PREVALENCE OF ANXIETY AND DEPRESSION AMONG COVID-19 PATIENTS: SYSTEMATIC REVIEW AND META-ANALYSIS Текст научной статьи по специальности «Клиническая медицина»

MEDICAL SCIENCES

РАСПРОСТРАНЕННОСТЬ ТРЕВОГИ И ДЕПРЕССИИ СРЕДИ БОЛЬНЫХ COVID-19: СИСТЕМАТИЧЕСКИЙ ОБЗОР И МЕТААНАЛИЗ

Туйчиев Ш. Т.

Ташкентский Педиатрический Медицинский институт, Ташкент, Узбекистан, Ассистент Абдуллаева В.К.

Ташкентский Педиатрический Медицинский институт, Ташкент, Узбекистан, д.м.н., Доцент Матвеева А.А.

Ташкентский Педиатрический Медицинский институт, Ташкент, Узбекистан, Ассистент

PREVALENCE OF ANXIETY AND DEPRESSION AMONG COVID-19 PATIENTS: SYSTEMATIC

REVIEW AND META-ANALYSIS.

Tuychiev Sh.

Tashkent Pediatric Medical Institute, Tashkent, Uzbekistan,

Assistant of professor Abdullaeva V.

Tashkent Pediatric Medical Institute, Tashkent, Uzbekistan,

DSc, Docent Matveeva A.

Tashkent Pediatric Medical Institute, Tashkent, Uzbekistan,

Assistant of professor

АННОТАЦИЯ

В декабре 2019 года инфекционное заболевание коронавируса распространилось в Ухане, Китай, и быстро распространилось по всему миру. Всемирная организация здравоохранения (ВОЗ) объявила коро-новирусную инфекцию (COVID-19) чрезвычайной ситуацией в области общественного здравоохранения, имеющей международное значение. Более того, 11 марта 2020 г. ВОЗ объявила вспышку COVID-19 «пандемией» (Harapan, et al., 2020) (Burki, 2020).

Депрессия может ухудшить прогноз многих заболеваний, в том числе COVID-19. Психологический дистресс и депрессия могут оказывать негативное влияние на реакцию иммунной системы пациентов (Leonard, 2001). Пациенты с депрессией также могут иметь негативное отношение к противовирусной терапии, что может снизить их приверженность лечению и выздоровление. Предыдущие исследования показали, что пациенты могут испытывать стойкую депрессию даже после вспышки инфекционного заболевания. Например, распространенность депрессии среди пациентов с атипичной пневмонией составила 18% через 1 месяц после их выписки (Wu et al., 2005) и 15,6% через 30 месяцев после вспышки атипичной пневмонии (Mak et al., 2009).

На сегодняшний день было проведено несколько исследований распространенности тревоги и депрессии среди перенесших COVID-19. Поэтому мы решили изучить распространенность депрессии и тревоги среди перенесших COVID-19.

Систематический обзор и метаанализ были проведены в двух базах данных (PubMed и Web of Science) для изучения распространенности депрессии и тревоги среди перенесших COVID-19.

В результате изучения, среди перенесших COVID-19 распространенность тревоги составила 34,66% (95% ДИ: 25,19; 44,78), распространенность депрессии — 30,11% (95% ДИ: 21,65; 39,30).

ABSTRACT

In December 2019, an infectious disease of a coronavirus spread in Wuhan, China, and swiftly spread globally. The Coronavirus disease (COVID-19) was declared by the World Health Organization (WHO) as a public health emergency of international concern. Moreover, the WHO announced the COVID-19 outbreak as a "pandemic" on 11 March 2020. (Harapan, et al. 2020) (Burki 2020)

Depression could worsen the prognosis of many diseases, as well as COVID-19. Psychological distress and depression may have a negative impact on patients' immune system response (Leonard, 2001). Patients with depression may also have negative attitudes towards antiviral therapy, which may reduce their treatment adherence and recovery. Previous studies found that patients could experience persistent depression even after the outbreak of infectious diseases. For instance, the prevalence of depression among patients with SARS were 18% at 1 month after their discharge (Wu et al., 2005), and 15.6% at 30-month assessment after SARS outbreak (Mak et al., 2009).

To date there have been some studies on prevalence of anxiety and depression among COVID-19 survivors. Therefore, we set out to examine the prevalence of depression and anxiety among COVID-19 survivors.

Systematic review and meta-analysis were done in two databases (PubMed and Web of Science) to examine prevalence of depression and anxiety among COVID-18 survivors.

