Immediate psychological distress in quarantined patients with COVID-19 and its association with peripheral inflammation: A mixed-method study
Immediate psychological distress in quarantined patients with COVID-19 and its association with peripheral inflammation: A mixed-method study
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DOI：
10.1016/j.bbi.2020.05.038
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发表时间：
2020-08-01
影响因子：
15.1
通讯作者：
Yang, Zongguo
中科院分区：
文献类型：
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作者：
Guo, Qian;Zheng, Yuchen;Yang, Zongguo
自二零一九年年底以来，2019冠状病毒病（COVID-19）已成为全球大流行的原因。被隔离的COVID-19患者的精神状态以及他们的心理困扰和生理炎症水平之间的相互作用尚未得到分析。本研究采用混合方法三角设计（QUAN + QUAL），调查并比较了103名因轻度症状住院的COVID-19检测阳性患者和103名COVID-19阴性匹配对照的精神状态和炎症标志物。通过在线调查测量抑郁、焦虑和创伤后应激症状（PTSS）的严重程度。使用方便的抽样技术，收集定性数据，直到数据饱和点。此外，还对5名COVID-19患者进行了半结构化访谈。还在基线和完成在线调查的+/-3天内收集患者的外周炎症标志物。结果显示，与非COVID对照组相比，COVID-19患者表现出更高水平的抑郁（P < 0.001），焦虑（P < 0.001）和创伤后应激症状（P < 0.001）。在PSS-10的子量表“自感无助”评分中观察到性别效应，女性患者的评分高于男性患者（Z = 2.56，P = 0.010）、女性（Z = 2.37，P = 0.018）和男性对照组（Z = 2.87，P = 0.004）。有抑郁症状的患者外周炎症指标CRP水平与PHQ-9总分呈正相关（R = 0.37，P = 0.003，斯皮尔曼相关）。此外，CRP水平较基线的变化与PHQ-9总分呈负相关（R =-0.31，P = 0.002），表明抑郁症状改善。定性分析显示，类似的结果与患者报告的负面情绪，包括恐惧，内疚和无助。污名化和病毒性疾病进展的不确定性是COVID-19患者表达的两个主要担忧。我们的研究结果表明，住院的COVID-19患者经历了显著的心理困扰，抑郁特征的水平可能与这些患者的炎症标志物有关。因此，我们建议应提供必要措施，以解决COVID-19患者的抑郁和其他精神症状，并在提供心理干预时应关注患者感知的耻辱和应对策略。
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.