University of São Paulo: Study shows high prevalence of depression, anxiety and post-covid-19 stress

In a study carried out with 425 patients who recovered from the moderate and severe forms of covid-19, researchers from USP observed a high prevalence of cognitive deficits and psychiatric disorders. Patient assessments were performed between six and nine months after hospital discharge from the Hospital das Clínicas (HC) of the USP School of Medicine (FMUSP).

More than half (51.1%) of the participants reported having perceived memory decline after infection and another 13.6% developed post-traumatic stress disorder. Generalized anxiety disorder was diagnosed in 15.5% of the volunteers, and in 8.14% of them the problem arose after the disease. The diagnosis of depression was established for 8% of patients – in 2.5% of them only after hospitalization.

The complete results of the research , which was supported by the Fundação de Amparo à Pesquisa do Estado de São Paulo (Fapesp), were published in the journal General Hospital Psychiatry .

“None of the cognitive or psychiatric changes seen in these patients correlate with the severity of the condition. We also did not see any association with the clinical conduct adopted during the hospitalization period or with socioeconomic factors, such as loss of family members or financial losses during the covid-19 pandemic”, says Rodolfo Damiano, resident physician at the Institute of Psychiatry (IPq) of the Faculty of Medicine. Medicine at USP and first author of the article.

The study is part of a broader project, coordinated by Professor Geraldo Busatto Filho, from FMUSP, in which a large group of people assisted at the HC between 2020 and 2021 has been accompanied by professionals from different areas, including otorhinolaryngology, physiatry and neurology, the in order to assess possible sequelae left by sars-cov-2.

“During my doctorate, I coordinated the neuropsychiatric assessment, the preliminary results of which were described in this article,” Damiano tells Agência Fapesp. The work was guided by Professor Eurípedes Constantino Miguel Filho, from FM.

“One of our concerns was to understand whether this virus and the disease it causes have a long-term impact, producing late manifestations in the central nervous system”, says E. Miguel.

For the researcher, the fact that a clear correlation was not found between the psychiatric condition and the magnitude of the disease in the acute phase or psychosocial factors – including those of a socioeconomic nature or traumatic experiences – corroborates the hypothesis that late changes related to infection by the sars-cov-2 (such as inflammatory processes associated with immunological alterations, vascular damage associated with coagulopathies or the very presence of the virus in the brain) would play a role in the origin of the disorders.

“The presence of clinical manifestations such as cognitive losses, headaches, anosmia [loss of smell] and other neurological changes in these patients contributes additional evidence that these psychiatric changes may reflect the action of sars-cov-2 in the central system.”

Methodology

All participants underwent a battery of cognitive tests to assess skills such as memory, attention, verbal fluency and spatio-temporal orientation.

“We saw a lot of cognitive loss. In a test that measures processing speed, for example, patients took on average twice as long as expected for their age [based on average values ​​described in the scientific literature for the Brazilian population]. And this was observed for all ages”, says Damiano. “In addition, more than half subjectively reported a decline in memory.”

Volunteers also underwent a structured interview with a psychiatrist and responded to standardized questionnaires used in diagnosing depression, anxiety and post-traumatic stress disorder.

As the authors describe in the article, the prevalence of “common mental disorder” (depressive symptoms, anxiety states, irritability, fatigue, insomnia, memory and concentration difficulties) in the studied group (32.2%) was higher than that reported for the general Brazilian population (26.8%) in epidemiological studies.

In these patients, the prevalence of generalized anxiety disorder (14.1%) was considerably higher than the average for Brazilians (9.9%). The prevalence of depression found (8%) is also higher than that estimated for the general population of the country (between 4% and 5%).

“Patients who progress to the severe form, in general, are more clinically compromised [by heart, kidney, diabetes and other comorbidities] and, consequently, already have more psychiatric symptoms. This was considered in the analysis. Even correcting for this factor, the prevalence observed in the study was very high”, says Damiano.

The worsening of psychiatric symptoms after acute infections is common and expected, comments the researcher. “But in no other viral disease has there been so much difference and cognitive losses as significant as with covid-19. One of the possible explanations is the effect of the virus itself on the central nervous system,” he comments. “Whether these losses are recoverable is something we don’t know yet.”

Next steps

Currently, the USP group is studying blood samples collected from volunteers during the period of hospitalization. The objective is to evaluate the profile of cytokines (immune system proteins that regulate the inflammatory response) to find out if there is a correlation between the degree of inflammation during the acute phase of covid-19 and the development of neuropsychiatric symptoms.

“If there is any correlation, the next step will be to investigate whether drugs that inhibit interleukins [one of the types of cytokine] can be used to prevent the onset or worsening of psychiatric symptoms”, he says.

For those who have already been affected, Damiano recommends vaccination and psychiatric follow-up. “There is evidence that physical exercises help to reverse cognitive changes associated with serious diseases and there are also cognitive rehabilitation training that can be done with the follow-up of a qualified neuropsychologist. Also, I believe that the practice of meditation can be beneficial.”

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