Anxiety, Post–COVID-19 Syndrome-Related Depression, and Suicidal Thoughts and Behaviors in COVID-19 Survivors: Cross-sectional Study. Woodward, S., F., Bari, S., Vike, N., Lalvani, S., Stetsiv, K., Kim, B., W., Stefanopoulos, L., Maglaveras, N., Breiter, H., & Katsaggelos, A., K. JMIR Formative Research, 6(10):e36656, JMIR Publications Inc., Toronto, Canada, 2022.
doi  abstract   bibtex   
BACKGROUND: While the psychiatric and psychological impacts of the COVID-19 pandemic on the general population have been studied since its onset, studies of the long-term impacts on individuals infected by the SARS-CoV-2 virus are relatively new. Depression, anxiety, and neurological symptoms associated with Post-COVID-Syndrome have been observed in the months following COVID-19 recovery. Suicidal thinking and behavior (STB) have been proposed as both sequalae of COVID-19 and as potential risk factors. OBJECTIVE: We asked three questions. First, do participants reporting a COVID-19 diagnosis and/or a close relation having severe COVID-19 symptoms score higher on depression (Patient Health Questionnaire-9, PHQ-9) and/or state anxiety (State Trait Anxiety Index, STAI) screens than those who do not? Second, do they exhibit increases in specific item PHQ-9 scores, and, for those participants admitting a COVID-19 diagnosis, specifically in Post-COVID-Syndrome-related scores? Lastly, do participants reporting a COVID-19 diagnosis and/or a close relation having severe COVID-19 symptoms report increased STB before, during, and/or after the first year of the pandemic? METHODS: This preliminary study involved analysis of responses to a COVID-19 and mental health questionnaire, obtained from a U.S. population sample of 379 adults, whose data was collected between February 2021 and March 2021. We used Mann Whitney U testing to detect differences in the medians of the total PHQ-9 scores, PHQ-9 component scores, and several STB scores between participants claiming a past clinician diagnosis of COVID-19, and those denying one; as well between participants claiming severe COVID-19 symptoms in a close relation, and those denying one. Where significant differences were found, we created linear regression models to predict the scores based on COVID-19 response as well as demographics, to identify potential confounding in the Mann-Whitney relationships. Moreover, for STB scores, which corresponded to 5 questions asking about three different time intervals (i.e., (i) Past 1 year or more, (ii) Past 1 month to 1 year, and (iii) Past 1 month), we ran Repeated-Measure ANOVAs to determine whether scores tended to vary over time. RESULTS: We discovered greater total depression (PHQ9) and state anxiety (STAI) scores in those with COVID-19 infection history than those without (PBonf = 0.001, PBonf = 0.004 respectively) despite a similar history of diagnosed depression and anxiety. Greater scores were noted for a subset of depression symptoms (PHQ9 items), which overlapped symptoms of Post-COVID Syndrome (all PBonf < 0.05, see text for breakdown). Moreover, we found greater overall STB scores in those with COVID-19 history, equally in time windows preceding, during, and proceeding infection (all PBonf < 0.05, see text). CONCLUSIONS: We confirm previous studies linking depression and anxiety diagnoses to COVID-19 recovery, and posit that depression diagnoses associated with COVID-19 may relate to PCS symptoms, and that STB associated with COVID-19 in some cases precedes infection. CSR - Reports results
@article{
 title = {Anxiety, Post–COVID-19 Syndrome-Related Depression, and Suicidal Thoughts and Behaviors in COVID-19 Survivors: Cross-sectional Study},
 type = {article},
 year = {2022},
 pages = {e36656},
 volume = {6},
 publisher = {JMIR Publications Inc., Toronto, Canada},
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 last_modified = {2023-03-15T17:04:35.847Z},
 read = {false},
 starred = {false},
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 citation_key = {Woodward2022a},
 source_type = {JOUR},
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 abstract = {BACKGROUND: While the psychiatric and psychological impacts of the COVID-19 pandemic on the general population have been studied since its onset, studies of the long-term impacts on individuals infected by the SARS-CoV-2 virus are relatively new. Depression, anxiety, and neurological symptoms associated with Post-COVID-Syndrome have been observed in the months following COVID-19 recovery. Suicidal thinking and behavior (STB) have been proposed as both sequalae of COVID-19 and as potential risk factors. OBJECTIVE: We asked three questions. First, do participants reporting a COVID-19 diagnosis and/or a close relation having severe COVID-19 symptoms score higher on depression (Patient Health Questionnaire-9, PHQ-9) and/or state anxiety (State Trait Anxiety Index, STAI) screens than those who do not? Second, do they exhibit increases in specific item PHQ-9 scores, and, for those participants admitting a COVID-19 diagnosis, specifically in Post-COVID-Syndrome-related scores? Lastly, do participants reporting a COVID-19 diagnosis and/or a close relation having severe COVID-19 symptoms report increased STB before, during, and/or after the first year of the pandemic? METHODS: This preliminary study involved analysis of responses to a COVID-19 and mental health questionnaire, obtained from a U.S. population sample of 379 adults, whose data was collected between February 2021 and March 2021. We used Mann Whitney U testing to detect differences in the medians of the total PHQ-9 scores, PHQ-9 component scores, and several STB scores between participants claiming a past clinician diagnosis of COVID-19, and those denying one; as well between participants claiming severe COVID-19 symptoms in a close relation, and those denying one. Where significant differences were found, we created linear regression models to predict the scores based on COVID-19 response as well as demographics, to identify potential confounding in the Mann-Whitney relationships. Moreover, for STB scores, which corresponded to 5 questions asking about three different time intervals (i.e., (i) Past 1 year or more, (ii) Past 1 month to 1 year, and (iii) Past 1 month), we ran Repeated-Measure ANOVAs to determine whether scores tended to vary over time. RESULTS: We discovered greater total depression (PHQ9) and state anxiety (STAI) scores in those with COVID-19 infection history than those without (PBonf = 0.001, PBonf = 0.004 respectively) despite a similar history of diagnosed depression and anxiety. Greater scores were noted for a subset of depression symptoms (PHQ9 items), which overlapped symptoms of Post-COVID Syndrome (all PBonf < 0.05, see text for breakdown). Moreover, we found greater overall STB scores in those with COVID-19 history, equally in time windows preceding, during, and proceeding infection (all PBonf < 0.05, see text). CONCLUSIONS: We confirm previous studies linking depression and anxiety diagnoses to COVID-19 recovery, and posit that depression diagnoses associated with COVID-19 may relate to PCS symptoms, and that STB associated with COVID-19 in some cases precedes infection. CSR - Reports results},
 bibtype = {article},
 author = {Woodward, Sean F and Bari, Sumra and Vike, Nicole and Lalvani, Shamal and Stetsiv, Khrystyna and Kim, Byoung Woo and Stefanopoulos, Leandros and Maglaveras, Nicos and Breiter, Hans and Katsaggelos, Aggelos K},
 doi = {10.2196/36656},
 journal = {JMIR Formative Research},
 number = {10}
}
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