Abstract
BackgroundDue to the dramatic measures accompanying isolation and the general uncertainty and fear associated with COVID-19, patients and relatives may be at high risk for adverse psychological outcomes. Until now there has been limited research focusing on the prevalence of psychological distress and associated factors in COVID-19 patients and their relatives. The objective of our study was to assess psychological distress in COVID-19 patients and their relatives 30 days after hospital discharge.MethodsIn this prospective observational cohort study at two Swiss tertiary-care hospitals we included consecutive adult patients hospitalized between March and June 2020 for a proven COVID-19 and their relatives. Psychological distress was defined as symptoms of anxiety and/or depression measured with the Hospital Anxiety and Depression Scale (HADS), i.e., a score of ≥8 on the depression and/or anxiety subscale. We further evaluated symptoms of post-traumatic stress disorder (PTSD), defined as a score of ≥1.5 on the Impact of Event Scale-Revised (IES-R).ResultsAmong 126 included patients, 24 (19.1%) had psychological distress and 10 (8.7%) had symptoms of PTSD 30 days after hospital discharge. In multivariate logistic regression analyses three factors were independently associated with psychological distress in patients: resilience (OR 0.82; 95%CI 0.71 to 0.94; p = 0.005), high levels of perceived stress (OR 1.21; 95%CI 1.06 to 1.38; p = 0.006) and low frequency of contact with relatives (OR 7.67; 95%CI 1.42 to 41.58; p = 0.018). The model showed good discrimination, with an area under the receiver-operating characteristic curve (AUC) of 0.92. Among 153 relatives, 35 (22.9%) showed symptoms of psychological distress, and 3 (2%) of PTSD. For relatives, resilience was negatively associated (OR 0.85; 95%CI 0.75 to 0.96; p = 0.007), whereas perceived overall burden caused by COVID-19 was positively associated with psychological distress (OR 1.72; 95%CI 1.31 to 2.25; p<0.001). The overall model also had good discrimination, with an AUC of 0.87.ConclusionA relevant number of COVID-19 patients as well as their relatives exhibited psychological distress 30 days after hospital discharge. These results might aid in development of strategies to prevent psychological distress in COVID-19 patients and their relatives.
Highlights
In December 2019, a novel Coronavirus causing the Coronavirus disease 2019 (COVID-19) emerged in Wuhan, China, leading to a global pandemic
The true impact of COVID-19 on mortality and morbidity has become more evident in recent studies, insights regarding psychological burden beyond the acute phase of the illness in these patients and their relatives who may be at high risk for adverse psychological outcomes is limited [8,9,10,11]
Between March and June 2020, a total of 301 patients with COVID-19 were hospitalized in the University Hospital Basel (n = 198) and the Kantonsspital Aarau (n = 103) (Fig 1)
Summary
In December 2019, a novel Coronavirus causing the Coronavirus disease 2019 (COVID-19) emerged in Wuhan, China, leading to a global pandemic. The true impact of COVID-19 on mortality and morbidity has become more evident in recent studies, insights regarding psychological burden beyond the acute phase of the illness in these patients and their relatives who may be at high risk for adverse psychological outcomes is limited [8,9,10,11]. A large Swiss survey including 10472 participants of the general public found the prevalence of moderately severe or severe depressive symptoms to increase from 9.1% during confinement at the time of the first pandemic wave to 11.7% during the following partial confinement, and 18% during the second wave [21, 22]. Due to the dramatic measures accompanying isolation and the general uncertainty and fear associated with COVID-19, patients and relatives may be at high risk for adverse psychological outcomes. The objective of our study was to assess psychological distress in COVID-19 patients and their relatives 30 days after hospital discharge
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