Evaluation of anxiety, depression, chronic fatigue (Fatigue),mental status, quality of life and sleep in post COVID-19 patients

Introduction and Aim: COVID-19 is a viral disease that emerged recently and spread all over the world in a short time. The disease can involve all organ systems, especially the lungs, and can be mortal. In the early stages of the epidemic, health care providers focused on the prevention of transmission and the treatment of acute infection, but the increasing number of people who had the disease and the continuation of some symptoms after the disease showed that the virus has effects not only in the acute period, but also in the long term. In this period, which is called post COVID-19, many symptoms such as fatigue, dyspnea, muscle/joint pain, headache, cough, hair loss, memory and attention disorders occur. The pathophysiology of prolonged symptoms has not yet been adequately clarified, and there is no consensus on follow-up/treatment. In our study, it was aimed to investigate the long-term symptoms of patients followed up with the diagnosis of COVID-19, the effects of disease severity on mental functions, quality of life and sleep, development of anxiety and depression, and chronic fatigue. Material and Method: In our study, 150 outpatients (Group 1), who were followed up in our outpatient clinic for control, who were diagnosed with COVID-19 with a Real-time Polymerase Chain Reaction (RT-PCR) positivity and at least 12 weeks after the diagnosis date, applied to our outpatient clinic, 91 patients were followed up in the service (Group 2) and 59 patients followed in the intensive care unit (Group 3) were included. Hospital Anxiety and Depression Scale (HAD), Pittsburg Sleep Quality Index (PUKI), which was used in the study to evaluate quality of life, post-traumatic stress disorder, chronic fatigue syndrome (burnout syndrome -fatigue), depression and anxiety, shortness of breath, sleep quality and mental status, Mini Mental State Test (MMDT), Modified Medical Research Council Dyspnea Scale (mMRC), Fatique Severity Scale (FSS), EuroQol-5D-5L Quality of Life Assessment Scale, Post Traumatic Stress Disorder Short Scale (PTSDIS) were used. Results: Of the patients included in the study, 45.3 % (n=136) were male and 54.7 % (n=164) were female. The mean age of the patients was 57.17 (18-89). HAD scale-Anxiety score 4.7 % (n=7) of group-1, 15.4 % (n=14) of group-2, 23.7 % (n=14) of group-3 was found to be abnormal. It was observed that the HAD scale-Anxiety score increased as the disease severity of the COVID-19 disease increased (p<0.001). Number of patients with abnormal HAD scale-Depression scores 5.3 % (n=8) in group-1, 14.3 % (n=13) in group-2, 22 % (n=13) in group-3 was detected. A significant correlation was found between disease severity and HAD scale-Depression score. As the severity of the disease increased, the HAD scale Depression score increased (p<0.001). 81.3 % (n=122) of the patients in group-1, 47.3 % (n=43) in group-2, 54.2 % (n=32) in group-3 MMDT scores it was found to be ≥24. More severe COVID-19 patients had a higher MMDT score (p <0.001). In the post-COVID-19 period, PUKI scores were found to be similar between the groups, but no significant difference was found between the groups (p=0.063). No significant correlation was found between the fatigue severity scale scores and the groups (p=0.779). EQ-5D-5L index score and Visual Analogue Scale scores decreased as the disease severity increased (for all p<0.001). Post-traumatic stress disorder short scale was applied to patients who had COVID-19 disease, and no patient with a score above 24 was found in the evaluation. Conclusion: Some of the patients have prolonged symptoms in the post COVID-19 period, but there is no consensus on the pathogenesis and treatment of these symptoms yet. The long-term effects of COVID-19 can be determined by using various questionnaires and scales. In our study, it was determined that there was an increase in the symptoms of fatigue in the long term, a decrease in the quality of life and cognitive functions, and an increase in the risk of anxiety and depression in relation to the severity of the disease. Keywords: COVID-19, prolonged symptoms, chronic fatigue, quality of life