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jqyk;) JOURNAL OF CLINICAL MEDICINE OF KAZAKHSTAN Original Article
(E-ISSN 2313-1519)
A determination of the relationship between the symptoms, hospital anxiety and depression levels, and quality of life patients diagnosed with Covid-19
Samet Sayilan1, Aylin Aydin Sayilan2, Melike Demir Dogan3, Emel £etinkaya4, Nuray Olcayturk5
'Department of Internal Medicine, Medicine Faculty, Kirklareli University, Kirklareli, Turkey 2Nursing Department, School of Health Science, Kirklareli University, Kirklareli, Turkey 3Faculty School of Health Science, Gumushane University, Gumuyhane, Turkey "Unit of Internal Disease, Kirklareli Educational and Research Hospital, Kirklareli, Turkey Unit of Infection Disease, Kirklareli Educational and Research Hospital, Kirklareli, Turkey
Abstract
Introduction: The worldwide spread of coronavirus over the last 20 years has resulted in its becoming a major threat to health. The virus is thought to be a zoonotic disease spread by means of direct and contact transmission. The purpose of this study was to investigate the symptoms, anxiety-depression levels, and quality of life of patients with Covid-19.
Material and methods: This descriptive, cross-sectional research was conducted in an education and research hospital between August and November 2020. An information form, the Hospital Anxiety and Depression Scale, and the Quality of Life Scale were employed as data collection tools. The study was completed with 103 individuals.
Results: The mean age of the patients enrolled in the study was 37.77±10.92 years, and 67% were women. Higher anxiety levels were determined in women compared to men (p=0.001) and in married participants compared to unmarried individuals (p=0.010). Significant negative correlation was determined between anxiety and the Quality of Life Scale sub-parameters of general health, physical health, psychological health, and environment. Positive correlation was found between Covid-19 severity and anxiety, and negative correlation between Covid-19 severity and physical health (p<0.001).
Conclusion: Higher anxiety was determined among women and married patients in this study, and quality of life (in the four subparameters) decreased as anxiety increased. Physical health decreased, while anxiety increased, with the severity of Covid.
Key words: anxiety, covid, depression, infection, life quality
Received: 2021-11-10. Accepted: 2021-12-11
© 0
This work is licensed under a Creative Commons Attribution 4.0 International License
J Clin Med Kaz 2021; 18(6):81-85
Corresponding author: Samet Sayilan.
E-mail: [email protected]; ORCID: 0000-0002-8959-8381
Introduction
The novel coronavirus SARS-CoV-2, officially described as Covid-19 by the World Health Organization (WHO) on 11 February, 2020, is a highly pathogenic virus affecting humans. Molecular techniques, serology, and viral culture are employed as serological diagnostic tools [1].
Although symptoms in diagnosed patients vary from individual to individual, symptoms ranging from mild to severe and worsening from day to day include fever, headache, cough, sore throat, nasal obstruction,
nausea, diarrhea, hoarseness, painful eating-drinking, fatigue, myalgia, and severe respiratory failure [2, 3].
Patients diagnosed with Covid-19 and requiring hospitalization are known to experience psychological as well as physical problems. These patients are reported to experience high levels of anxiety and depression, with anxiety levels increasing still further and mental state worsening in patients with chronic disease and disability [4, 5]. At the same time, studies have reported that patients who have experienced Covid-19 experience more depressive symptoms and problems such as sleep
disorder compared to other patients, while their mental health is also at risk and they require constant observation [6].
Quality of life, a dynamic characteristic, is an important parameter in the evaluation of health and is known to be closely linked to sociological, psychologial, cultural, and economic factors [7]. Studies have reported that the quality of life and mental health of the great majority of individuals are adversely affected by Covid-19, and that this can in turn trigger depression [8, 9]. It has also been emphasized that this persists even after discharge [10].