In summary, among COVID-19 survivors the prevalence of anxiety was 34.66% (95% CI: 25.19; 44.78), the prevalence of depression was 30.11% (95% CI: 21.65; 39.30).

Ключевые слова: SARS-CoV-2, COVID-19, тревога, депрессия, распространенность. Keywords: SARS-CoV-2, COVID-19, anxiety, depression, prevalence.

Introduction. In December 2019, an infectious disease of a coronavirus spread in Wuhan, China, and swiftly spread globally. The Coronavirus disease (COVID-19) was declared by the World Health Organization (WHO) as a public health emergency of international concern. Moreover, the WHO announced the COVID-19 outbreak as a "pandemic" on 11 March 2020. (Harapan, et al. 2020) (Burki 2020)

As with the two other coronaviruses that caused major outbreaks in humans in recent years (namely, severe acute respiratory syndrome and the Middle Eastern Respiratory Syndrome) (WHO. 2020) (Yin Y. 2018), COVID-19 is transmitted from human-to-human through inhalation of respiratory droplets from each symptomatic and a-symptomatic infectious people. (Bai Y. 2020).

Patients infected with COVID-19 experienced physical discomfort, fear of developing complications, and discrimination by the mass media (e.g., WeChat and Weibo) (Lu et al., 2020; Shigemura et al., 2020). These negative feelings could lead to elevated risk of psychiatric problems, particularly, depressive symptoms (depression hereafter) (Bondade et al., 2019; Ren et al., 2019; Xiang et al., 2020). Moreover, isolation in designated hospital for COVID-19 for treatment, the loneliness during treatment could trigger depression as well (Li et al., 2020).

Depression could worsen the prognosis of many diseases, as well as COVID-19. Psychological distress and depression may have a negative impact on patients' immune system response (Leonard, 2001). Patients with depression may also have negative attitudes towards antiviral therapy, which may reduce their treatment adherence and recovery. Previous studies found that patients could experience persistent depression even after the outbreak of infectious diseases. For instance, the prevalence of depression among patients with SARS were 18% at 1 month after their discharge (Wu et al., 2005), and 15.6% at 30-month assessment after SARS outbreak (Mak et al., 2009).

To date there have been some studies on prevalence of anxiety and depression among COVID-19 survivors. Therefore, we set out to examine the prevalence of depression and anxiety among COVID-19 survivors.

Aim of the study: Identify prevalence of the anxiety and depression among COVID-19 infection patients.

Materials and methods

Data source and study selection

Database searches were done by manual search in PubMed and Web of Science. Studies reporting prevalence of anxiety and / or depression among COVID-19 infection patients published from 2019 were included. Studies reporting prevalence among whole population, healthcare workers, among students, meta-analysis, case studies, case reports were excluded. A complete list of the search queries is shown in Supplementary Table. The last search was conducted on June 4th, 2021, and records on English or Russian were eligible. Search results were downloaded as .csv file. After removing duplicates using Endnote records were screened based on their title and abstracts. Screening were done by two authors independently (T.Sh.T and M.A.A.) and conflicts were resolved by third author (A.V.K.)

Data extraction

A pre-piloted standardized electronic data extraction form was used to extract relevant data: authors names, year of publication, study setting, study design, study period, characteristics of study subjects (age, sex, location), sample size. In this paper, a "report" refers to any document mentioning prevalence of anxiety and/or depression among COVID-19 patient's data,

Data analysis

A meta-analysis of proportion was performed using the 'meta' and 'metafor' packages in the statistical program R. Data were transformed using the Freeman-Tukey double arcsine method to account for small proportions. The Dersimonian and Laird method, based on the random-effects model, was used to perform the meta-analysis, and summarize data in a forest plot. Confidence-interval (CI) for individual studies proportions were calculated using the Clopper-Pearson method.

Ethical approval

This research does not require ethical approval.

Results

Search results

A total of 955 records were identified from the PubMed and 1347 records were identified from Web of Science databases. After duplicates exclusion and titles and abstracts screening, 41 reports were selected for full-text review. Of these, 20 met the inclusion criteria. The selection process is summarized in Figure 1. Search strategy summarized in Table 1.

Figure 1. Flow diagram of systematic review and meta-analysis.

Table 1.

