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Immediate psychological distress in quarantined patients with COVID-19 and its association with peripheral inflammation: A mixed-method study.
Brain Behav Immun. 2020 08; 88:17-27.BB

Abstract

Since the end of 2019, Corona Virus Disease 2019 (COVID-19) has been the cause of a worldwide pandemic. The mental status of patients with COVID-19 who have been quarantined and the interactions between their psychological distress and physiological levels of inflammation have yet to be analyzed. Using a mixed-method triangulation design (QUAN + QUAL), this study investigated and compared the mental status and inflammatory markers of 103 patients who, while hospitalized with mild symptoms, tested positive with COVID-19 and 103 matched controls that were COVID-19 negative. The severity of depression, anxiety, and post-traumatic stress symptoms (PTSS) was measured via an on-line survey. Using a convenience sampling technique, qualitative data were collected until the point of data saturation. In addition, a semi-structured interview was conducted among five patients with COVID-19. Peripheral inflammatory markers were also collected in patients, both at baseline and within ± three days of completing the on-line survey. Results revealed that COVID-19 patients, when compared to non-COVID controls, manifested higher levels of depression (P < 0.001), anxiety (P < 0.001), and post-traumatic stress symptoms (P < 0.001). A gender effect was observed in the score of "Perceived Helplessness", the subscale of PSS-10, with female patients showing higher scores compared to male patients (Z = 2.56, P = 0.010), female (Z = 2.37, P = 0.018) and male controls (Z = 2.87, P = 0.004). Levels of CRP, a peripheral inflammatory indicator, correlated positively with the PHQ-9 total score (R = 0.37, P = 0.003, Spearman's correlation) of patients who presented symptoms of depression. Moreover, the change of CRP level from baseline inversely correlated with the PHQ-9 total score (R = -0.31, P = 0.002), indicative of improvement of depression symptoms. Qualitative analysis revealed similar results with respect to patient reports of negative feelings, including fear, guilt, and helplessness. Stigma and uncertainty of viral disease progression were two main concerns expressed by COVID-19 patients. Our results indicate that significant psychological distress was experienced by hospitalized COVID-19 patients and that levels of depressive features may be related to the inflammation markers in these patients. Thus, we recommend that necessary measures should be provided to address depression and other psychiatric symptoms for COVID-19 patients and attention should be paid to patient perceived stigma and coping strategies when delivering psychological interventions.

Authors+Show Affiliations

Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China.Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China.Department of Integrative Medicine, Shanghai Public Health Clinical Center, Fudan University, Shanghai 201508, China; Graduate School, Nanjing University of Chinese Medicine, Nanjing 210046, China.Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China.Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China.Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China.Department of Psychiatry, Brigham & Women's Hospital, and Department of Psychiatry, Harvard Medical School, Boston, MA, United States.Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China.Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China.Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China.Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China.Department of Integrative Medicine, Shanghai Public Health Clinical Center, Fudan University, Shanghai 201508, China.Department of Integrative Medicine, Shanghai Public Health Clinical Center, Fudan University, Shanghai 201508, China.Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China.Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China.Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China.Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China.Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China.Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China. Electronic address: annedoctor@163.com.Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China. Electronic address: wangzhen@smhc.org.cn.Department of Integrative Medicine, Shanghai Public Health Clinical Center, Fudan University, Shanghai 201508, China. Electronic address: yangzongguo@shphc.org.cn.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