While previous studies have more frequently evaluated Covid-19-related symptoms in health workers, the general public, and patients with psychological problems [11-13], and post-discharge studies have been performed, there has to date been no investigation in hospitalized patients diagnosed with Covid-19 [10, 14]. This study was therefore intended to investigate symptoms, anxiety-depression levels, and quality of life in diagnosed patients.
Materials and methods
Following receipt of the requisite approvals, data were collected using a questionnaire to be applied to patients diagnosed with Covid-19 presenting to and being treated at an education and training hospital between 15 August-15 November 2020. All patients giving consent between those dates were included in the study.
The questionnaire consisted of an information form, the HADS, and the WHO Quality of Life Scale.
1. Hospital Anxiety and Depression Scale (HADS)
HADS was originally developed by Zigmond and Snaith
in 1983 [15].Its validity and reliability were subsequently confirmed by Aydemir et al. in 1997 [16]. This four-point Likert-type scale measures patient anxiety and depression. HADS contains 14 questions, seven involving anxiety and seven measuring depression.
2. World Health Organization Quality of Life Scale
The short form of the WHO Quality of Life Scale for Turks (WHOQOL BREF TR) was used to determine patients' quality of life. The WHOQOL BREF TR consists of 27 questions. The form reveals individuals' general health and quality of life (GHQL) and their physical, social, psychological, and environmental well-being. The short from of the Turkish-language Quality of Life Scale (WHOQOLBREF-TR) was developed by the WHO, and Eser et al. (1999) subsequently investigated its validity and reliability for Turkey [17]. The WHOQOLBREF contains 26 questions in four domains (physical, psychological, social relationships, and environmental) selected from the WHOQOL-100.
The requisite approval for the research was obtained from the Turkish Ministry of Health. Ethical committee approval was granted by the Gumu§hane University Scientific Research and Publication Ethics Committee (2020/7).
The patient's sociodemographic characteristics were expressed using descriptive statistics, means, median, frequencies, and percentage values. Comparisons were made using the t test, Pearson's Correlation, and Spearman's Correlation for all statistical analyses. A two-sided p value of less than 0.05 was considered statistically significant.
Results
The mean age of the patients in the study was 37.77±10.92 years; 67% were women, 70.9% were married, and 28.2% had at least one chronic disease. Almost all patients reported complying with precautions against contagion set out by the Ministry of Health (Table 1).
Sociodemographic characteristics of the study participants
n %
Gender
Female 69 67.0
Male 34 33.0
Marital status
Married 73 70.9
Unmarried 30 29.1
Presence of chronic disease
Yes 29 28.2
No 74 71.8
Have you taken protective measures against the risk of Covid-19 infection?
Yes 102 99.0
No 1 1.0
Have any members of your family been diagnosed with Covid-19? (Mother-Father-Spouse-Child-Brother-Sister)
Yes 66 64.1
No 37 35.9
The most frequent symptom was fatigue, observed in 76.7% of patients, followed by back and joint pain in 67.0%. In addition, 54.5% of patients experienced headache, 51.5% fever, and 47.6% cough (Table 2).
Symptoms observed (more than one ; was given)
n %
Fever 53 51.5
Cough 49 47.6
Hoarseness 22 21.4
Loss of taste and smell 49 47.6
Lack of appetite 49 47.6
Fatigue 79 76.7
Respiratory distress 18 17.5
Sore throat 31 30.1
Headache 56 54.4
Diarrhea 24 23.3
Conjunctivitis 4 3.9
Skin eruptions or color changes in the fingers or toes 5 4.9
Back pain 69 67.0
Nasal discharge 33 32.0
Loss of speech and movement 4 3.9
Chest pain 19 18.4
Statistical analysis revealed significant correlation between gender and anxiety levels, with anxiety levels being higher in women than in men (t=3.42, p=0.001). The quality of life subdomains of physical health, psychological health, and environment differed significantly in terms of gender. Physical health was better among women than among men (t=3.37, p=0.001). Psychological health was also better in women than in men (t=-2.80, p=0.006). The environment subdimension was similarly better in women than in men (t=-2.62, p=0.010).