Search strategy of systematic review

# Database Search strategy Number of articles

1 Web of science ((ALL=(Prevalence)) AND (ALL=(COVID -19) OR ALL=(SARS-CoV-2))) AND (ALL=(Anxiety) OR ALL=(Depression)) 1347

2 PubMed ("covid 19"[All Fields] OR "covid 19"[MeSH Terms] OR "sars cov 2"[All Fields] OR "sars cov 2"[MeSH Terms] OR "severe acute respiratory syndrome coronavirus 2"[All Fields]) AND ("depression"[All Fields] OR "anxiety" [All Fields] OR "depression"[MeSH Terms] OR "anxi-ety"[MeSH Terms]) AND ("prevalence"[All Fields] OR "prevalence"[MeSH Terms]) 995

Study characteristics

The details about the characteristics of each study are reported in Table 2. Studies were conducted between 2019 and 2021. Total 1837 COVID-19 infection

patients reported anxiety in 19/20 records and 1837 patients reported depression in 18/20 records involved in review. 6/20 articles published in 2020, 14/20 articles published in 2021.

Study Events Total

Ma YF etal. 2020 332 770

Tomasoni □ etal. 2021 12 105 ~B

NieXD etal, 2021 28 78

Dai LLetal. 2020 41 307

Jeong SJ etal. 2020 37 234 -

LiTetal. 2021 72 183

BeckKetal, 2021 10 126

Wang Metal. 2021 246 460

Chen Yetal, 2021 189 898

HuQetal. 2021 323 867

Li L et al. 2021 216 782

KongXetal. 2020 41 144

Khademi M etal. 2021 30 602

Peluso MJ etal, 2021 64 179

ZandifarAetal. 2020 103 106

LiXetal. 2020 29 99

ParkerGetal, 2021 17 58

MendezR etal. 2021 48 179

Random effects model 6177

Heterogeneity: I = r = 0.0413, p < 0.01

Events per 100 observations

r

20

40

60

SO

Events

43.12 11.43 35.90 13.36 15.31 39.34 7.94 53.43 21.05 37.25 27.62 28.47 4.93 35.75 97.17 29.29 29.31 26.82

95%-CI Weight

[39.59; 46.70]

[6.05 [25.34 [9.76 [11.38 [32.22 [3.87 [48.SO [18.42 [34.03 [24.51 [21.27

19.11!

47.56] 17.68] 21.13] 46.82] 14.11] 58.11" 23.86]

40.57] 30.90]

36.58]

^ 3.39; 7.04]

[28.74 [91.95 [20.57 [18.09

43.25] 99.41" 39.29] 42.73]

[20.48; 33.94]

5.7% 5.4% 5.3% 5.6% 5.6% 5.6% 5.5% 5.7% 5.7% 5.7% 5.7% 5.5% 5.7% 5.6% 5.4% 5.4% 5.2% 5.6%

30.11 [21,65; 39.30] 100.0%

Figure 2 Prevalence of anxiety among COVID-19 survivors

Among region 9/20 records reported China, 3/20 records in USA, Iran 2/20 records and Italy, England, South Korea, Switzerland, France, Spain 1/20 records each. Diagnostic strategy was used Hamilton anxiety and depression scale (HADS) 6 records, different versions of Patient's health questionary -7 (PHQ), General Anxiety Disorder - 5 (GAD), Zung self-rating anxiety scale and Zung self-rating depression scale - 3, Symptom checklist 90 - 1, Depression, Anxiety and Stress

Scale - 1, Perceived Stress Scale - 1, phone call - 1. Some studies used different diagnostic strategy for anxiety and depression. Thus, total number of questionar-ies more than number of records.

The prevalence of anxiety among COVID-19 patients was from 5.80% (among both hospitalized and non-hospitalized patients) to 100% (among hospitalized patients with ICU). The pooled prevalence of anxiety was 34.66% (95% CI: 25.19; 44.78). (Fig.2)

Study Events Total

Tomasoni □ etal, 2021 30 105

NieXD etal. 2021 30 78

Dai LLetal. 2020 57 307

Jeong SJ etal. 2020 24 234

Li J etal, 2021 173 296

LiTetal, 2021 103 183

BeckKetal. 2021 22 126

Wang Metal. 2021 213 460

ChenYetal, 2021 147 898

HuQetal. 2021 330 867

Li L etal, 2021 247 782

KongXetal, 2020 50 144

Khademi M et al, 2021 35 602

PelusoMJ etal. 2021 100 179

ZandllfarA et al. 2020 106 106

LiXetal, 2020 15 99

ParkerCetal, 2021 21 58

etal. 2021 81 311

MendezR etal. 2021 53 179

Random effects model 6014

Heterogeneity:,' = r = 0.0510, p<(JD1 '

