Understanding the psychiatric symptoms of COVID-19: a meta-analysis of studies assessing psychiatric symptoms in Chinese patients with and survivors of COVID-19 and SARS by using the Symptom Checklist-90-Revised

Qin Xie,Bao-Liang Zhong,Yan-Min Xu,Xiao-Bo Liu

doi:10.1038/s41398-021-01416-5

Qin Xie, Bao-Liang Zhong + Show 2 more

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https://doi.org/10.1038/s41398-021-01416-5

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Abstract

Understanding the psychiatric symptoms of COVID-19 could facilitate the clinical management of COVID-19 patients. However, the profile of psychiatric symptoms among COVID-19 patients has been understudied. We performed a meta-analysis of studies assessing psychiatric symptoms of COVID-19 and SARS patients and survivors by using the Symptom Checklist-90-Revised (SCL-90-R), an instrument covering a wide spectrum of psychiatric symptoms. Studies reporting SCL-90-R subscale scores among patients with and survivors of COVID-19 and SARS were retrieved from major English and Chinese literature databases. Patients’ pooled SCL-90-R subscale scores were compared to the Chinese normative SCL-90-R data, and Cohen’s d values were calculated to indicate the severity of psychiatric symptoms. The Joanna Briggs Institute Critical Appraisal Checklist for Studies Reporting Prevalence Data was used to assess the quality of the included studies. The search yielded 25 Chinese studies with 1675 acute COVID-19 and 964 acute SARS patients, 30 COVID-19 and 552 SARS survivors during very early recovery (up to 1 month since discharge), 291 SARS survivors during early recovery (1–6 months after discharge), and 48 SARS survivors during late recovery (12 months after discharge). None of the included studies were rated as good quality. The ten SCL-90-R-defined psychiatric symptoms, which were of medium-to-severe severity (d = 0.68–3.01), were all exhibited in acute COVID-19 patients, and the severity of these symptoms decreased to mild-to-medium during very early recovery (d = 0.17–0.73). SARS patients presented eight psychiatric symptoms with mild-to-severe severity during the acute stage (d =0.43–1.88), and thereafter, the severity of symptoms decreased over the follow-up period. However, somatization (d = 0.30) and anxiety (d = 0.28) remained at mild levels during late recovery. A wide variety of severe psychiatric symptoms have been reported by acute COVID-19 patients, and these symptoms, despite decreasing in severity, persist in very early recovery. The changing trajectory observed with SARS suggests that psychiatric symptoms of COVID-19 may persist for a long time after discharge, and therefore, periodic monitoring of psychiatric symptoms, psychosocial support, and psychiatric treatment (when necessary) may be necessary for COVID-19 patients from the acute to convalescent stages.

Highlights

Psychiatric presentations and mental disorders are common among COVID-19 patients[1,2]
Most the psychiatric symptoms of COVID-19 were severe during the acute stage, and their severity decreased to mild-to-medium during very early recovery: somatization (d = 2.33 and 0.55, respectively), obsessive-compulsive (d = 0.98 and 0.17), interpersonal sensitivity (d = 1.28 and 0.43), depression (d = 1.56 and 0.44), anxiety (d = 2.27 and 0.64), hostility (d = 0.97 and 0.36), phobia (d = 3.01 and 0.73), paranoid ideation (d = 0.68 and 0.45), psychoticism (d = 0.83 and 0.47), and appetite and sleep (d = 1.74 and 0.19; Table 2 and Fig. 2)
This study systematically summarized the profile of psychiatric symptoms in patients with COVID-19 and SARS, during both the acute and convalescent stages

Summary

Introduction

Psychiatric presentations and mental disorders are common among COVID-19 patients[1,2]. Empirical data have shown that 43.1% and 40.2% of COVID-19 patients suffer from depressive symptoms and mental illnesses, Xie et al Translational Psychiatry (2021)11:290. A timely and detailed assessment of mental health morbidities is important for the effective clinical management of COVID-19 patients and survivors. Available research on mental health problems associated with COVID-19 is limited to case reports/series, self-report questionnaire surveys, and mental disorder surveys[3,4,7–10]. Most prior questionnaire surveys focused on depressive and anxiety symptoms, so data regarding psychiatric symptoms other than depression and anxiety associated with COVID-19 are still limited. Despite having first-hand data on a variety of mental disorders, mental disorder surveys have provided little information on subclinical psychiatric symptoms of COVID-19. The assessment and identification of psychiatric symptoms have clinical implications for early psychological interventions for COVID-19 patients. Data regarding the full spectrum of psychiatric symptoms among persons with COVID-19 are still very limited

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