Psychological morbidities and fatigue in patients with confirmed COVID-19 during disease outbreak: prevalence and associated biopsychosocial risk factors

  1. Rongfeng Qi
  2. Wei Chen
  3. Saiduo Liu
  4. Paul M. Thompson
  5. Long Jiang Zhang
  6. Fei Xia
  7. Fang Cheng
  8. Ailing Hong
  9. Wesley Surento
  10. Song Luo
  11. Zhi Yuan Sun
  12. Chang Sheng Zhou
  13. Lingjiang Li
  14. Xiangao Jiang
  15. Guang Ming Lu

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Abstract

Objective

The coronavirus disease 2019 (COVID-19) – a novel and highly infectious pneumonia – has now spread across China and beyond for over four months. However, its psychological impact on patients is unclear. We aim to examine the prevalence and associated risk factors for psychological morbidities and fatigue in patients with confirmed COVID-19 infection.

Methods

Amidst the disease outbreak, 41 out of 105 COVID-19 patients in a local designated hospital in China were successfully assessed using a constellation of psychometric questionnaires to determine their psychological morbidities and fatigue. Several potential biopsychosocial risk factors (including pre-existing disabilities, CT severity score of pneumonia, social support, coping strategies) were assessed through multivariable logistic regression analyses to clarify their association with mental health in patients.

Results

43.9% of 41 patients presented with impaired general mental health, 12.2% had post-traumatic stress disorder (PTSD) symptoms, 26.8% had anxiety and/or depression symptoms, and 53.6% had fatigue. We did not find any association between pneumonia severity and psychological morbidities or fatigue in COVID-19 patients. However, high perceived stigmatization was associated with an increased risk of impaired general mental health and high perceived social support was associated with decreased risk. Besides, negative coping inclination was associated with an increased risk of PTSD symptoms; high perceived social support was associated with a decreased risk of anxiety and/or depression symptoms.

Conclusions

Psychological morbidities and chronic fatigue are common among COVID-19 patients. Negative coping inclination and being stigmatized are primary risk factors while perceived social support is the main protective factor.

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  1. ScreenIT

    SciScore for 10.1101/2020.05.08.20031666: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board StatementIRB: This study was approved by Medical Research Ethics Committee of Jinling Hospital; written informed consent was obtained from all participants.
    Consent: This study was approved by Medical Research Ethics Committee of Jinling Hospital; written informed consent was obtained from all participants.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    SPSS version 25 (IBM Corp, Armonk
    SPSS
    suggested: (SPSS, RRID:SCR_002865)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Limitations: Our study had several limitations. First, the results in this study are limited to a small sample size of patients with non-severe disease type. The association between disease severity and psychological morbidities and fatigue, although not found in this study, should be further assessed by recruiting more patients with severe disease. Second, we originally designed this study to investigate both the prevalence and associated biopsychosocial risk factors (including clinical symptoms and disease severity parameters) for mental health problems. Suspected cases of COVID-19 who were quarantined in homes, hotels, and hospitals were not included in this study. However, these suspected cases may also have psychological morbidities especially if they have been facing considerable mental stress – fear of contagion, feeling frightened, and helplessness3,30. The psychosocial impact of the COVID-19 outbreak on suspected cases needs to be clarified in future studies. Third, the questionnaires used in this study are brief and self-reported. As patients are easily tired and are under treatment in isolation wards8, face-to-face psychiatric assessment was not conducted in the present study. A formal post-discharge evaluation of psychometric properties via psychological experts should be conducted for these patients.

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  2. Version published to 10.1101/2020.05.08.20031666 on medRxiv