Events per 100 observations

T

20 40

~T

60

T

Events

28.57 38.46 18.57 10.26

58.45 56.23

17.46 46.30 16.37 38.06 31.59 34.72

5.81 55.87 100.00 15.15 36.21 26.05 29.61

95%-CI Weight

[20.18 [27.66 [14.38 [6.68 [52.60 [48.77 [11.28 [41.68 [14.01 [34.82 [28.34 [26.99; [4.08;

38.21] 50.17]

23.38] 14.88] 64.12] 63.59] 2523] 50.98] 18.95]

41.39] 34.97]

43.10;

7.99]

[48.27; 63.27] [96.58; 100.00; [8.74; 23.76] [23.99: 49.88] [21.26; 31.30] [23.03; 36.88]

5.2% 5.1% 5.3% 5.3% 5.3% 5.3% 5.2% 5.4% 5.4% 5.4% 5.4% 5.2% 5.4% 5.3% 5.2% 5.2% 5.0% 5.3% 5.3%

1

34.66 [25.19; 44.7Ä] 100.0%

80 100

Figure 3 Prevalence of depression among COVID-19 survivors

The prevalence of depression among COVID-19 patients was from 7.90% (among both hospitalized and non-hospitalized patients) to 97.2% (among hospitalized patients with ICU). The pooled prevalence of depression was 30.11% (95% CI: 21.65; 39.30). (Fig.3)

Summary

In summary, among COVID-19 survivors the prevalence of anxiety was 34.66% (95% CI: 25.19; 44.78), the prevalence of depression was 30.11% (95% CI: 21.65; 39.30). These numbers are higher in relation to the general population. More research is needed on the effect of depression and anxiety among COVID-19 survivors.

Supplementary table. Characteristics of eligible studies for systematic review and meta-analyses

© z Title First author, year Country Study year Study design Subject Total number of patients Diagnostic strategy Prevalence of anxiety % Number of patients with anxiety Prevalence of depression % Number of patients with depression

1 Prevalence of depression and its association with quality of life in clinically stable patients with COVID-19. Ma YF et al, 2020 China 2021.02-2021.03 Cross-sectional Patients in isolation hospitals 0 r- 7 PHQ-9 43.10% 2 m 3

2 Anxiety and depression symptoms after viro-logical clearance of COVID-19: A cross-sectional study in Milan, Italy. Tomasoni D et al, 2021 Î 2020.04-2020.06 Cross-sectional Clinical recovery and virological clearance Hospitalized patients d5 © HADS 29.00% © m 11.00% <N

3 Anxiety and depression and its correlates in patients with coro-navirus disease 2019 in Wuhan. Nie XD et al, 2021 England Cross-sectional 00 r- Zung SDS 38.50% © m 35.90% OO <N

4 Anxiety and depressive symptoms among COVID-19 patients in Jianghan Fang-cang Shelter Hospital in Wuhan, China. Dai LL et al, 2020 China Feb. March 2020 Cross-sectional Recovered patients 7 © 3 Self rating anxiety & Self rating depression scale 18.60% f- 13.40%

5 Clinical characteristics and online mental health care of asymptomatic or mildly symptomatic patients with coronavirus disease 2019. Jeong SJ et al, 2020 South Korea 15.03-10.04.2020 Cross-sectional Asymptomatic and mild symptomatic patients 4 m 2 HADS 10.30% <N 15.80% t'en

The psychologi- c 0 9

cal symptoms of 1 0 2 al atic tis

patients with 20 2 China 0 2 n io S to M c ÏN

6 mild symptoms of coronavirus disease (2019) in China: A cross- 13 u 1—1 J h ë S 1 m tc <D s - s s sor rC t s Mil 6 OS 2 £ o s to f 0 OO 5 3 r-

sectional study. S

Prevalence and Zung SAS, SDS

7 Risk Factors for Anxiety and Depression in Patients With COVID-19 in Wuhan, China. Li T et al, 2021 United States Jan.-Feb 2020 Cross-sectiona Patients with COVID-19 3 00 56.30% 3 o 39.30% <N f-

Prevalence and

factors associ-

8 ated with psychological burden in COVID-19 patients and their relatives: A prospective observational cohort study. Beck K et al, 2021 Switzerland March-June 2020 Cohort Adult patients 6 <N HADS 17.50% <N <N 7.90% O

Acute psycho- 12

9 logical impact on COVID-19 patients in Hu-bei: a multicenter observational 0 2 al tu s m a & China 2 Feb-5 March 2020 aln io 0 tc CJ 0s - s s sor rC patients 0 VO PHQ 9 PHQ 15 GAD 7 46.30% 3 <N 53.48% 6 2

study.

