Psychological outcomes after hospitalization for COVID-19: data from a multidisciplinary follow-up screening program for recovered patients

  • Federica Bonazza Department of Health Science, University of Milan, Italy. https://orcid.org/0000-0003-0258-1796
  • Lidia Borghi Department of Health Science, University of Milan;, Italy.
  • Eugenia Cao di San Marco Unit of Clinical Psychology, Santi Paolo and Carlo Hospital, Milan, Italy.
  • Kyrie Piscopo Unit of Clinical Psychology, Santi Paolo and Carlo Hospital, Milan, Italy.
  • Francesca Bai Clinic of Infectious Diseases and Tropical Medicine, Department of Health Sciences, University of Milan, ASST Santi Paolo e Carlo, Milan, Italy.
  • Antonella d’Arminio Monforte Clinic of Infectious Diseases and Tropical Medicine, Department of Health Sciences, University of Milan, ASST Santi Paolo e Carlo, Milan, Italy.
  • Elena Vegni Department of Health Science, University of Milan; Unit of Clinical Psychology, Santi Paolo and Carlo Hospital, Milan, Italy.

Abstract

Patients who are hospitalized for COronaVIrus Disease 2019 (COVID-19) face an extremely stressful experience that might challenge their mental health. The study aims to describe the psychological condition of recovered patients, focusing on anxiety and depression symptoms, as well as post-traumatic stress. All the recovered COVID-19 patients who accessed to a multidisciplinary followup screening program scheduled within two months after their hospital discharge were included. As far as the psychological assessment, patients completed the Hospital Anxiety and Depression Scale and the Impact of Event Scale-Revised for post-traumatic stress. Socio-demographic and clinical data (days of hospitalization, intensity of received care, and number of supportive sessions with the hospital psychologist after the hospitalization) were collected. Descriptive, correlation and regression analyses were conducted. The sample includes 261 patients (68.2% men), aged between 23 and 90 (mean=58.9 st. dev=13.3). High numbers of patients reported anxiety (28%) and depression symptoms (17%), as well as post-traumatic stress (36.4%). Impaired outcomes were associated with female gender, while patient’s age was found to be negatively correlated with anxiety symptoms. 13.8% of patients underwent a psychological visit and 6.1% of them were taken in charge for psychological support. Few months after hospital discharge, individuals recovered by COVID-19 reported negative consequences on their mental health. Understanding the impact that COVID-19 and hospitalization have on recovered patients may provide insights about how to develop an effective psychological intervention to help them deal with such psychological distress and prevent further psychopathological effects.

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Ahmed, H., Patel, K., Greenwood, D. C., Halpin, S., Lewthwaite, P., Salawu, A., Eyre, L., Breen, A., O’Connor, R., Jones, A., & Sivan, M. (2020). Long-term clinical outcomes in survivors of severe acute respiratory syndrome and Middle East respiratory syndrome coronavirus outbreaks after hospitalization or ICU admission: a systematic review and meta-analysis. Journal of Rehabilitation Medicine, 52(5), 1-11. doi: 10.2340/16501977-2694. DOI: https://doi.org/10.2340/16501977-2694

Balachandar, V., Mahalaxmi, I., Subramaniam, M., Kaavya, J., Senthil Kumar, N., Laldinmawii, G., Narayanasamy, A., Janardhana Kumar Reddy, P., Sivaprakash, P., Kanchana, S., Vivekanandhan, G., & Cho, S. G. (2020). Follow-up studies in COVID-19 recovered patients-is it mandatory?. Science of the Total Environment, 729, 1-8. doi: 10.1016/j.scitotenv.2020.139021 DOI: https://doi.org/10.1016/j.scitotenv.2020.139021

Bansal, M. (2020). Cardiovascular disease and COVID-19. Diabetes & Metabolic Syndrome: Clinical Research & Reviews, 14, 247-250. doi: 10.1161/CIRCULATIONAHA.120.046941. DOI: https://doi.org/10.1161/CIRCULATIONAHA.120.046941

Batawi, S., Tarazan, N., Al-Raddadi, R., Al Qasim, E., Sindi, A., Al Johni, S., Al-Hameed, F. M., Arabi, Y. M., Uyeki, T. M., & Alraddadi, B. M. (2019). Quality of life reported by survivors after hospitalization for Middle East respiratory syndrome (MERS). Health and Quality of Life Outcomes, 17(1), 1-7. doi: 10.1186/s12955-019-1165-2. DOI: https://doi.org/10.1186/s12955-019-1165-2

