Patients' Clinical and Psychological Status in Different COVID-19 Waves in Italy: A Quanti-Qualitative Study

Martina Vigorè, Andrea Steccanella, Marina Maffoni, Valeria Torlaschi, Alessandra Gorini, Maria Teresa La Rovere, Roberto Maestri, Maurizio Bussotti, Sergio Masnaghetti, Francesco Fanfulla, Antonia Pierobon, Martina Vigorè, Andrea Steccanella, Marina Maffoni, Valeria Torlaschi, Alessandra Gorini, Maria Teresa La Rovere, Roberto Maestri, Maurizio Bussotti, Sergio Masnaghetti, Francesco Fanfulla, Antonia Pierobon

Abstract

Background: COVID-19 waves have been characterized by different clinical manifestations, a decrease of functional abilities, and the presence of psychological symptoms. The aims of this study were to investigate differences in physical and psychological symptoms during the three Italian waves of the coronavirus pandemic.

Methods: Patients undergoing a functional, cardiological and pneumological check-up follow-up at ICS Maugeri Institutes, 2-3 months after recovery from COVID-19 were consecutively recruited to participate in the study, completing a quanti-qualitative questionnaire about anxiety, depression, PTSD symptoms, and personal resources.

Results: 104 patients were recruited: 44 and 60 during the first and second/third pandemic waves, respectively. Physical comorbidities were more present in the second/third waves compared to the first one, while no significant differences were found in anxious and depressive symptoms, which were significantly higher than normal during the three waves; PTSD symptoms were reported by 56.3% of patients. Family, social support, and a positive mindset were described as resources to cope with the COVID-19 burden. Negative affects arose during outbreaks (panic) and the disease (fear), while positive affect (joy) characterized only the follow-up period.

Conclusion: This study shows how psychophysical symptoms might change during the pandemic waves and highlights the importance of protective factors to balance the subjective distress.

Keywords: COVID-19; PTSD; depression; distress; functional; pandemic waves.

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Flow diagram of case selection and research timing.
Figure 2
Figure 2
Percentage of difficulties faced in returning to work in different waves. * p < 0.05.
Figure 3
Figure 3
Percentage of coping resources reported in different waves.