Prevalence and

predictors of 0 2 s tn

posttraumatic stress disorder, Chen Y et al, 202 China 0 2 sa aln io e atie p PHQ 9 GAD 7

10 depression and anxiety among hospitalized patients with coro-navirus disease 2019 in China. s 2 - r -rMa 2 2 tc CJ M - s s sor rC 'cp s soh r te teAf 8 OS 8 0 6. 7 % 0 O 12 9 OO

11 Mental Health Outcomes Among Civil Servants Aiding in Coronavirus Disease 2019 Control. Hu Q et al, 2021 China 9-11 April 2020 Cross-sectional Chinese civil servants 7 8 PHQ 9 GAD 7 38.06% 0 m 3 37.25% 3 <N 3

A Follow-Up In-

vestigation of Mental Health 12 0 2 China 3-10 Apr 2020 aln io PHQ 9 GAD 8

12 Among Discharged COVID-19 Patients in Wuhan, China. et L tc CJ s - s s sor rC 2 OO 7 % 9 3 7 2 % 2 .7 2 o <N

vo 00 On

Prevalence and characteristics of persistent symptoms after non-severe COVID-19: a prospective cohort study. Depression, Anxiety, and Acute Stress Disorder Among Patients Hospitalized With COVID-19: A Prospective Cohort Study. The Associated Factors of Anxiety and Depressive Symptoms in COVID-19 Patients Hospitalized in Wuhan, China. Prevalence and severity of depression, anxiety, stress and perceived stress in hospitalized patients with COVID-19. Rapid implementation of a cohort for the study of post-acute sequelae of SARS-CoV-2 infec- tion/COVID-19. Prevalence of Mental Health Problems and Its Associated Factors Among Recovered COVID-19 Patients During the Pandemic: A Single-Center Study. Effect of Psy-chological-Be-havioral Intervention on the Depression and Anxiety of COVID-19 Patients.

et al, 2021 Parker C et al, 2021 Li X et al, 2020 Zandifar A et al, 2020 Peluso MJ et al, 2021 Khademi M et al, 2021 Kong X et al, 2020

France USA China Iran USA Iran China

3 Mar.-23 June 7070 24 Apr. -1 June 2020 18 Mar -18 Apr 2020 Apr. 2020 21 Apr-31 Dec 2020 20 Apr-20 June 2020 23 Feb-13 Mar.2020

Cross-sectional Cohort Cross-sectional Cross-sectional Cohort Cross-sectional Cross-sectional

Non severe patients ICU patients after 2 weeks Hospitalized patients Hospitalized patients Patients after more than 2 weeks Hospitalized and non hospitalized patients

311 58 99 106 179 602 144

HADS HADS DASS 21 PSS 4 GAD 7 PHQ 8 PHQ 4 PTSD checklist HADS

26.20% 36.00% 15.20% 100.00% 56.00% 5.80% 34.72%

81 21 15 106 100 35 50

29.00% 29.30% 97.20% 36.00% 5.00% 28.47%

17 29 103 64 30 41

Short-term neu-ropsychiatric <D r iP 1 io - ap

20 outcomes and quality of life in iez R 2021 Spain ar-25 2020 o CJ 0s - s e iz 1 tients OS r- c ä o 5 ON m «1 0 00 OO

COVID-19 sur- n e S s or ip s ¿H PH 2 2

vivors. S OO o o X

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STUDY OF THE NOSOLOGICAL AND SYNDROMOLOGICAL STRUCTURE OF MENTAL PATHOLOGY IN PERSONS WHO HAVE COMMITTED SOCIALLY DANGEROUS ACTS

Abdullaeva V., Parpiev Sh.

Tashkent Pediatric Medical Institute

ABSTRACT

This article presents the results of a study of the nosological and syndromogical representation of mental pathology in persons who have committed socially dangerous acts, studied gender characteristics, socio-psycho-logical characteristics of patients, tendencies to relapse of illegal violations.

Keywords: mental disorder, social dangerous actions of persons with mental disorders.

Introduction. The relevance of the problem were widely publicized, the participants of which were persons under the supervision of a psychiatrist [1]. The degree of public danger of this category of citizens, in comparison with the general population indicators, is heterogeneous in the understanding of various special-

ists, which is associated primarily with the polymorphism of mental pathology [5,7]. An analysis of scientific research indicates a greater prevalence of illegal behavior among the mentally ill, compared with general population indicators, which is confirmed by their greater representation among offenders in prisons [3].