Anxiety, Post-COVID-Syndrome-related depression, and suicidal thinking and behavior in COVID-19 survivors: a preliminary study (Preprint)

Abstract

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.

We asked three questions. First, do participants who report 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 the same participants exhibit increases in specific item PHQ-9 scores, and, for those patients admitting a COVID-19 diagnosis, specifically in PCS-related scores? Lastly, do participants who report 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, approximately March 2020-March 2021?

This preliminary study involved analysis of responses to a COVID-19 and mental health questionnaire, obtained from a U.S. population sample of 506 adults between late February 2021 and early 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 logistic 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.

We discovered significantly greater total depression (PHQ9) and state anxiety (STAI) scores in those with a history of COVID-19 infection than those without (PBonf = 0.001, PBonf = 0.004 respectively) despite a similar history of diagnosed depression and anxiety. Higher scores were noted for a subset of depression symptoms (PHQ9 items), which overlapped symptoms associated with Post-COVID Syndrome (psychomotor retardation/agitation, fatigue, difficulty concentrating, and change in appetite) (all PBonf < 0.05, see text for breakdown). Moreover, we found greater overall Suicidal Thinking and Behavior (STB) scores in those with COVID-19 history, equally in time windows preceding, during, and proceeding infection (all PBonf < 0.05, see text).

We confirm previous studies linking depression and anxiety to COVID-19 recovery, and further posit that depression associated with COVID-19 may relate to PCS symptoms, and that STB associated with COVID-19 in some cases precedes infection.

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