Bhopal, S. S., & Bhopal, R. (2020). Sex differential in COVID-19 mortality varies markedly by age. The Lancet, 396, 532-533. doi: 10.1016/S0140-6736(20)31748-7 DOI: https://doi.org/10.1016/S0140-6736(20)31748-7

Bjelland, I., Dahl, A. A., Haug, T. T., & Neckelmann, D. (2002). The validity of the Hospital Anxiety and Depression Scale: an updated literature review. Journal of Psychosomatic Research, 52(2), 69-77. doi: 10.1016/s0022-3999(01)00296-3. DOI: https://doi.org/10.1016/S0022-3999(01)00296-3

Bo, H. X., Li, W., Yang, Y., Wang, Y., Zhang, Q., Cheung, T., Wu, X., & Xiang, Y. T. (2020). Posttraumatic stress symptoms and attitude toward crisis mental health services among clinically stable patients with COVID-19 in China. Psychological Medicine, 1-2. doi: 10.1017/S0033291720000999. DOI: https://doi.org/10.1017/S0033291720000999

Borghi, L., Vegni, E.A.M., Raisi, S., Cardani, E., De Stasio, M., Leone, D., Study Group VeP (2020). La visita e parere psicologico in ambito ospedaliero un modello di intervento attraverso la pratica clinica. Psicologia della Salute, 1, 55-67. doi: 10.3280/PDS2020-001005

Bose, R. J., & McCarthy, J. R. (2020). Direct SARS-CoV-2 infection of the heart potentiates the cardiovascular sequelae of COVID-19. Drug Discovery Today, 25, 1559-1560. doi: 10.1016/j.drudis.2020.06.021. DOI: https://doi.org/10.1016/j.drudis.2020.06.021

Bottesi, G., Ghisi, M., Altoè, G., Conforti, E., Melli, G., & Sica, C. (2015). The Italian version of the Depression Anxiety Stress Scales-21: Factor structure and psychometric properties on community and clinical samples. Comprehensive Psychiatry, 60, 170-181. doi: 10.1016/j.comppsych.2015.04.005 DOI: https://doi.org/10.1016/j.comppsych.2015.04.005

Brooks, S. K., Webster, R. K., Smith, L. E., Woodland, L., Wessely, S., Greenberg, N., & Rubin, G. J. (2020). The psychological impact of quarantine and how to reduce it: rapid review of the evidence. The Lancet, 395, 912-920. doi: 10.1016/S0140-6736(20)30460-8 DOI: https://doi.org/10.1016/S0140-6736(20)30460-8

Chua, S. E., Cheung, V., McAlonan, G. M., Cheung, C., Wong, J. W., Cheung, E. P., Chan, M. T., Wong, T. K., Choy, K. M.,

Chu, C. M., Lee, P. W., & Tsang, K. W. (2004). Stress and psychological impact on SARS patients during the outbreak. The Canadian Journal of Psychiatry, 49(6), 385-390. doi: 10.1177/070674370404900607. DOI: https://doi.org/10.1177/070674370404900607

Craparo, G., Faraci, P., Rotondo, G., Gori, A. (2013). The Impact of Event Scale-Revised: psychometric properties of the Italian version in a sample of flood victims. Neuropsychiatric Disease and Treatment, 9, 1427-1432. doi: 10.2147/NDT.S51793 DOI: https://doi.org/10.2147/NDT.S51793

Crawford, J. R., & Henry, J. D. (2003). The Depression Anxiety Stress Scales (DASS): Normative data and latent structure in a large non-clinical sample. British Journal of Clinical Psychology, 42(2), 111-131. doi: 10.1348/014466503321903544 DOI: https://doi.org/10.1348/014466503321903544

Creamer, M., Bell, R., & Failla, S. (2003). Psychometric properties of the impact of event scale-revised. Behaviour Research and Therapy, 41(12), 1489-1496. doi:10.1016/j.brat.2003.07.010 DOI: https://doi.org/10.1016/j.brat.2003.07.010

Costantini, M., Musso, M., Viterbori, P., Bonci, F., Del Mastro, L., Garrone, O., Venturini, M., & Morasso, G. (1999). Detecting psychological distress in cancer patients: validity of the Italian version of the Hospital Anxiety and Depression Scale. Supportive Care in Cancer, 7(3), 121-127. doi: 10.1007/s005209900026