Anxiety was significantly correlated with marital status (t=2.64, p=0.010). Married participants had higher anxiety levels than single individuals. Anxiety levels were also higher among individuals with family members with a history of Covid compared to those with no infected relative (t=2.73, p=0.007).
Significant negative correlation was determined between anxiety and all four Quality of Life Scale domains (general health, physical health, psychological health, and environment) (p<0.001). Anxiety levels decreased as general health, physical health, psychological health, and environment-related quality of life increased. Significant negative correlation was determined between depression and the Quality of Life Scale sub-parameters of general health, physical health, psychological health, and environment (p<0.001). Depression levels decreased as general health, physical health, psychological health, and environment-related quality of life increased. A significant negative association was determined between Covid-19 severity and physical health (p<0,001). Physical health improved as the severity of Covid-19 decreased. A positive association was determined between severity of Covid-19 and anxiety levels (p<0.001). Anxiety levels rose in line with Covid-19 severity (Table 3).
Correlations between various parameters and Quality of Life and Hospital Anxiety and Depression Scale parameters
Depression Anxiety Covid severity
r p r p r p
General health -0.630 p<0.001 -0.474 p<0.001 -0.156 0.115
Physical health -0.657 p<0.001 -0.648 p<0.001 -0.388 p<0.001
Psychological health -0.762 p<0.001 -0.673 p<0.001 -0.192 .052
Social relations -0.500 p<0.001 -0.427 p<0.001 -0.110 0.269
Environment -0.530 p<0.001 -0.446 p<0.001 -0.188 0.058
Anxiety 0.745 p<0.001 1 - 0.241 0.014
Depression 1 - 0.745 p<0.001 0.189 0.056
Discussion
The Covid-19 pandemic has been reported to trigger anxiety and depression, with quality of life also being adversely affected [8, 14].
Statistical analysis revealed a significant gender difference in anxiety levels, being higher in women than in men. One meta-analysis performed to determine the effects of Covid-19 on mental health reported that the anxiety experienced by women is greater than that experienced by men [18]. A previous study from Turkey also determined higher Covid-19-related anxiety and depression levels in women [19]. Our finding is consistent with the previous literature and is important in showing that more anxiety is experienced by women. It can be thought that estrogen, progesterone and prolactin hormones increase the stress response in women.
Comparison of Quality of Life Scale subgroups revealed significant gender differences in physical health, psychological health, and environment, all three being better in women than in men. A meta-analysis by Vindegard & Benro (2020) investigating the effects of Covid-19 on mental health reported lower psychological health among women [18]. Ma et al. (2020) investigated depression and quality of life among individuals with Covid-19 but reported no gender difference in terms of quality of life [20]. The discrepancies among the findings may be due to the samples involved.
Anxiety levels were higher among married individuals in the present study compared to unmarried participants. In a study from Canada investigating the effect of Covid-19, Nkire et al. (2020) determined high levels of anxiety and depression in
single individuals [21]. Ozdin & Bayrak Ozdin 2020 and Passos et al. (2020) both found no difference in anxiety in terms of marital status [19, 22].
In the present study, anxiety and depression levels decreased as the Quality of Life subscale sub-parameters of general health, physical health, psychological health, and environment increased. One meta-analysis (1963 studies and 87 preprints) considered the psychiatric and neuropsychiatric symptoms of Covid-19 and reported that patients experienced symptoms such as intense sleeplessness, stress, anxiety, forgetfulness, and fatigue, even extending to psychosis in advanced stages, and that their quality of life was adversely affected [23]. Another study investigating the effect of Covid-19 on quality of life described anxiety and depression, fatigue, pain, and sleep and concentration problems as frequently experienced symptoms, and emphasized the adverse impacts of these on quality of life [10]. Another study of healthy individuals examined the general effects of Covid-19 on mental health and quality of life and reported that individuals experienced stress and anxiety because of the pandemic, but that family support enhanced quality of life [24]. Previous studies have more frequently involved healthy individuals or the post-discharge period, and no previous studies have investigated the hospitalization period. Consistent with the previous literature, anxiety and depression levels in the present study decreased as Covid-19-related quality of life increased.
