Stress, anxiety, depressive symptoms and quality of life in patients with and without common cardiovascular diseases at long-term follow-up after COVID-19

Tóm tắt

Background

It is well known that psychosocial factors, including stress level, anxiety and depressive symptoms, negatively affect prognosis, risk factors control, and overall well-being in patients with cardiovascular disease (CVDs). During the COVID-19 pandemic, many people face new or worsened mental health issues that may pose further risks for CVD patients. This is particularly true for those surviving COVID-19 infection especially if it was severe enough to require hospitalization.

Purpose

To assess stress level, anxiety and depression symptoms in patients (pts) hospitalized for moderate to severe COVID-19 infection through April to May, 2020.

Methods

This is a cross-sectional survey of consecutive 759 pts who survived hospitalization for COVID-19. All consecutive patients discharged alive were approached by phone 3-7 months later and invited for a follow-up visit. Exclusion criteria were limited to the refusal to participate and inability to complete the questionnaires due to illiteracy or severe cognitive impairment. Hospital Anxiety and Depression Scale (HADS) was used to assess the anxiety and depression symptoms. A score of 8-10 points on HADS-A and HADS-D subscales were considered as subclinical anxiety and depressive symptoms, and a score of ≥11 points – moderate/severe anxiety and depressive symptoms. The stress level was assessed by means of the Visual Analog Scale (VAS) according to question “Please grade the level of constant stress or tension in your life over the preceding year using the 10-point scale below”, and participant had to mark one number on the scale (0 to 10 VAS).  VAS score <4 was considered as low, 5-7 – as moderate, and ≥7 – as high stress level. Quality of life was measured using a VAS. The VAS asks subjects to place a mark on a graduated line ranging from 0 (worst imaginable health state) to 100 (best imaginable health state), indicating their current health status.

Results

A total of 212 pts gave their consent to participate, and 162 (76.4%) of them had a history of any CVDs (mainly hypertension, atherosclerotic CVDs or atrial fibrillation).  Participants were distributed into CVD group (n=162, 54.3% males, aged 57.5±12.4 years) and non-CVD group (n=50, 58% males, aged 56.6±12.4 years). About one thirds (28.8%) of pts had high stress level. The majority of pts were free of anxiety and depressive symptoms. HADS-A scores > 8 points had 23% of pts. HADS-D scores > 8 points had 18% of pts. Proportion of pts with increased stress level, anxiety and depressive symptoms did not differ in CVD and non-CVD groups.  CVD pts had significantly lower quality of life as compared to non-CVD pts (p=0.03).

Conclusion

About 30% patients at long-term follow-up after hospitalization for COVID-19 had a high stress level, every fifth patient had anxiety or depressive symptoms. Proportion of patients with increased stress level, anxiety and depressive symptoms did not differ in CVD and non-CVD patients.