of COVID-19 - a systematic review.Brain Behav Immun. 2021; 97 ([published Online First: 2021/08/03]): 328-348https://doi.org/10.1016/j.bbi.2021.07.018Google Scholar thus, suggesting that we should focus on long-term mental illness in COVID-19 patients after discharge. PTSD is a serious mental health condition that is triggered by a terrifying event.2Mei Z. Wu X. Zhang X. Zheng X. Li W. Fan R. et al.The occurrence and risk factors associated with post-traumatic stress disorder among discharged COVID-19 patients in Tianjin, China.Brain Behav. 2022; ([published Online First: 2022/01/23]): e2492https://doi.org/10.1002/brb3.2492Google Scholar We found that many published studies investigated the occurrence and risk factors of PTSD among discharged COVID-19 patients. They may experience psychosocial difficulties while interacting with others after discharge although patients recover physically in the hospital.3Park H.Y. Jung J. Park H.Y. Lee S.H. Kim E.S. Kim H.B. et al.Psychological consequences of survivors of COVID-19 pneumonia 1 month after discharge.J Korean Med Sci. 2020; 35 ([published Online First: 2020/12/09]): e409https://doi.org/10.3346/jkms.2020.35.e409Google Scholar It was showed that PTSD is a common psychological problem in patients after discharge, and they found that age, gender, and smoking history can increase the incidence of PTSD in Tianjin, China.2Mei Z. Wu X. Zhang X. Zheng X. Li W. Fan R. et al.The occurrence and risk factors associated with post-traumatic stress disorder among discharged COVID-19 patients in Tianjin, China.Brain Behav. 2022; ([published Online First: 2022/01/23]): e2492https://doi.org/10.1002/brb3.2492Google Scholar PubMed, Web of Science, Embase, and Cochrane Library databases were extensively searched for all compliant studies published from January 1, 2020, to February 15, 2022. The following keywords were used for the search strategy: “COVID-19,” “2019-nCoV,” “SARS-CoV-2,” “2019 novel coronavirus,” “coronavirus disease 2019,” “severe acute respiratory syndrome coronavirus 2,”“Post-COVID-19,” “post-traumatic stress disorder”, and “PTSD”. Reference lists of the included studies and relevant reviews were searched for additional studies. The inclusion criteria were as follows: (1) adult patients with COVID-19 confirmed by reverse transcriptase–polymerase chain reaction; (2) peer-reviewed original studies in English; (3) individual study populations with at least 100 cases; and (4) key available data of the included studies, four-table data, or effect [95% confidence interval (CI)] clearly stated. Case reports, repeated articles, review papers, and preprints were excluded. After searching the PubMed and other websites, seven eligible studies involving 1426 patients with COVID-19 were included in our meta-analysis. Seven studies reported PTSD symptoms of COVID-19 patients discharged from the hospital. The general information of included studies is summarized in Table 1.2Mei Z. Wu X. Zhang X. Zheng X. Li W. Fan R. et al.The occurrence and risk factors associated with post-traumatic stress disorder among discharged COVID-19 patients in Tianjin, China.Brain Behav. 2022; ([published Online First: 2022/01/23]): e2492https://doi.org/10.1002/brb3.2492Google Scholar,4Beck K. Vincent A. Becker C. Keller A. Cam H. Schaefert R. et al.Prevalence and factors associated with psychological burden in COVID-19 patients and their relatives: a prospective observational cohort study.PLoS ONE. 2021; 16 ([published Online First: 2021/05/06])e0250590https://doi.org/10.1371/journal.pone.0250590Google Scholar, 5Ju Y. Liu J. Ng R.M.K. Liu B. Wang M. Chen W. et al.Prevalence and predictors of post-traumatic stress disorder in patients with cured coronavirus disease 2019 (COVID-19) one month post-discharge.Eur J Psychotraumatol. 