Cullen, W., Gulati, G., & Kelly, B. D. (2020). Mental health in the Covid-19 pandemic. QJM: An International Journal of Medicine, 113(5), 311-312. doi: 10.1093/qjmed/hcaa110 DOI: https://doi.org/10.1093/qjmed/hcaa110

Davydow, D. S., Gifford, J. M., Desai, S. V., Needham, D. M., & Bienvenu, O. J. (2008). Posttraumatic stress disorder in general intensive care unit survivors: a systematic review. General Hospital Psychiatry, 30(5), 421-434. doi: 10.1016/j.genhosppsych.2008.05.006

de Girolamo, G., Polidori, G., Morosini, P., Scarpino, V., Reda, V., Serra, G., Mazzi, F., Alonso, J., Vilagut, G., Visonà, G., Falsirollo, F., Rossi, A., & Warner, R. (2006). Prevalence of common mental disorders in Italy. Social Psychiatry and Psychiatric Epidemiology, 41(11), 853-861. doi: 10.1016/j.genhosppsych.2008.05.006. DOI: https://doi.org/10.1016/j.genhosppsych.2008.05.006

Eaton, N. R., Keyes, K. M., Krueger, R. F., Balsis, S., Skodol, A. E., Markon, K. E., Grant, B. F., & Hasin, D. S. (2012). An invariant dimensional liability model of gender differences in mental disorder prevalence: evidence from a national sample. Journal of Abnormal Psychology, 121(1), 282. doi: 10.1037/a0024780. DOI: https://doi.org/10.1037/a0024780

Faravelli, C., Abrardi, L., Bartolozzi, D., Cecchi, C., Cosci, F., D’Adamo, D., Lo Iacono, B., Ravaldi, C., Scarpato, M. A., Truglia, E., Rosi, S. (2004). The Sesto Fiorentino Study: background, methods and preliminary results. Psychotherapy and Psychosomatics, 73(4), 216-225. doi: 10.1159/000077740 DOI: https://doi.org/10.1159/000077740

Fiani, B., Covarrubias, C., Desai, A., Sekhon, M., & Jarrah, R. (2020). A contemporary review of neurological sequelae of COVID-19. Frontiers in Neurology, 11, 640. doi: 10.3389/fneur.2020.00640 DOI: https://doi.org/10.3389/fneur.2020.00640

Franceschini, C., Musetti, A., Zenesini, C., Palagini, L., Pelosi, A., Quattropani, M. C., Lenzo, V., Freda, M. F., Lemmo, D., Vegni, E., Borghi, L., Saita, E., Cattivelli, R., De Gennaro, L., Plazzi, G., Riemann, D., Castelnuovo, G. (2020). Poor quality of sleep and its consequences on mental health during COVID-19 lockdown in Italy. Frontiers, in press. DOI: https://doi.org/10.3389/fpsyg.2020.574475

Hong, X., Currier, G. W., Zhao, X., Jiang, Y., Zhou, W., & Wei, J. (2009). Posttraumatic stress disorder in convalescent severe acute respiratory syndrome patients: a 4-year followup study. General Hospital Psychiatry, 31(6), 546-554. doi: 10.1016/j.genhosppsych.2009.06.008. DOI: https://doi.org/10.1016/j.genhosppsych.2009.06.008

Iani, L., Lauriola, M., & Costantini, M. (2014). A confirmatory bifactor analysis of the hospital anxiety and depression scale in an Italian community sample. Health Qual Life Outcomes, 12(84), 1-8. doi: 10.1186/1477-7525-12-84 DOI: https://doi.org/10.1186/1477-7525-12-84

James, P. B., Wardle, J., Steel, A., & Adams, J. (2020). An assessment of Ebola-related stigma and its association with informal healthcare utilisation among Ebola survivors in Sierra Leone: a cross-sectional study. BMC Public Health, 20(1), 1-12. doi: 10.1186/s12889-020-8279-7. DOI: https://doi.org/10.1186/s12889-020-8279-7

