An interesting article by Liyanage-Don and others published in the Journal of General Internal Medicine in May 2021 researched this issue.
Many patients hospitalised for COVID-19 report physical and psychological symptoms that persist for months after viral clearance.
These are the so called long haulers or post-acute COVID sufferers.
Symptom persistence is not only limited to those with severe forms of COVID-19, but also often occurs in patients with mild to moderate illness not requiring intensive care or prolonged hospitalisation.
COVID-19 can also result in symptoms of depression, anxiety, stroke or posttraumatic stress disorder and PTSD, which may interfere with subsequent physical recovery.
The researchers examined the association of depression and PTSD with perceived recovery following COVID-19 illness.
The researchers looked at adults hospitalised for COVID-19 at two Columbia University Hospitals and discharged home between March 26th and May 27th 2020.
They were invited to complete a three-month post discharge survey assessing the physical and psychological impact of their COVID-19 illness.
Of the 510 eligible patients, 153 completed the survey.
The mean age was 54.5. 39.9% were female, 17% were white, 15% were black, 54.9% were Hispanic.
15% reported a history of mental illness, 13 of these 13.1% depression, 8.5%, anxiety, 2.6% PTSD and 2% other.
The mean length of COVID-19 hospitalisation was eight days and 5.9% of the patients required ICU admission and 4.6% were intubated.
Only 35.5% of patients reported full recovery from their COVID-19 illness, 23.5% had COVID related PTSD, 18.3% had depression, and 12.4% met the criteria for both.
The most common persistent COVID related physical symptoms were:
- Body aches 23.5%.
- Fatigue 20.3%.
- Shortness of breath 19%
- Headaches 13.1% and each of these were more likely to be reported by patients with depression or PTSD.
Depression and PTSD were all each associated with a greater mean number of persistent physical symptoms and a higher likelihood of feeling unrecovered.
The researchers found that patients with COVID related PTSD and depression had a higher burden of persistent physical symptoms and were less likely to feel fully recovered three months after their COVID-19 illness.
PTSD and depression have been associated with introspective dysfunction, which may perpetuate physical symptoms long after the acute illness has resolved.
Therefore, one interpretation they offered was that patients with PTSD and stroke or depression are more sensitive to physical symptoms. This has led to experiencing heightened psychological distress in response, and consequently feel less recovered in their COVID-19 illness.
The authors concluded that their study highlighted the importance of mental health screening in the management of post-acute COVID-19.
Furthermore, they suggested that addressing depression and PTSD may be needed to optimise psychological and physical recovery from COVID-19.
The London General Practice has brought together a multidisciplinary team to help look after all sufferers with long COVID, post-acute COVID and any form of disorder as a result of COVID infection.
Please do not hesitate to make an appointment if you so require.
Dr Paul Ettlinger
BM, DRCOG, FRCGP, FRIPH, DOccMed