Anxiety and depression symptoms among patients with long COVID: a retrospective cohort study

Michael C Sauer; Patrick B Barlow; Alejandro P Comellas; Alpana Garg

doi:10.1007/s00406-023-01740-5

Anxiety and depression symptoms among patients with long COVID: a retrospective cohort study

Eur Arch Psychiatry Clin Neurosci. 2024 Jan 17. doi: 10.1007/s00406-023-01740-5. Online ahead of print.

Authors

Michael C Sauer¹, Patrick B Barlow^{2

3}, Alejandro P Comellas^{3

4}, Alpana Garg²

Affiliations

¹ Department of Internal Medicine, University of Iowa Division of General Internal Medicine, University of Iowa, 200 Hawkins Drive, Iowa City, IA, 52242, USA. mcsr@uiowa.edu.
² Department of Internal Medicine, University of Iowa Division of General Internal Medicine, University of Iowa, 200 Hawkins Drive, Iowa City, IA, 52242, USA.
³ Institute for Clinical and Translational Science, University of Iowa, Iowa City, IA, USA.
⁴ Division of Pulmonary and Critical Care, Department of Internal Medicine, University of Iowa, Iowa City, IA, USA.

PMID: 38231397
DOI: 10.1007/s00406-023-01740-5

Abstract

Patients suffering from post-acute sequelae of COVID-19 (PASC) have a higher prevalence of anxiety and depression than the general population. The long-term trajectory of these sequelae is still unfolding. To assess the burden of anxiety and depression among patients presenting to the University of Iowa Hospitals and Clinics (UIHC) post-COVID-19 clinic, we analyzed how patient factors influenced Generalized Anxiety Disorder-7 (GAD-7) and Patient Health Questionnaire-9 (PHQ-9) scores. In this retrospective cohort study, the GAD-7 and PHQ-9 questionnaire scores of patients presenting to the UIHC post-COVID clinic between March 2021-February 2022 (N = 455) were compared to the scores of a sample of patients presenting to the general internal medicine (GIM) clinic during the same period (N = 94). Our analysis showed that patients with an absent history of depression on their electronic medical record (EMR) problem list scored significantly higher on the GAD-7 (mean difference -1.62, 95% CI -3.12 to -0.12, p = 0.034) and PHQ-9 (mean difference -4.45, 95% CI -5.53 to -3.37, p < 0.001) questionnaires compared to their similar counterparts in the GIM clinic. On the other hand, patients with an absent history of anxiety on their EMR problem list scored significantly higher on the GAD-7 (mean difference -2.90, 95% CI -4.0 to -1.80, p < 0.001) but not on the PHQ-9 questionnaire (p = 0.196). Overall, patients with PASC may have experienced a heavier burden of newly manifest anxiety and depression symptoms compared to patients seen in the GIM clinic. This suggests that the mental health impacts of PASC may be more pronounced in patients with no prior history of anxiety or depression.

Keywords: Anxiety; Brain fog; COVID-19; Depression; Fatigue; Generalized anxiety disorder-7 (GAD-7); Long-COVID; Mental health; Patient Health Questionnaire-9 (PHQ-9); Post-acute COVID-19 syndrome (PACS); Post-acute sequelae of COVID-19 (PASC).