Physical health improved in the present study as the severity of Covid-19 decreased. Precious studies have reported symptoms ranging from mild to severe in individuals with Covid-19, describing symptoms starting with cough, fatigue, and joint pain worsening from day to day, together with severe levels of respiratory and movement difficulty [25, 26]. The negative effect on physical and mental health in particular among individuals exposed to these symptoms has also been emphasized [27, 28].
Anxiety levels increased in line with the severity of Covid-19 in this study. Similarly, Mazza et al. (2020) also reported that anxiety and depression levels as the severity of the disease worsened among individuals with Covid-19 [29]. Another study from Ireland also reported that anxiety levels increased with disease severity [30]. These findings are consist with those of the present study.
Since the present study was performed in a single center, at a specific time, and during the first wave of Covid-19, the research results cannot be generalized.
Conclusion
The findings of this study show high levels of anxiety among women and married patients, but that anxiety decreased as quality of life (general health, physical health, psychological health, and environment) increased. Physical health decreased as the severity of Covid-19 worsened, while anxiety increased. We recommend that the potential effects of the severity of the disease and quality of life should not be overlooked when caring for patients with Covid-19, and that programs aimed at reducing anxiety should be developed and implemented.
Disclosures: There is no conflict of interest for all authors. Funding: None. Acknowledgments: None.
References
1. Seyed Hosseini E, Riahi Kashani N, Nikzad H, Azadbakht J, Hassani Bafrani H, Haddad Kashani H. The novel Coronavirus Disease-2019 (COVID-19): Mechanism of action, detection and recent therapeutic strategies. Virology. 2020; 551:1-9. doi: 10.1016/j. virol.2020.08.011.
2. Umakanthan S, Sahu P, Ranade AV, Bukelo MM, Rao JS, Abrahao-Machado LF, Dahal S, Kumar H, Kv D. Origin, transmission, diagnosis and management of coronavirus disease 2019 (COVID-19). Postgrad Med J. 2020; 96(1142):753-758.
3. Yürük Bal E, Qelik H. COVID-19 Salgini ile Mücadelede Hem§irenm Rolü. Turkiye Klinikleri J Nurs Sci. 2020;12(2):300-4. https://doi.org/10.5336/nurses.2020-75315
4. Hajure M, Tariku M, Mohammedhussein M, Dule A. Depression, Anxiety and Associated Factors Among Chronic Medical Patients Amid COVID-19 Pandemic in Mettu Karl Referral Hospital, Mettu, Ethiopia, 2020. Neuropsychiatr Dis Treat. 2020; 16:2511-2518. https://doi.org/10.2147/NDT.S281995
5. Necho M, Birkie M, Gelaye H, Beyene A, Belete A, Tsehay M. Depression, anxiety symptoms, Insomnia, and coping during the COVID-19 pandemic period among individuals living with disabilities in Ethiopia, 2020. PLoS One. 2020; 15(12):e0244530. https:// doi.org/10.1371/journal.pone.0244530
6. Huang Y, Zhao N. Generalized anxiety disorder, depressive symptoms and sleep quality during COVID-19 outbreak in China: a web-based cross-sectional survey. Psychiatry Res, 2020; 288:112954. https://doi.org/10.1016/j.psychres.2020.112954
7. Rubin RR, Peyrot M. Quality of life and diabetes. Diabetes Metab Res Rev. 1999; 15(3):205-18. https://doi.org/10.1002/(SICI)1520-7560(199905/06)15:3<205::AID-DMRR29>3.0.CO;2-O
8. Shader RI. COVID-19 and Depression. Clin Ther. 2020; 42(6):962-963. doi: 10.1016/j.clinthera.2020.04.010.
9. Choi EPH, Hui BPH, Wan EYF. Depression and Anxiety in Hong Kong during COVID-19. Int J Environ Res Public Health. 2020; 17(10):3740. doi: 10.3390/ijerph17103740.