References

    1. World Health Organization WHO: Director-General’s Opening Remarks at the Media Briefing on COVID-19. [(accessed on 2 February 2022)]. Available online: .
    1. Caramello V., Catalano A., Macciotta A., Dansero L., Sacerdote C., Costa G., Aprà F., Tua A., Boccuzzi A., Ricceri F. Improvements throughout the Three Waves of COVID-19 Pandemic: Results from 4 Million Inhabitants of North-West Italy. J. Clin. Med. 2022;11:4304. doi: 10.3390/jcm11154304.
    1. Fernández-de-Las-Peñas C., Palacios-Ceña D., Gómez-Mayordomo V., Florencio L.L., Cuadrado M.L., Plaza-Manzano G., Navarro-Santana M. Prevalence of Post-COVID-19 Symptoms in Hospitalized and Non-Hospitalized COVID-19 Survivors: A Systematic Review and Meta-Analysis. Eur. J. Intern. Med. 2021;92:55–70. doi: 10.1016/j.ejim.2021.06.009.
    1. Lopez-Leon S., Wegman-Ostrosky T., Perelman C., Sepulveda R., Rebolledo P.A., Cuapio A., Villapol S. More than 50 Long-Term Effects of COVID-19: A Systematic Review and Meta-Analysis. medRxiv Prepr. Serv. Health Sci. 2021;11:16144.
    1. Crook H., Raza S., Nowell J., Young M., Edison P. Long Covid-Mechanisms, Risk Factors, and Management. BMJ. 2021;374:n1648. doi: 10.1136/bmj.n1648.
    1. Oronsky B., Larson C., Hammond T.C., Oronsky A., Kesari S., Lybeck M., Reid T.R. A Review of Persistent Post-COVID Syndrome (PPCS) Clin. Rev. Allergy Immunol. 2023;64:66–74. doi: 10.1007/s12016-021-08848-3.
    1. Shanbehzadeh S., Tavahomi M., Zanjari N., Ebrahimi-Takamjani I., Amiri-Arimi S. Physical and Mental Health Complications Post-COVID-19: Scoping Review. J. Psychosom. Res. 2021;147:110525. doi: 10.1016/j.jpsychores.2021.110525.
    1. Ya’qoub L., Elgendy I.Y., Pepine C.J. Sex and gender differences in COVID-19: More to be learned! Am. Heart J. Plus Cardiol. Res. Pract. 2021;3:100011. doi: 10.1016/j.ahjo.2021.100011.
    1. Chen W., Ju Y., Liu B., Huang M., Yang A., Zhou Y., Wang M., Liao M., Shu K., Liu J., et al. Negative Appraisals of the COVID-19 Social Impact Associated with the Improvement of Depression and Anxiety in Patients After COVID-19 Recovery. Front. Psychiatry. 2021;12:585537. doi: 10.3389/fpsyt.2021.585537.
    1. De Sousa Moreira J.L., Barbosa S.M.B., Vieira J.G., Chaves N.C.B., Felix E.B.G., Feitosa P.W.G., da Cruz I.S., da Silva C.G.L., Neto M.L.R. The Psychiatric and Neuropsychiatric Repercussions Associated with Severe Infections of COVID-19 and Other Coronaviruses. Prog. Neuropsychopharmacol. Biol. Psychiatry. 2021;106:110159. doi: 10.1016/j.pnpbp.2020.110159.
    1. Jafri M.R., Zaheer A., Fatima S., Saleem T., Sohail A. Mental Health Status of COVID-19 Survivors: A Cross Sectional Study. Virol. J. 2022;19:3. doi: 10.1186/s12985-021-01729-3.
    1. Kyzar E.J., Purpura L.J., Shah J., Cantos A., Nordvig A.S., Yin M.T. Anxiety, Depression, Insomnia, and Trauma-Related Symptoms following COVID-19 Infection at Long-Term Follow-Up. Brain Behav. Immun. Health. 2021;16:100315. doi: 10.1016/j.bbih.2021.100315.
    1. Mazza M.G., De Lorenzo R., Conte C., Poletti S., Vai B., Bollettini I., Melloni E.M.T., Furlan R., Ciceri F., Rovere-Querini P., et al. 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.
    1. Liu N., Zhang F., Wei C., Jia Y., Shang Z., Sun L., Wu L., Sun Z., Zhou Y., Wang Y., et al. Prevalence and Predictors of PTSS during COVID-19 Outbreak in China Hardest-Hit Areas: Gender Differences Matter. Psychiatry Res. 2020;287:112921. doi: 10.1016/j.psychres.2020.112921.
    1. Halpin S.J., McIvor C., Whyatt G., Adams A., Harvey O., McLean L., Walshaw C., Kemp S., Corrado J., Singh R., et al. Postdischarge Symptoms and Rehabilitation Needs in Survivors of COVID-19 Infection: A Cross-Sectional Evaluation. J. Med. Virol. 2021;93:1013–1022. doi: 10.1002/jmv.26368.
