Three-Month Follow-Up of the Post-COVID Syndrome after Admission to a Specialised Post-COVID Centre—A Prospective Study Focusing on Mental Health with Patient Reported Outcome Measures (PROMs) †
Abstract
:1. Introduction
1.1. Post-COVID Syndrome
1.2. Mental Health Impairments in PASC
1.3. Research Objectives
2. Material and Methods
2.1. Participants and Data Collection
2.2. Measures/Variables
2.2.1. Sociodemographic and Health-Related Data
2.2.2. PASC Symptoms
2.2.3. Mental Health Symptoms
Generalized Anxiety Disorder-7 (GAD-7)
Patient Health Questionnaire-9 (PHQ-9)
Patient Health Questionnaire-15 (PHQ-15)
The Fatigue Severity Scale (FSS)
DePaul Post-Exertional Malaise (PEM) Screening
Psychotherapeutic Treatment
Cardiological Data
Other Data
2.3. Data Analysis
2.4. Missings
3. Results
3.1. Sociodemographic and Health-Related Data
3.2. Post-COVID-Related and Cardiac Variables
3.3. Mental Health
3.3.1. Severity of Symptoms and Development at Follow-Up (T1)
3.3.2. Frequency of Symptoms
3.4. Utilization of Psychotherapeutic Treatment
3.5. Mixed Model Analysis
4. Discussion
4.1. Sociodemographic and Health-Related Variables
4.2. Post-COVID-Related Variables and Post-COVID Syndrome Score
4.3. Mental Health
4.3.1. Depression, Anxiety, Persisting Somatic Symptoms
4.3.2. Fatigue and Post-Exertional Malaise
4.3.3. Persistence of Symptoms
4.4. Risk and Protective Factors
4.4.1. Sociodemographic Data and Time
4.4.2. Psychotherapeutic Utilization before PASC
4.5. Strengths and Limitations
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Variables | Sample at Baseline (T0) (n = 265) |
---|---|
Sex, n (%) | |
Women | 187 (70.6) |
Men | 75 (28.3) |
Missing | 3 (1.1) |
Age, years | |
M (SD) | 45.5 (12.1) |
Range | 19–79 |
Marital status, n (%) | |
Single without partnership | 46 (17.4) |
Single with partnership | 43 (16.2) |
Married | 157 (59.2) |
In separation | 2 (0.8) |
Widowed | 2 (0.8) |
Divorced | 12 (4.5) |
Missing | 3 (1.1) |
Children, n (%) | |
Yes | 161 (60.8) |
No | 101 (38.1) |
Missing | 3 (1.1) |
Education level, n (%) | |
Without certificate | 1 (0.4) |
Lower secondary school certificate | 44 (16.6) |
Secondary school certificate | 86 (32.5) |
High school certificate | 128 (48.3) |
Other | 3 (1.2) |
Missing | 3 (1.1) |
Professional qualification, n (%) | |
None | 13 (4.9) |
Master school | 54 (20.4) |
Apprenticeship certificate | 97 (36.6) |
University degree | 97 (36.6) |
Missing | 4 (1.5) |
Employment status, n (%) | |
Full-time employed | 88 (33.2) |
Part-time employed | 74 (27.9) |
Unemployed | 14 (5.3) |
Retired/pensioned | 18 (6.8) |
Sick leave/incapacitated for work | 40 (15.0) |
Other | 27 (10.3) |
Missing | 4 (1.5) |
Smoking, n (%) | |
Yes | 19 (7.2) |
No | 238 (89.8) |
Missing | 8 (3.0) |
BMI, kg/m2 | |
