Anxiety, depression, insomnia, and trauma-related symptoms following COVID-19 infection at long-term follow-up

Abstract

A developing finding from the novel coronavirus 2019 (COVID-19) pandemic is the burden of neuropsychiatric symptoms seen in COVID-19 survivors. While studies have shown clinically significant rates of depression, anxiety, insomnia, and trauma-related symptoms such as post-traumatic stress disorder (PTSD) after COVID-19, little is known about how these symptoms evolve over time. Here, we report findings from a cohort study of 52 participants recruited from the greater New York City area following acute COVID-19 infection. Participants completed the Patient Health Questionnaire-9 (PHQ-9) for depressive symptoms, the Generalized Anxiety Disorder-7 (GAD-7) for anxiety-related symptoms, the Insomnia Severity Scale (ISS) for sleep-related symptoms, and the PTSD Checklist-Civilian version (PCL-C) for trauma-related symptoms both at baseline and at long-term (24-60 weeks post-infection) follow-up. We found a high degree of correlation between psychiatric symptom scales within participants. More participants met established cutoffs for clinically significant insomnia and post-traumatic stress at follow-up compared to baseline. Symptom scales for depression, insomnia, and PTSD were increased at long-term follow-up, with only increased PCL-C scores surviving correction for multiple comparisons (Z ​= ​2.92, W ​= ​434, p ​= ​0.004). Our results present evidence from a small cohort that neuropsychiatric symptoms, particularly those related to PTSD, may worsen over time in COVID-19 survivors. Future studies should continue to investigate these questions in broader populations, while additionally exploring the potential biological and sociological mechanisms that may contribute to neuropsychiatric pathology after COVID-19 infection.

Keywords: Anxiety; COVID-19; Depression; Insomnia; Long-term; Post-traumatic stress.

Fig. 1

Correlation analysis of PHQ-9, GAD-7, ISS, and PCL-C scores. Pearson correlation matrix for PHQ-9, GAD-7, ISS, and PCL-C scores within individual participants generated in R (R-project,org; Vienna, Austria). Pearson correlation (r) values are represented in cool-warm colors (see legend) and all p ​< ​0.001 (significant after Bonferroni correction for multiple comparisons) Abbreviations: PHQ-9 - Patient Health Questionnaire-9; GAD-7 – Generalized Anxiety Disorder-7; ISS - Insomnia Severity Scale; PCL-C - PTSD Checklist-Civilian version. (For interpretation of the references to color in this figure legend, the reader is referred to the Web version of this article.)

Fig. 2

Comparison of PHQ-9, GAD-7, ISS, and PCL-C scores at baseline and at long-term follow-up. Scores were compared within-subject with Wilcoxon signed rank test (for PHQ-9, GAD-7, and PCL-C) or t-test (for ISS) depending of data distribution, with exact p values shown in figure. Abbreviations: PHQ-9 - Patient Health Questionnaire-9; GAD-7 - Generalized Anxiety Disorder-7; ISS - Insomnia Severity Scale; PCL-C - PTSD Checklist-Civilian version.