Depressive symptoms in post-Covid patients

Abstract Background Recent Sars-Cov-2 pandemics posed a great challenge for cardiovascular and mental health. Cytokine-induced hyperinflammation and oxidative stress contributed to dysautonomia leading to dysfunction of both cardiovascular and neurological systems. Objective The aim of our study was to identify predictors of depression in patients with Sars-Cov-2. Methods Depression screening was conducted in 101 patients who survived Sars-Cov-2 infection during the 2020-2022 period. 50% of Sars-Cov-2 positive patients were diagnosed with acute coronary syndrome (ACS), based on having chest pain, ST segment and T wave changes on ECG and positive troponin test. Supplementary information (Clinical data) was also obtained from the hospital's electronic medical record system. Results Out of 101 Sars-Cov-2 positive patients 54% were females and 47% males. The mean age was 55 (SD 15.9). The mean depression score was 15.4 (SD 9.2). 50% of patients suffered with ACS. Patients with Sars-Cov-2 and acute coronary syndrome were older and had a higher cardiometabolic risk burden, compared to Covid only. In particular 74% of patients from Covid/ACS group had arterial hypertension, 70% - diabetes mellitus and 83% previous coronary disease. A categorical principal component analysis (CATPSA) was conducted for assessment of structure of depressive symptoms. CATPSA revealed 2 dimensions. Dimension 1 explained 32.67% of variance, with 0.892 Cronbach alpha and represented a general depressive mood including both somatic and cognitive symptoms of depression, such as concentration difficulty, irritability, sleeplessness (insomnia), loss of interests, devaluation, guilty feelings, worthlessness, crying, self-criticism. The joint plot (Figure 1) indicated a high degree of co-occurence of cognitive and somatic symptoms in dimension 1. Dimension 2 explained only 9.5% of variance with low Cronbach alpha (0.499). The most important symptoms in this dimension were pessimism, past failure and loss of energy (Figure 1). Patients with Sars-Cov-2 and acute coronary syndrome were more depressed compared to patients with Sars-Cov-2 only (Figure 2). Figure 1. Joint plot for cognitive and somatic symptoms of depression Figure 2. Distribution of dimensions across groups Conclusion In clinical practice the presence of somatic symptoms of depression (fatigue, sleeplessness, loss of appetite) is mainly explained by the main disease, while recognition of depression is based on identification of cognitive symptoms of depression, Our findings indicate that a multidisciplinary approach is needed for assessment of depressive symptoms in post-ACS patients.Joint Plot of Category PointsFor image description, please refer to the figure legend and surrounding text. For image description, please refer to the figure legend and surrounding text.