M (SD) | 26.2 (5.4) |
Range | 16.6–49.6 |
<18.5 (n, %) | 9 (3.4) |
18.5–24.9 (n, %) | 116 (43.8) |
≥25–29.9 (n, %) | 80 (30.2) |
>30–39.9 (n, %) | 53 (20.0) |
>40 (n, %) | 4 (1.5) |
Missing | 3 (1.1) |
Self-reported pre-existing disease, n (%) 1 | |
Yes | 112 (42.3) |
No | 153 (57.7) |
Hormonal or metabolic | 37 (14) |
Psychiatric diseases | 25 (9.4) |
Nervous system | 7 (2.6) |
Cardiovascular system | 18 (6.8) |
Respiratory system | 28 (10.6) |
Musculoskeletal and connective tissue | 24 (9.1) |
Digestive system | 20 (7.5) |
Dermatological | 16 (6.0) |
Other | 32 (12.1) |
Variables | Sample at Follow-Up (T1) (n = 265) |
---|---|
Time between the SARS-CoV-2 infection and baseline (T0), months | |
M (SD) | 17.1 (8.7) |
Range | 3–42 |
Time between the SARS-CoV-2 infection and follow-up (T1), months | |
M (SD) | 22.5 (8.2) |
Range | 10–47 |
Time between baseline (T0) and follow-up (T1), months | |
M (SD) | 5.0 (2.4) |
Range | 3–11 |
Course of the acute SARS-CoV-2 infection, n (%) | |
Asymptomatic | 14 (5.3) |
Symptomatic, therapy at home or outpatient | 224 (84.5) |
Symptomatic, inpatient therapy without intensive care admission | 21 (7.9) |
Symptomatic, inpatient therapy with intensive care admission | 6 (2.3) |
PCR, n (%) | |
Carried out | 236 (89.1) |
Not carried out | 29 (10.9) |
Vaccine, n (%) | |
None | 14 (5.3) |
1× | 11 (4.2) |
2× | 58 (21.9) |
3× | 154 (58.1) |
4× | 24 (9.1) |
5× | 4 (1.5) |
Cardiac pathology, n (%) | |
Yes (Scores 1–3) | 28 (10.6) |
No (Score 0) | 197 (74.3) |
Missing | 40 (15.1) |
Ejection fraction | 3 (1.1) |
Pulmonic artery pressure elevation | 5 (1.9) |
Left ventricle dilatation | 9 (3.4) |
Pericardial effusion present | 13 (4.9) |
Atrial fibrillation | 0 (0.0) |
Variables | Sample at Baseline (T0) (n = 265) 1 | Sample at Follow-Up (T1) (n = 265) |
---|---|---|
Post-COVID Symptom Score (PCS-S), cut-off >26.25 | ||
n (%) | 224 (84.5) | 214 (80.8) |
Fatigue Severity Scale (FSS), cut-off ≥4 | ||
n (%) | 237 (89.4) | 237 (89.4) |
Patient Health Questionnaire-9 (PHQ-9), cut-off ≥10 | ||
n (%) | 181 (68.3) | 148 (55.8) |
Generalized Anxiety Disorder-7 (GAD-7), cut-off ≥10 | ||
n (%) | 64 (24.2) | 50 (18.9) |
Patient Health Questionnaire-15 (PHQ-15), cut-off >10 | ||
n (%) | 230 (86.8) | 192 (72.5) |
Variable (T1) | ||||
---|---|---|---|---|
Outcome Measure (Coefficient, [95% Confidence Interval], p-Value) | PHQ-9 1 | PHQ-15 2 | GAD-7 3 | FSS 4 |
Intercept | 7.830, [4.104; 11.556], <0.001 * | 17.206, [12.929; 21.483], <0.001 | 4.748, [1.274; 8.222], 0.008 | 5.102, [4.12; 6.084], <0.001 |
Sex (Male) | 0.120, [−1.20; 1.441], 0.858 | −1.321, [−2.847; 0.205], 0.091 | 0.318, [−0.911; 1.547], 0.612 | 0.001, [−0.346; 0.349], 0.995 |