    1. Townsend L., Dyer A.H., Jones K., Dunne J., Mooney A., Gaffney F., O’Connor L., Leavy D., O’Brien K., Dowds J., et al. Persistent Fatigue following SARS-CoV-2 Infection Is Common and Independent of Severity of Initial Infection. PLoS ONE. 2020;15:e0240784. doi: 10.1371/journal.pone.0240784.
    1. Tomasoni D., Bai F., Castoldi R., Barbanotti D., Falcinella C., Mulè G., Mondatore D., Tavelli A., Vegni E., Marchetti G., et al. Anxiety and Depression Symptoms after Virological Clearance of COVID-19: A Cross-Sectional Study in Milan, Italy. J. Med. Virol. 2021;93:1175–1179. doi: 10.1002/jmv.26459.
    1. Daher A., Balfanz P., Cornelissen C., Müller A., Bergs I., Marx N., Müller-Wieland D., Hartmann B., Dreher M., Müller T. Follow up of Patients with Severe Coronavirus Disease 2019 (COVID-19): Pulmonary and Extrapulmonary Disease Sequelae. Respir. Med. 2020;174:106197. doi: 10.1016/j.rmed.2020.106197.
    1. ATS Statement: Guidelines for the Six-Minute Walk Test. Am. J. Respir. Crit. Care Med. 2002;166:111–117. doi: 10.1164/ajrccm.166.1.at1102.
    1. Kilpatrick D.G., Resnick H.S., Friedman M.J. Severity of Posttraumatic Stress Symptoms—Adult (National Stressful Events Survey PTSD Short Scale [NSESSS]) American Psychiatric Association; Washington, DC, USA: 2013.
    1. LeBeau R., Mischel E., Resnick H., Kilpatrick D., Friedman M., Craske M. Dimensional Assessment of Posttraumatic Stress Disorder in DSM-5. Psychiatry Res. 2014;218:143–147. doi: 10.1016/j.psychres.2014.03.032.
    1. Spitzer R.L., Kroenke K., Williams J.B. Validation and Utility of a Self-Report Version of PRIME-MD: The PHQ Primary Care Study. Primary Care Evaluation of Mental Disorders. Patient Health Questionnaire. JAMA. 1999;282:1737–1744. doi: 10.1001/jama.282.18.1737.
    1. Kroenke K., Spitzer R.L., Williams J.B.W., Löwe B. The Patient Health Questionnaire Somatic, Anxiety, and Depressive Symptom Scales: A Systematic Review. Gen. Hosp. Psychiatry. 2010;32:345–359. doi: 10.1016/j.genhosppsych.2010.03.006.
    1. Spitzer R.L., Kroenke K., Williams J.B.W., Löwe B. A Brief Measure for Assessing Generalized Anxiety Disorder: The GAD-7. Arch. Intern. Med. 2006;166:1092–1097. doi: 10.1001/archinte.166.10.1092.
    1. Plutchik R. The Multifactor-Analytic Theory of Emotion. J. Psychol. 1960;50:153–171. doi: 10.1080/00223980.1960.9916432.
    1. Plutchik R. The Nature of Emotions: Human Emotions Have Deep Evolutionary Roots, a Fact That May Explain Their Complexity and Provide Tools for Clinical Practice. Am. Sci. 2001;89:344–350. doi: 10.1511/2001.28.344.
    1. Semeraro A., Vilella S., Ruffo G. PyPlutchik: Visualising and Comparing Emotion-Annotated Corpora. PLoS ONE. 2021;16:e0256503. doi: 10.1371/journal.pone.0256503.
    1. Löwe B., Decker O., Müller S., Brähler E., Schellberg D., Herzog W., Herzberg P.Y. Validation and Standardization of the Generalized Anxiety Disorder Screener (GAD-7) in the General Population. Med. Care. 2008;46:266–274. doi: 10.1097/MLR.0b013e318160d093.
    1. Kocalevent R.-D., Hinz A., Brähler E. Standardization of the Depression Screener Patient Health Questionnaire (PHQ-9) in the General Population. Gen. Hosp. Psychiatry. 2013;35:551–555. doi: 10.1016/j.genhosppsych.2013.04.006.
    1. Gasmi A., Peana M., Pivina L., Srinath S., Gasmi Benahmed A., Semenova Y., Menzel A., Dadar M., Bjørklund G. Interrelations between COVID-19 and Other Disorders. Clin. Immunol. 2021;224:108651. doi: 10.1016/j.clim.2020.108651.
    1. Boriani G., Palmisano P., Guerra F., Bertini M., Zanotto G., Lavalle C., Notarstefano P., Accogli M., Bisignani G., Forleo G.B., et al. Impact of COVID-19 pandemic on the clinical activities related to arrhythmias and electrophysiology in Italy: Results of a survey promoted by AIAC (Italian Association of Arrhythmology and Cardiac Pacing) Intern. Emerg. Med. 2020;15:1445–1456. doi: 10.1007/s11739-020-02487-w.