Ji, D., Ji, Y. J., Duan, X. Z., Li, W. G., Sun, Z. Q., Song, X. A., Meng, Y. H., Tang, H. M., Chu, F., Niu, X. X., Chen, G. F., Li, J., & Duan, H. J.. (2017). Prevalence of psychological symptoms among Ebola survivors and healthcare workers during the 2014-2015 Ebola outbreak in Sierra Leone: a cross-sectional study. Oncotarget, 8(8), 12784-12791. doi: 10.18632/oncotarget.14498. DOI: https://doi.org/10.18632/oncotarget.14498

Jin, J. M., Bai, P., He, W., Wu, F., Liu, X. F., Han, D. M., Shi, L., Yang, J. K. (2020). Gender differences in patients with COVID-19: Focus on severity and mortality. Frontiers in Public Health, 8, 152. doi: 10.3389/fpubh.2020.00152 DOI: https://doi.org/10.3389/fpubh.2020.00152

Karademas, E. C., Tsagaraki, A., & Lambrou, N. (2009). Illness acceptance, hospitalization stress and subjective health in a sample of chronic patients admitted to hospital. Journal of Health Psychology, 14(8), 1243-1250. doi: 10.1177/1359105309345169. DOI: https://doi.org/10.1177/1359105309345169

Kwek, S. K., Chew, W. M., Ong, K. C., Ng, A. W. K., Lee, L. S. U., Kaw, G., & Leow, M. K. S. (2006). Quality of life and psychological status in survivors of severe acute respiratory syndrome at 3 months postdischarge. Journal of Psychosomatic Research, 60(5), 513-519. doi: 10.1016/j.jpsychores.2005.08.020. DOI: https://doi.org/10.1016/j.jpsychores.2005.08.020

Lazarus, R. S., & Folkman, S. (1984). Stress, appraisal, and coping. New York: Springer publishing company.

Lenzo, V., Quattropani, M. C., Musetti, A., Zenesini, C., Freda, M. F., Lemmo, D., Vegni, E., Borghi, L., Plazzi, G., Castelnuovo, G., Cattivelli, R., Saita, E., Franceschini, C. (2020). Resilience contributes to low emotional impact of the COVID-19 outbreak among the general population in Italy. Frontiers, in press.

Mazza, C., Ricci, E., Biondi, S., Colasanti, M., Ferracuti, S., Napoli, C., & Roma, P. (2020). A nationwide survey of psychological distress among italian people during the COVID-19 pandemic: Immediate psychological responses and associated factors. International Journal of Environmental Research and Public Health, 17, 1-14. doi: 10.3390/ijerph17093165. DOI: https://doi.org/10.3390/ijerph17093165

McCann, I. L., & Pearlman, L. A. (1990). Psychological trauma and the adult survivor: Theory, therapy, and transformation (No. 21). New York: Psychology Press.

Ministero della salute (2020, July 31). COVID.19 - Situazione in Italia. Available from: http://www.salute.gov.it/portale/nuovocoronavirus/dettaglioContenutiNuovoCoronavirus. jsp?lingua=italiano&id=5351&area=nuovoCoronavirus&menu=vuoto)%20-

Nolen-Hoeksema, S. (2012). Emotion regulation and psychopathology: The role of gender. Annual Review of Clinical Psychology, 8, 161-187. doi: 10.1146/annurev-clinpsy-032814-112739. DOI: https://doi.org/10.1146/annurev-clinpsy-032814-112739

Norton, P.J. (2007). Depression Anxiety and Stress Scales (DASS-21): Psychometric analysis across four racial groups. Anxiety, stress, and coping, 20(3), 253-265. DOI: https://doi.org/10.1080/10615800701309279

Remuzzi, A., & Remuzzi, G. (2020). COVID-19 and Italy: what next?. The Lancet, 395, 1225-28. doi: 10.1016/S0140-6736(20)30627-9. DOI: https://doi.org/10.1016/S0140-6736(20)30627-9

Rogers, J. P., Chesney, E., Oliver, D., Pollak, T. A., McGuire, P., Fusar-Poli, P., ..., David, A. S. (2020). Psychiatric and neuropsychiatric presentations associated with severe coronavirus infections: a systematic review and meta-analysis with comparison to the COVID-19 pandemic. The Lancet Psychiatry, 7, 611-627. doi: 10.1016/S2215-0366(20)30203-0. DOI: https://doi.org/10.1016/S2215-0366(20)30203-0