Age | 0.064, [0.011; 0.117], 0.018 | −0.003, [−0.063; 0.058], 0.927 | 0.027, [−0.022; 0.076], 0.284 | 0.009, [−0.005; 0.023], 0.216 |
BMI ≥25 | 0.371, [−0.777; 1.519], 0.527 | −0.532, [−1.758; 0.694], 0.396 | 0.096, [−0.001; 1.184], 0.862 | −0.173, [−0.481; 0.134], 0.27 |
Smoker | −0.889, [−2.567; 0.789], 0.3 | −1.425, [−3.2; 0.35], 0.116 | −0.767, [−2.316; 0.827], 0.346 | −0.093, [−0.543; 0.357], 0.685 |
Pathologic echocardiography | −0.409, [−2.22; 1.404], 0.659 | 0.219, [−1.88; 2.317], 0.839 | 0.545, [−1.14; 2.23], 0.527 | −0.274, [−0.751; 0.203], 0.261 |
Working | −0.806, [−1.924; 0.312], 0.659 | −0.453, [−1.537; 0.631], 0.413 | −0.430, [−1.518; 0.658], 0.439 | −0.234, [−0.539; 0.071], 0.133 |
Not working | −0.630, [−1.848; 0.588], 0.311 | 0.102, [−1.077; 1.281], 0.866 | −0.382, [−1.569; 0.804], 0.528 | −0.077, [−0.412; 0.258], 0.651 |
Prior psychiatric illness without prior psychotherapy | −3.641, [−8.752; 1.471], 0.164 | −2.604, [−8.523; 3.314], 0.389 | −0.386, [−5.139; 4.366], 0.874 | 0.047, [−1.299; 1.393], 0.945 |
Prior psychiatric illness with prior psychotherapy | 2.370, [0.186; 4.554], 0.035 | 3.566, [1.039; 6.039], 0.006 | 2.159, [0.128; 4.191], 0.038 | 0.424, [−0.151; 1], 0.15 |
Partnership (Yes) | 0.710, [−0.513; 1.933], 0.256 | 0.995, [−0.301; 2.291], 0.133 | 0.284, [−0.877; 1.444], 0.632 | −0.155, [−0.483; 0.174], 0.357 |
Time between the acute infection and T0 | <0.001, [−0.75; 0.076], 1 | 0.024, [−0.063; 0.112], 0.586 | −0.011, [−0.081; 0.06], 0.765 | 0.013, [−0.007; 0.033], 0.207 |
High school certificate | −0.603, [−1.841; 0.635], 0.341 | −1.178, [−2.604; 0.249], 0.107 | −0.543, [−1.696; 0.609], 0.357 | 0.035, [−0.291; 0.36], 0.834 |
Acute infection with inpatient treatment | 0.080, [−1.899; 2.059], 0.937 | 0.898, [−1.396; 3.192], 0.444 | 1.278, [−0.561; 3.118], 0.175 | −0.213, [−0.734; 0.308], 0.424 |
Number of vaccinations | 0.364, [−0.287; 1.016], 0.275 | −0.287, [−1.042; 0.468], 0.457 | 0.165, [−0.441; 0.771], 0.595 | 0.141, [−0.031; 0.312], 0–109 |
Time to T1 | −1.613, [−2.158; −1.069], <0.001 | −2.716, [−3.209; −2.223], <0.001 | −0.621, [−1.164; −0.078], 0.026 | −0.045, [−0.198; 0.108], 0.565 |
Outcome Measure (Coefficient, 95% Confidence Interval, p-Value) | PCS-S 5 | PEM Frequency 6 | PEM Severity 6 | |
Intercept | 34.203, [25.427; 42.978], <0.001 | 8.719, [4.25; 13.189], <0.001 | 9.262, [5.369; 13.154], <0.001 | |
Sex (Male) | −2.762, [−5.883; 0.359], 0.084 | 0.408, [−1.187; 2.004], 0.616 | 0.227, [−1.163; 1.617], 0.749 | |
Age | 0.095, [−0.03; 0.219], 0.138 | −0.004, [−0.068; 0.061], 0.91 | −0.013, [−0.069; 0.044], 0.661 | |
BMI ≥25 | −0.915, [3.565; 1.734], 0.499 | −0.451, [−1.817; 0.916], 0.518 | 0.045, [−1.137; 1.228], 0.94 | |
Smoker | −0.530, [−4.388; 3.328], 0.788 | −0.439, [−2.54; 1.662], 0.682 | −0.160, [−1.98; 1.659], 0.863 | |