    1. Ferraris M., Maffoni M., De Marzo V., Pierobon A., Sommaruga M., Barbara C., Porcile A., Russo C., Ghio L., Clavario P., et al. Post-Traumatic Stress Disorder, Depression and Anxiety Symptoms in COVID-19 Outpatients with Different Levels of Respiratory and Ventilatory Support in the Acute Phase Undergoing Three Months Follow Up. Minerva Med. 2022;114:169–177. doi: 10.23736/S0026-4806.22.07847-8.
    1. Renaud-Charest O., Lui L.M.W., Eskander S., Ceban F., Ho R., Di Vincenzo J.D., Rosenblat J.D., Lee Y., Subramaniapillai M., McIntyre R.S. Onset and Frequency of Depression in Post-COVID-19 Syndrome: A Systematic Review. J. Psychiatr. Res. 2021;144:129–137. doi: 10.1016/j.jpsychires.2021.09.054.
    1. Cai X., Hu X., Ekumi I.O., Wang J., An Y., Li Z., Yuan B. Psychological Distress and Its Correlates Among COVID-19 Survivors During Early Convalescence Across Age Groups. Am. J. Geriatr. Psychiatry. 2020;28:1030–1039. doi: 10.1016/j.jagp.2020.07.003.
    1. Wang T., Du Z., Zhu F., Cao Z., An Y., Gao Y., Jiang B. Comorbidities and Multi-Organ Injuries in the Treatment of COVID-19. Lancet. 2020;395:e52. doi: 10.1016/S0140-6736(20)30558-4.
    1. Vlake J.H., Wesselius S., van Genderen M.E., van Bommel J., Boxma-de Klerk B., Wils E.-J. Psychological Distress and Health-Related Quality of Life in Patients after Hospitalization during the COVID-19 Pandemic: A Single-Center, Observational Study. PLoS ONE. 2021;16:e0255774. doi: 10.1371/journal.pone.0255774.
    1. Brunoni A.R., Suen P.J.C., Bacchi P.S., Razza L.B., Klein I., Santos L.A.D., de Souza Santos I., da Costa Lane Valiengo L., Gallucci-Neto J., Moreno M.L. Prevalence and risk factors of psychiatric symptoms and diagnoses before and during the COVID-19 pandemic: Findings from the ELSA-Brasil COVID-19 mental health cohort. Psychol. Med. 2023;53:446–457. doi: 10.1017/S0033291721001719.
    1. Choflet A., Packard T., Stashower K. Rethinking Organizational Change in the COVID-19 Era. J. Hosp. Manag. Health Policy. 2021;5:16. doi: 10.21037/jhmhp-21-11.
    1. Ksinan Jiskrova G. Impact of COVID-19 Pandemic on the Workforce: From Psychological Distress to the Great Resignation. J. Epidemiol. Community Health. 2022;76:525–526. doi: 10.1136/jech-2022-218826.
    1. Maffoni M., Zanatta F., Setti I., Giorgi I., Velutti L., Giardini A. SMiLE to Life: Meaning in Life in Healthcare Professionals Working in Palliative Care and Rehabilitation Medicine: SMiLE to Life: Meaning in Life in Healthcare Professionals. Med. Lavoro. 2021;112:387.
    1. Granata N., Torlaschi V., Zanatta F., Giardini A., Maestri R., Pavesi C., Sommaruga M., Gazzi L., Bertolotti G., Sarzi Braga S., et al. Positive Affect as a Predictor of Non-Pharmacological Adherence in Older Chronic Heart Failure (CHF) Patients Undergoing Cardiac Rehabilitation. Psychol. Health Med. 2022;28:606–620. doi: 10.1080/13548506.2022.2077394.
    1. Kazanas S.A., Altarriba J. Did Our Ancestors Fear the Unknown? The Role of Predation in the Survival Advantage. Evol. Behav. Sci. 2017;11:83–91. doi: 10.1037/ebs0000074.
    1. Ornell F., Schuch J.B., Sordi A.O., Kessler F.H.P. “Pandemic Fear” and COVID-19: Mental Health Burden and Strategies. Rev. Bras. Psiquiatr. 2020;42:232–235. doi: 10.1590/1516-4446-2020-0008.
    1. Gunlu A., Koç H., Asici E., Oral T. Positivity and Post-Traumatic Stress Disorder (PTSD) in COVID-19 Survivors: Mediating Role of Rumination and Fear of COVID-19. Psychiatr. Danub. 2022;34:578–586. doi: 10.24869/psyd.2022.578.
    1. Yang Q., Young I.F., Wan J., Sullivan D. Culturally Grounded Scapegoating in Response to Illness and the COVID-19 Pandemic. Front. Psychol. 2021;12:632641. doi: 10.3389/fpsyg.2021.632641.
    1. Porumbescu G., Moynihan D., Anastasopoulos J., Olsen A.L. When Blame Avoidance Backfires: Responses to Performance Framing and Outgroup Scapegoating during the COVID-19 Pandemic. Governance. 2022;36:776–803. doi: 10.1111/gove.12701.

Source: PubMed

Sponsors et collaborateurs

Les conditions médicales

Interventions en matière de drogue

3
S'abonner