10. Garrigues E, Janvier P, Kherabi Y, Le Bot A, Hamon A, Gouze H, Doucet L, Berkani S, Oliosi E, Mallart E, Corre F, Zarrouk V, Moyer JD, Galy A, Honsel V, Fantin B, Nguyen Y. Post-discharge persistent symptoms and health-related quality of life after hospitalization for COVID-19. J Infect. 2020; 81(6):e4-e6. doi: 10.1016/j.jinf.2020.08.029.
11. Wang S, Wen X, Dong Y, Liu B, Cui M. Psychological Influence of Coronovirus Disease 2019 (COVID-19) Pandemic on the General Public, Medical Workers, and Patients With Mental Disorders and its Countermeasures. Psychosomatics. 2020; 61(6):616-624. https://doi.org/10.1016Zj.psym.2020.05.005
12. Talevi D, Socci V, Carai M, Carnaghi G, Faleri S, Trebbi E, di Bernardo A, Capelli F, Pacitti F. Mental health outcomes of the CoViD-19 pandemic. Riv Psichiatr. 2020; 55(3):137-144.
13. Arbelo N, López-Pelayo H, Sagué M, Madero S, Pinzón-Espinosa J, Gomes-da-Costa S, Ilzarbe L, Anmella G, Llach CD, Imaz ML, Cámara MM, Pintor L. Psychiatric Clinical Profiles and Pharmacological Interactions in COVID-19 Inpatients Referred to a Consultation Liaison Psychiatry Unit: a Cross-Sectional Study. Psychiatr Q. 2021; 7:1-13. doi: 10.1007/s11126-020-09868-6.
14. Klok FA, Boon GJAM, Barco S, Endres M, Geelhoed JJM, Knauss S, Rezek SA, Spruit MA, Vehreschild J, Siegerink B. The Post-COVID-19 Functional Status scale: a tool to measure functional status over time after COVID-19. Eur Respir J. 2020; 56(1):2001494. https://doi.org/10.1183/13993003.01494-2020
15. Zigmond AS, Snaith RP. Hastane Anksiyete Depresyon Ölfegi (HAD). Acta psychiatry scand. 1983; 67:361-370. https://doi. org/10.1111/j.1600-0447.1983.tb09716.x
16. Aydemir Ö, Güvenir T, Küey L, Kültür S. Hastane Anksiyete ve Depresyon Ölfegi Türkfe Formunun Geferlilik ve Güvenirlik Qal^masi. TürkPsikiyatri Dergisi. 1997; 8(4):280-287.
17. Eser E, Fidaner H, Fidaner C, Eser S, Elbi H, Göker E. Psychometric properties of the WHOQOL- 100 and WHOQOL-BREF. J Psychiatry Psychol Psychopharmacol. 1999; 7(2):2340.
18. Vindegaard N, Benros ME. COVID-19 pandemic and mental health consequences: Systematic review of the current evidence. Brain Behav Immun. 2020; 89:531-542. doi: 10.1016/j.bbi.2020.05.048.
19. Özdin S, Bayrak Özdin §. Levels and predictors of anxiety, depression and health anxiety during COVID-19 pandemic in Turkish society: The importance of gender. Int J Soc Psychiatry. 2020; 66(5):504-511. doi: 10.1177/0020764020927051.