2021; 12 ([published Online First: 2022/01/08])1915576https://doi.org/10.1080/20008198.2021.1915576Google Scholar, 6Méndez R. Balanzá-Martínez V. Luperdi S.C. Estrada I. Latorre A. González-Jiménez P. et al.Short-term neuropsychiatric outcomes and quality of life in COVID-19 survivors.J Intern Med. 2021; 290 ([published Online First: 2021/02/04]): 621-631https://doi.org/10.1111/joim.13262Google Scholar, 7Huang L. Xu X. Zhang L. Zheng D. Liu Y. Feng B. et al.Post-traumatic stress disorder symptoms and quality of life of COVID-19 survivors at 6-month follow-up: a cross-sectional observational study.Front Psychiatry. 2021; 12 ([published Online First: 2022/01/28])782478https://doi.org/10.3389/fpsyt.2021.782478Google Scholar, 8Tarsitani L. Vassalini P. Koukopoulos A. Borrazzo C. Alessi F. Di Nicolantonio C. et al.Post-traumatic stress disorder among COVID-19 survivors at 3-month follow-up after hospital discharge.J Gen Intern Med. 2021; 36 ([published Online First: 2021/03/31]): 1702-1707https://doi.org/10.1007/s11606-021-06731-7Google Scholar, 9De Lorenzo R. Conte C. Lanzani C. Benedetti F. Roveri L. Mazza M.G. et al.Residual clinical damage after COVID-19: a retrospective and prospective observational cohort study.PLoS ONE. 2020; 15 ([published Online First: 2020/10/15])e0239570https://doi.org/10.1371/journal.pone.0239570Google Scholar The results of seven studies listed in Fig. 1 showed the occurrence of PTSD in 18% of the patients (95% CI, 0.12–0.24; P < 0.01). It indicated that, out of every 100 patients, 18 experienced PTSD due to some reason after discharge. This suggested that these symptoms might indeed be the sequelae after recovery of COVID-19 survivors. The reasons for PTSD and other symptoms may be as follows: Infection with COVID-19 causes great psychological stress in patients. Factors, such as hospitalization, isolation, and restrictions on family member visits, may create a psychological burden on patients and their families.4Beck K. Vincent A. Becker C. Keller A. Cam H. Schaefert R. et al.Prevalence and factors associated with psychological burden in COVID-19 patients and their relatives: a prospective observational cohort study.PLoS ONE. 2021; 16 ([published Online First: 2021/05/06])e0250590https://doi.org/10.1371/journal.pone.0250590Google Scholar Exposure to war, physical or sexual assault, disasters, and vehicle accidents are the most common causes of PTSD. In addition, experience of an acute or critical illness is also considered a potential risk factor for PTSD.8Tarsitani L. Vassalini P. Koukopoulos A. Borrazzo C. Alessi F. Di Nicolantonio C. et al.Post-traumatic stress disorder among COVID-19 survivors at 3-month follow-up after hospital discharge.J Gen Intern Med. 2021; 36 ([published Online First: 2021/03/31]): 1702-1707https://doi.org/10.1007/s11606-021-06731-7Google Scholar Meanwhile, it was showed PTSD during follow-up was associated with persistent respiratory symptoms, sleep difficulty, and a diagnosis of anxiety. Respiratory manifestations are the main symptoms of COVID-19 patients. The association between PTSD and respiratory symptoms and sleep difficulty was bidirectional. Persistent physical symptoms can lead to mental illness, and conversely, increased mental distress can manifest as physical symptoms. In addition, many patients experience difficulty sleeping, and long-term lack of sleep can also lead to mental and psychological disorders. People with anxiety disorders were 15 times more likely to develop PTSD than people without anxiety disorders.7Huang L. Xu X. Zhang L. Zheng D. Liu Y. Feng B. et al.Post-traumatic stress disorder symptoms and quality of life of COVID-19 survivors at 6-month follow-up: a cross-sectional observational study.Front Psychiatry. 2021; 12 ([published Online First: 2022/01/28])782478https://doi.org/10.3389/fpsyt.2021.782478Google Scholar However, further research is needed to confirm the correlation. The results showed that older age, female gender, current smoking status, and the number of involved pulmonary lobes (≥3) are risk factors for PTSD.2Mei Z. Wu X. Zhang X. Zheng X. Li W. Fan R. et al.The occurrence and risk factors associated with post-traumatic stress disorder among discharged COVID-19 patients in Tianjin, China.Brain Behav. 