Do Anxiety and Depression Predict Persistent Physical Symptoms After a Severe COVID-19 Episode? A Prospective Study, 2021, Bottemanne et al

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ola_cohn

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Background: Persistent physical symptoms are common after a coronavirus disease 2019 (COVID-19) episode, but their pathophysiological mechanisms remain poorly understood. In this study, we aimed to explore the association between anxiety and depression at 1-month after acute infection and the presence of fatigue, dyspnea, and pain complaints at 3-month follow-up.

Methods: We conducted a prospective study in patients previously hospitalized for COVID-19 followed up for 3 months. The Hospital Anxiety and Depression Scale (HAD-S) was administered by physicians at 1-month follow-up, and the presence of fatigue, dyspnea, and pain complaints was assessed at both 1 month and 3 months. Multivariable logistic regressions explored the association between anxiety and depression subscores and the persistence of each of the physical symptom at 3 months.

Results: A total of 84 patients were included in this study (Median age: 60 years, interquartile range: 50.5–67.5 years, 23 women). We did not find any significant interaction between anxiety and the presence of fatigue, dyspnea, or pain complaints at 1 month in predicting the persistence of these symptoms at 3 months (all p ≥ 0.36). In contrast, depression significantly interacted with the presence of pain at 1 month in predicting the persistence of pain at 3 months (OR: 1.60, 95% CI: 1.02–2.51, p = 0.039), with a similar trend for dyspnea (OR: 1.51, 95% CI: 0.99–2.28, p = 0.052).

Discussion and Conclusion: Contrary to anxiety, depression after an acute COVID-19 episode may be associated with and increased risk of some persistent physical symptoms, including pain and dyspnea.

Authors
Hugo Bottemanne, Clément Gouraud, Jean-Sébastien Hulot, Anne Blanchard, Brigitte Ranque, Khadija Lahlou-Laforêt, Frédéric Limosin, Sven Günther, David Lebeaux and Cédric Lemogne on behalf of The French COVID Study Group

Open access full text
https://www.frontiersin.org/articles/10.3389/fpsyt.2021.757685/full
 
It's very small to be a prospective study of persistent symptoms after Covid-19 infection. A study these authors quote found 14% of patients had persistent symptoms at 3 months. With only 84 participants in this study, that's not many people with persistent symptoms at 3 months, especially not with the three symptoms this study looked at.

Also, this sample was hospitalised patients, mostly men and mostly relatively old (mean age 60). That limits the extrapolation of the findings to general populations, and to ME/CFS-like Long Covid a lot. It's likely that this sample had high rates of cardiopulmonary and other tissue damage.*

Also of note is the fact that levels of depression and anxiety weren't assessed prior to Covid-19 infection. The assessment was done 1 months and 3 months after hospitalisation.

this study said:
Between March 17th and April 29th, 2020, 354 patients hospitalized at HEGP were included in the French COVID cohort. Among these patients, 29 were lost at follow-up because of inter-hospital transfer, 78 died and 2 withdrew their consent. Among the 245 patients eligible for the clinical follow-up, 7 died during the follow-up, 22 withdrew their consent, and 6 were not reachable.

Among the 210 remaining patients who underwent the follow-up, 132 attended the 1-day follow-up examination at 1 month, including 109 who also attended the 1-day follow-up examination at 3 months. Among these 109 patients, 84 had HAD-S data at 1-month follow-up.
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The description of the losses to follow-up include a lot of death. Worry and sadness would be entirely normal responses to many of the circumstances people found themselves in.

For anxiety, we did not find any significant interaction between anxiety and fatigue, dyspnea, or pain complaints at 1 month in predicting the persistence of any of these symptoms at 3 months. For depression, we found a significant interaction with the presence of pain at 1 month in predicting the persistence of pain at 3 months, with a similar, yet not significant trend for dyspnea (Table 2). Concerning the other variables included in the regression models, none of them were significantly associated with the presence of any symptom at 3 months.
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So, it doesn't sound as though any of the variables, not anxiety, not depression, not even fatigue or breathlessness or pain at 1 month predicted any symptom at 3 months. Anxiety did not interact with fatigue, breathlessness or pain to predict persistence of the symptoms. Depression did not interact with fatigue or breathlessness or pain to predict the persistence of symptoms. Only one relationship tested turned out to be statistically significant and that was depression interacting with pain to predict the persistence of pain at 3 months - and that was only just significant (p=0.039). They note that neither depression alone nor pain alone predicted pain at 3 months.

So, they tried lots of things and found one marginally significant result. It's not convincing. There's also some nasty BPS carry-on ("Second, anxiety and depression may share some vulnerability factors with functional somatic symptoms (e.g., female gender, high level of neuroticism").

All in all, this is a study that is probably not worth spending time on. Unfortunately, the indications are that these researchers will continue to milk the cash cow of trying to relate mental health issues to post-Covid persistent symptoms.


* This point has not escaped them. They see opportunities to investigate cohorts that will, they believe, provide richer pickings.
Noteworthy, our cohort may not be representative of the patients diagnosed with “long COVID” who are mostly young women with mild initial infection, so our results may not be generalized to these patients. Further studies should explore the role of these psychological dimensions regarding persistent physical symptoms after mild and severe COVID-19 episodes.
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Brigitte Ranque
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Some of the same people that did the other "study" asserting LC is a belief. Ranque has been pushing this very hard in France and is (or was) on the government LC workgroup.

I have no idea how "anxiety" and "depression", however ill-defined, following the infection could be a predicting factor. Things happening after usually do not cause something. And by usually I mean they literally can't because of the linear passage of time. In this household, we respect the linear passage of time. Hey, it's not as if separating cause and effect was some big issue in science or anything like that.

And also depression questionnaires do not differentiate from illness so basically depressed = ill for the most part. So that's double useless.

However poor this study may be, I'm pretty sure it will be pushed hard. Looks like France is the new center of BPSland in the COVID era.
 
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