20. Ma YF, Li W, Deng HB, Wang L, Wang Y, Wang PH, Bo HX, Cao J, Wang Y, Zhu LY, Yang Y, Cheung T, Ng CH, Wu X, Xiang YT. Prevalence of depression and its association with quality of life in clinically stable patients with COVID-19. J Affect Disord. 2020; 275:145-148. doi: 10.1016/j.jad.2020.06.033.
21. Nkire N, Nwachukwu I, Shalaby R, Hrabok M, Vuong W, Gusnowski A, Surood S, Greenshaw AJ, Agyapong VIO. COVID-19 pandemic: influence of relationship status on stress, anxiety, and depression in Canada. Ir J Psychol Med. 2021; 14:1-12. doi: 10.1017/ipm.2021.1.
22. Passos L, Prazeres F, Teixeira A, Martins C. Impact on Mental Health Due to COVID-19 Pandemic: Cross-Sectional Study in Portugal and Brazil. Int J Environ Res Public Health. 2020; 17(18):6794. doi: 10.3390/ijerph17186794.
23. Rogers JP, Chesney E, Oliver D, Pollak TA, McGuire P, Fusar-Poli P, Zandi MS, Lewis G, David AS. Psychiatric and neuropsychiatric presentations associated with severe coronavirus infections: a systematic review and meta-analysis with comparison to the COVID-19 pandemic. Lancet Psychiatry. 2020; 7(7):611-627. doi: 10.1016/S2215-0366(20)30203-0.
24. Zhang Y, Ma ZF. Impact of the COVID-19 Pandemic on Mental Health and Quality of Life among Local Residents in Liaoning Province, China: A Cross-Sectional Study. Int J Environ Res Public Health. 2020; 17(7):2381. doi: 10.3390/ijerph17072381.
25. Khan M, Khan H, Khan S, Nawaz M. Epidemiological and clinical characteristics of coronavirus disease (COVID-19) cases at a screening clinic during the early outbreak period: a single-centre study. J Med Microbiol. 2020; 69(8):1114-1123. doi: 10.1099/ jmm.0.001231.
26. Adil MT, Rahman R, Whitelaw D, Jain V, Al-Taan O, Rashid F, Munasinghe A, Jambulingam P. SARS-CoV-2 and the pandemic of COVID-19. Postgrad Med J. 2021; 97(1144):110-116. doi: 10.1136/postgradmedj-2020-138386.
27. Holmes EA, O'Connor RC, Perry VH, Tracey I, Wessely S, Arseneault L, Ballard C, Christensen H, Cohen Silver R, Everall I, Ford T, John A, Kabir T, King K, Madan I, Michie S, Przybylski AK, Shafran R, Sweeney A, Worthman CM, Yardley L, Cowan K, Cope C, Hotopf M, Bullmore E. Multidisciplinary research priorities for the COVID-19 pandemic: a call for action for mental health science. Lancet Psychiatry. 2020; 7(6):547-560. doi: 10.1016/S2215-0366(20)30168-1.
28. Pieh C, Budimir S, Probst T. The effect of age, gender, income, work, and physical activity on mental health during coronavirus disease (COVID-19) lockdown in Austria. JPsychosom Res. 2020;136:110186. doi: 10.1016/j.jpsychores.2020.110186.
29. Mazza MG, De Lorenzo R, Conte C, Poletti S, Vai B, Bollettini I, Melloni EMT, Furlan R, Ciceri F, Rovere-Quermi P; COVID-19 BioB Outpatient Clinic Study group, Benedetti F. Anxiety and depression in COVID-19 survivors: Role of inflammatory and clinical predictors. Brain Behav Immun. 2020; 89:594-600. doi: 10.1016/j.bbi.2020.07.037.
30. Hyland P, Shevlin M, McBride O, Murphy J, Karatzias T, Bentall RP, Martinez A, Vallieres F. Anxiety and depression in the Republic of Ireland during the COVID-19 pandemic. Acta Psychiatr Scand. 2020;142(3):249-256. doi: 10.1111/acps.13219.