2022; ([published Online First: 2022/01/23]): e2492https://doi.org/10.1002/brb3.2492Google Scholar A research suggests that obesity predicted the development of PTSD and reasons for this unexpected association should be further investigated,8Tarsitani L. Vassalini P. Koukopoulos A. Borrazzo C. Alessi F. Di Nicolantonio C. et al.Post-traumatic stress disorder among COVID-19 survivors at 3-month follow-up after hospital discharge.J Gen Intern Med. 2021; 36 ([published Online First: 2021/03/31]): 1702-1707https://doi.org/10.1007/s11606-021-06731-7Google Scholar but De Lorenzo R did not observe any impact of body mass index (BMI) or other comorbidities on the development of PTSD.9De Lorenzo R. Conte C. Lanzani C. Benedetti F. Roveri L. Mazza M.G. et al.Residual clinical damage after COVID-19: a retrospective and prospective observational cohort study.PLoS ONE. 2020; 15 ([published Online First: 2020/10/15])e0239570https://doi.org/10.1371/journal.pone.0239570Google Scholar Therefore, the association between obesity and PTSD needs to be investigated further. Lower age, female gender, and positive psychiatric history were significantly associated with the risk of developing PTSD after COVID-19.9De Lorenzo R. Conte C. Lanzani C. Benedetti F. Roveri L. Mazza M.G. et al.Residual clinical damage after COVID-19: a retrospective and prospective observational cohort study.PLoS ONE. 2020; 15 ([published Online First: 2020/10/15])e0239570https://doi.org/10.1371/journal.pone.0239570Google Scholar At present, our research has certain limitations. Most of the included studies assessed the mental health status of discharged patients through instruments, such as telephone interviews and questionnaires. Neuropsychological evaluation in patients was inconsistent across studies, and the research results were heterogeneous to a certain extent; hence, more research is needed in the future. In conclusion, our study showed that the occurrence of PTSD was not rare among patients with confirmed COVID-19 infection. This also suggests that we should pay attention to the mental health and social interaction status of patients after discharge, which is very important for disease prognosis and healthy life of patients. PTSD can be treated with medication and psychological intervention.8Tarsitani L. Vassalini P. Koukopoulos A. Borrazzo C. Alessi F. Di Nicolantonio C. et al.Post-traumatic stress disorder among COVID-19 survivors at 3-month follow-up after hospital discharge.J Gen Intern Med. 2021; 36 ([published Online First: 2021/03/31]): 1702-1707https://doi.org/10.1007/s11606-021-06731-7Google Scholar Enhancing emotional support during hospitalization could help prevent PTSD in patients with COVID-19.5Ju Y. Liu J. Ng R.M.K. Liu B. Wang M. Chen W. et al.Prevalence and predictors of post-traumatic stress disorder in patients with cured coronavirus disease 2019 (COVID-19) one month post-discharge.Eur J Psychotraumatol. 2021; 12 ([published Online First: 2022/01/08])1915576https://doi.org/10.1080/20008198.2021.1915576Google Scholar Therefore, clinicians need to pay more attention to the risk predictors of patients' mental health, and develop corresponding diagnosis and treatment measures in a timely manner during treatment. FundingThis study was supported by Hangzhou Science and Technology Bureau fund (Nos. 20191203B96 ; 20191203B105 ; 20191231Y039 ); Youth Fund of Zhejiang Academy of Medical Sciences (No. 2019Y009); Medical and Technology Project of Zhejiang Province (Nos. 2020362651 ; 2021KY890 ; 2022KY970 ); Clinical Research Fund of Zhejiang Medical Association (No. 2020ZYC-A13); Hangzhou Health and Family Planning Technology Plan Key Projects (No. 2017ZD02). Hangzhou Medical and Health Technology Project (No. 0020290592). Zhejiang Traditional Chinese Medicine Scientific Research Fund Project (No. 2022ZB280).