The novel Severe Acute Respiratory Syndrome (SARS-CoV-2) coronavirus, more commonly known as COVID-19, has lambasted the globe with its symptoms ranging from negligible to annoying to deadly. The Johns Hopkins University Coronavirus Resource Center reports more than 44 million global COVID-19 cases, at the time of writing, with more than one million global deaths. While we often track the numbers of cases and deaths, it is becoming clear that it is important to track the aftermath of recovering from the coronavirus as well as the trauma entire generations are currently experiencing. A recent study out of Italy investigated the psychological impacts of contracting and recovering from the virus. While we know the physical toll that being ill can take on a person, we also need to consider the mental health consequences of living through such traumatic and stressful times. In this study, Mazza et al. surveyed 402 adult survivors of COVID-19 and measured levels of inflammatory markers at a one-month follow up appointment. The goal of this study was to determine whether there is a link between levels of inflammation and mental state in COVID-19 survivors. The research group hypothesized that COVID-19 survivors would show a high prevalence of new psychiatric illnesses. Specifically, the researchers looked for psychiatric effects similar to what was seen following the Severe Acute Respiratory Syndrome and Middle East Respiratory Syndrome (MERS) outbreaks including post-traumatic stress disorder (PTSD), panic disorder, obsessive compulsive disorder (OCD), and insomnia

How do you examine psychological impact from a viral infection? 

Of the 402 participants in the study, 300 were admitted to the hospital for severe pneumonia from COVID-19 while 102 of these participants were seen in the emergency department, but then sent home to recover. One month after recovery, the participants were interviewed and the researchers collected data from the participants’ emergency department charts. The participants’ charts gave researchers a baseline of physical health measurements to compare to, including pulse-oxygen levels and immune markers. 

During this one-month follow up, participants answered questionnaires to assess depression, post-traumatic stress disorder, anxiety, sleep quality, insomnia, OCD, and the amount of stress they associated with having COVID-19. Researchers then used statistical analyses to compare how patients categorized by different factors (sex, hospitalization, previous psychiatric illness) rated symptom severity. The researchers also evaluated correlations and predictions between age, duration of hospitalization, baseline inflammatory markers, oxygen levels and current psychological symptoms. Researchers hoped to see if, for instance, inflammatory markers might predict psychological symptom severity.

What did the researchers find?

The researchers discovered that nearly 60% of participants experienced clinical levels of at least one psychological symptom. Almost 37% of participants showed pathological levels on two measurements, and 20% on three measurements. Perhaps most interestingly, these symptoms were not evenly spread amongst groups. It appeared that females and people with prior mental illnesses were most affected and showed increases on most of the mental health measures. The baseline inflammatory markers and follow-up oxygen levels did not correlate with psychological symptoms. While studies have shown that higher levels of inflammatory markers might mean a tougher road to recovery, they do not seem to indicate much about the mental health of patients after recovery. 

Interestingly, there did seem to be differences in mental health depending on where the patient recovers. Participants that were hospitalized did not report worsened depression, anxiety, obsessive compulsive, or PTSD symptoms. Whereas participants that recovered at home measured higher on scales of anxiety and sleep disturbances. The researchers concluded that the observed psychiatric symptoms were not a manifestation of the physical illness. The researchers observed higher levels of psychiatric illness following COVID-19 recovery, supporting their initial hypothesis. But, psychiatric illness did not correlate with any  physical measurements of COVID-19 illness. The only predictors of psychiatric illness seemed to be being a female and/or already having a psychiatric diagnosis. 

Where do we go from here?

This study has made it clear that people need to take care of their mental health up front. Do not wait until you get physically ill to worry about your mental state! Merely existing during this pandemic has forced multiple generations of people to live under constant stress. The effects of this global pandemic will undoubtedly be seen and measured for decades to come. An article published in the New England Journal of Medicine discussed the weight and grief we all feel daily during this time. It is important to take note of all of the “little” losses we experience throughout this process as well as the more major ones. Be a little more kind to yourself and to those around you. Reach out for help. Offer some help to a loved one. 

Please see below for available resources: 

National Suicide Prevention Lifeline: 1-800-273-8255

Crisis Text Line: Text “HELLO” to 741741 

Use Psychology Today to find a therapist near you!

Peer edited by Dominika Trzilova and Jeanne-Marie McPherson

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