32416290

Citation

Guo, Qian, et al. "Immediate Psychological Distress in Quarantined Patients With COVID-19 and Its Association With Peripheral Inflammation: a Mixed-method Study." Brain, Behavior, and Immunity, vol. 88, 2020, pp. 17-27.
Guo Q, Zheng Y, Shi J, et al. Immediate psychological distress in quarantined patients with COVID-19 and its association with peripheral inflammation: A mixed-method study. Brain Behav Immun. 2020;88:17-27.
Guo, Q., Zheng, Y., Shi, J., Wang, J., Li, G., Li, C., Fromson, J. A., Xu, Y., Liu, X., Xu, H., Zhang, T., Lu, Y., Chen, X., Hu, H., Tang, Y., Yang, S., Zhou, H., Wang, X., Chen, H., ... Yang, Z. (2020). Immediate psychological distress in quarantined patients with COVID-19 and its association with peripheral inflammation: A mixed-method study. Brain, Behavior, and Immunity, 88, 17-27. https://doi.org/10.1016/j.bbi.2020.05.038
Guo Q, et al. Immediate Psychological Distress in Quarantined Patients With COVID-19 and Its Association With Peripheral Inflammation: a Mixed-method Study. Brain Behav Immun. 2020;88:17-27. PubMed PMID: 32416290.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Immediate psychological distress in quarantined patients with COVID-19 and its association with peripheral inflammation: A mixed-method study. AU - Guo,Qian, AU - Zheng,Yuchen, AU - Shi,Jia, AU - Wang,Jijun, AU - Li,Guanjun, AU - Li,Chunbo, AU - Fromson,John A, AU - Xu,Yong, AU - Liu,Xiaohua, AU - Xu,Hua, AU - Zhang,Tianhong, AU - Lu,Yunfei, AU - Chen,Xiaorong, AU - Hu,Hao, AU - Tang,Yingying, AU - Yang,Shuwen, AU - Zhou,Han, AU - Wang,Xiaoliang, AU - Chen,Haiying, AU - Wang,Zhen, AU - Yang,Zongguo, Y1 - 2020/05/19/ PY - 2020/04/22/received PY - 2020/05/11/revised PY - 2020/05/12/accepted PY - 2020/5/18/pubmed PY - 2020/8/15/medline PY - 2020/5/17/entrez KW - COVID-19 KW - Depression KW - Mixed-method KW - Peripheral inflammation KW - Stress SP - 17 EP - 27 JF - Brain, behavior, and immunity JO - Brain Behav Immun VL - 88 N2 - Since the end of 2019, Corona Virus Disease 2019 (COVID-19) has been the cause of a worldwide pandemic. The mental status of patients with COVID-19 who have been quarantined and the interactions between their psychological distress and physiological levels of inflammation have yet to be analyzed. Using a mixed-method triangulation design (QUAN + QUAL), this study investigated and compared the mental status and inflammatory markers of 103 patients who, while hospitalized with mild symptoms, tested positive with COVID-19 and 103 matched controls that were COVID-19 negative. The severity of depression, anxiety, and post-traumatic stress symptoms (PTSS) was measured via an on-line survey. Using a convenience sampling technique, qualitative data were collected until the point of data saturation. In addition, a semi-structured interview was conducted among five patients with COVID-19. Peripheral inflammatory markers were also collected in patients, both at baseline and within ± three days of completing the on-line survey. Results revealed that COVID-19 patients, when compared to non-COVID controls, manifested higher levels of depression (P < 0.001), anxiety (P < 0.001), and post-traumatic stress symptoms (P < 0.001). A gender effect was observed in the score of "Perceived Helplessness", the subscale of PSS-10, with female patients showing higher scores compared to male patients (Z = 2.56, P = 0.010), female (Z = 2.37, P = 0.018) and male controls (Z = 2.87, P = 0.004). Levels of CRP, a peripheral inflammatory indicator, correlated positively with the PHQ-9 total score (R = 0.37, P = 0.003, Spearman's correlation) of patients who presented symptoms of depression. Moreover, the change of CRP level from baseline inversely correlated with the PHQ-9 total score (R = -0.31, P = 0.002), indicative of improvement of depression symptoms. Qualitative analysis revealed similar results with respect to patient reports of negative feelings, including fear, guilt, and helplessness. Stigma and uncertainty of viral disease progression were two main concerns expressed by COVID-19 patients. Our results indicate that significant psychological distress was experienced by hospitalized COVID-19 patients and that levels of depressive features may be related to the inflammation markers in these patients. Thus, we recommend that necessary measures should be provided to address depression and other psychiatric symptoms for COVID-19 patients and attention should be paid to patient perceived stigma and coping strategies when delivering psychological interventions. SN - 1090-2139 UR - https://www.unboundmedicine.com/medline/citation/32416290/Immediate_psychological_distress_in_quarantined_patients_with_COVID_19_and_its_association_with_peripheral_inflammation:_A_mixed_method_study_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0889-1591(20)30618-8 DB - PRIME DP - Unbound Medicine ER -