Rossi, R., Socci, V., Talevi, D., Mensi, S., Niolu, C., Pacitti, F., ..., Di Marco, A., Rossi, A., Siracusano, L., Di Lorenzo, G. (2020). COVID-19 pandemic and lockdown measures impact on mental health among the general population in Italy. Frontiers in Psychiatry, 11, 1-6. doi: 10.3389/fpsyt.2020.00790. DOI: https://doi.org/10.3389/fpsyt.2020.00790

Tadolini, M., Codecasa, L. R., García-García, J. M., Blanc, F. X., Borisov, S., Alffenaar, J. W., Andréjak, C., Bachez, P., Bart, P. A., Belilovski, E., Cardoso-Landivar, J., Centis, R., D’Ambrosio, L., Luiza De Souza-Galvão, M., Dominguez-Castellano, A., Dourmane, S., Fréchet Jachym, M., Froissart, A., Giacomet, V., Goletti, D., … Migliori, G. B. (2020). Active tuberculosis, sequelae and COVID-19 co-infection: first cohort of 49 cases. European Respiratory Journal, 56(1). doi: 10.1183/13993003.01398-2020 DOI: https://doi.org/10.1183/13993003.01398-2020

Taylor, M. R., Agho, K. E., Stevens, G. J., & Raphael, B. (2008). Factors influencing psychological distress during a disease epidemic: data from Australia’s first outbreak of equine influenza. BMC Public Health, 8(1), 347. doi: 10.1186/1471-2458-8-347. DOI: https://doi.org/10.1186/1471-2458-8-347

Troyer, E. A., Kohn, J. N., & Hong, S. (2020). Are we facing a crashing wave of neuropsychiatric sequelae of COVID-19? Neuropsychiatric symptoms and potential immunologic mechanisms. Brain, Behavior, And Immunity, 87, 34-39. doi: 10.1016/j.bbi.2020.04.027 DOI: https://doi.org/10.1016/j.bbi.2020.04.027

Tomasoni, D., Bai, F., Castoldi, R., Barbanotti, D., Falcinella, C., Mulè, Mondatore, D., Tavelli, A., Vegni, E., Marchetti, G., & d’Arminio Monforte, A. (2020). Anxiety and depression symptoms after virological clearance of COVID-19: a cross-sectional study in Milan, Italy. Journal of Medical Virology, 1-5. doi: 10.1002/jmv.26459. DOI: https://doi.org/10.1002/jmv.26459

Wang, C., Pan, R., Wan, X., Tan, Y., Xu, L., Ho, C. S., & Ho, R. C. (2020). Immediate psychological responses and associated factors during the initial stage of the 2019 coronavirus disease (COVID-19) epidemic among the general population in China. International Journal of Environmental Research and Public Health, 17(5), 1729. doi: 10.3390/ijerph17051729 DOI: https://doi.org/10.3390/ijerph17051729

Weiss, D., & Marmar, C. (1997). The Impact of Event Scale - Revised. In J. Wilson & T. Keane Assessing psychological trauma and PTSD: A handbook for practitioners. New York: Guilford Press.

Wilkowska-Chmielewska, J., Szelenberger, W., & Wojnar, M. (2013). Age-dependent symptomatology of depression in hospitalized patients and its implications for DSM-5. Journal of Affective Disorders, 150(1), 142-145. doi: 10.1016/j.jad.2012.12.012. DOI: https://doi.org/10.1016/j.jad.2012.12.012

World Health Organization. (2020a). Coronavirus disease (COVID-19). Situation report. (August 1). Available from: https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200731-covid-19-sitrep-193.pdf?sfvrsn=42a0221d_4

Zigmond, A. S., & Snaith, R. P. (1983). The hospital anxiety and depression scale. Acta Psychiatrica Scandinavica, 67(6), 361-370. doi: 10.1111/j.1600-0447.1983.tb09716.x DOI: https://doi.org/10.1111/j.1600-0447.1983.tb09716.x

Published
2021-01-14
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Special section COVID-19
Keywords:
Anxiety, depression, COVID-19 recovered patients, post-traumatic stress, mental health.
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How to Cite
Bonazza, F., Borghi, L., Cao di San Marco, E., Piscopo, K., Bai, F., d’Arminio Monforte, A., & Vegni, E. (2021). Psychological outcomes after hospitalization for COVID-19: data from a multidisciplinary follow-up screening program for recovered patients. Research in Psychotherapy: Psychopathology, Process and Outcome, 23(3). https://doi.org/10.4081/ripppo.2020.491