Pathologic echocardiography | −1.554, [−5.843; 2.734], 0.478 | −1.327, [−3.522; 0.867], 0.237 | −0.707, [−2.619; 1.206], 0.47 | |
Working | −1.847, [−4.318; 0.623], 0.144 | −0.516, [−1.763; 0.731], 0.418 | −0.549, [−1.617; 0.518], 0.314 | |
Not working | 1.103, [−1.612; 3.818], 0.427 | 0.235, [−1.141; 1.611], 0.738 | 0.462, [−0.717; 1.641], 0.443 | |
Prior psychiatric illness without prior psychotherapy | −3.446, [−15.541; 8.648], 0.577 | 2.068, [−4.099; 8.236], 0.512 | 1.747, [−3.629; 7.123], 0.525 | |
Prior psychiatric illness with prior psychotherapy | 5.509, [0.342; 10.676], 0.038 | 1.462, [−1.167; 4.092], 0.277 | 1.421, [−0.871; 3.713], 0.226 | |
Partnership (Yes) | −0.227, [−3.046; 2.592], 0.875 | −0.066, [−1.497; 1.365], 0.928 | −0.240, [−1.477; 0.997], 0.704 | |
Time between the acute infection and T0 | 0.131, [−0.047; 0.309], 0.151 | 0.112, [0.021; 0.203], 0.017 | 0.085, [0.005; 0.164], 0.038 | |
High school certificate | −0.522, [−3.441; 2.397], 0.726 | −0.499, [−1.993; 0.995], 0.513 | −0.740, [−2.042; 0.561], 0.266 | |
Acute infection with inpatient treatment | −2.500, [−7.184; 2.183], 0.297 | −1.559, [−3.943; 0.826], 0.202 | −1.267, [−3.345; 0.812], 0.234 | |
Number of vaccinations | 0.014, [−1.527; 1.554], 0.986 | 0.378, [−0.407; 1.162], 0.347 | 0.298, [−0.386; 0.982], 0.394 | |
Time to T1 | −2.233, [−3.413; −1.054], <0.001 | −0.422, [−1.017; 0.174], 0.167 | −0.425, [−0.959; 0.055], 0.082 |
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Schäfer, I.C.; Krehbiel, J.; Adler, W.; Borho, A.; Herold, R.; Greiner, B.; Reuner, M.; Morawa, E.; Erim, Y. Three-Month Follow-Up of the Post-COVID Syndrome after Admission to a Specialised Post-COVID Centre—A Prospective Study Focusing on Mental Health with Patient Reported Outcome Measures (PROMs). Int. J. Environ. Res. Public Health 2024, 21, 1076. https://doi.org/10.3390/ijerph21081076
Schäfer IC, Krehbiel J, Adler W, Borho A, Herold R, Greiner B, Reuner M, Morawa E, Erim Y. Three-Month Follow-Up of the Post-COVID Syndrome after Admission to a Specialised Post-COVID Centre—A Prospective Study Focusing on Mental Health with Patient Reported Outcome Measures (PROMs). International Journal of Environmental Research and Public Health. 2024; 21(8):1076. https://doi.org/10.3390/ijerph21081076
Chicago/Turabian StyleSchäfer, Isabel Cecil, Johannes Krehbiel, Werner Adler, Andrea Borho, Regina Herold, Brigitte Greiner, Miriam Reuner, Eva Morawa, and Yesim Erim. 2024. "Three-Month Follow-Up of the Post-COVID Syndrome after Admission to a Specialised Post-COVID Centre—A Prospective Study Focusing on Mental Health with Patient Reported Outcome Measures (PROMs)" International Journal of Environmental Research and Public Health 21, no. 8: 1076. https://doi.org/10.3390/ijerph21081076