Post-infection depressive, anxiety and post-traumatic stress symptoms: a retrospective cohort study with mild COVID-19 patients

Background It remains unclear whether COVID-19 is associated with psychiatric symptoms during or after the acute illness phase. Being affected by the disease exposes the individual to an uncertain prognosis and a state of quarantine. These factors can predispose individuals to the development of mental symptoms during or after the acute phase of the disease. There is a need for prospective studies assessing mental health symptoms in COVID-19 patients in the post-infection period. Methods In this retrospective cohort study, nasopharyngeal swabs for COVID-19 tests were collected at patients’ homes under the supervision of trained healthcare personnel. Patients who tested positive for COVID-19 and were classified as mild cases (N=895) at treatment intake were further assessed for the presence of mental health disorders (on average, 56.6 days after the intake). We investigated the association between the number of COVID-19 symptoms at intake and depressive, anxiety and post-traumatic symptoms, adjusting for previous mental health status, time between baseline and outcome, and other confounders. Multivariate logistic regression and generalized linear models were employed for categorical and continuous outcomes, respectively. Outcomes A clinically significant level of depressive, anxiety and post-traumatic stress symptoms were reported by 26.2% (N=235), 22.4% (N=201), and 17.3% (N=155) of the sample. Reporting an increased number of COVID-related symptoms was associated with clinically significant level of depressive (aOR=1.059;95%CI=1.002-1.119), anxiety (aOR=1.072;95%CI=1.012-1.134), and post-traumatic stress (aOR=1.092;95%CI=1.024-1.166) symptoms. Sensitivity analyses supported findings for both continuous and categorical measures. Interpretation Exposure to an increased number of COVID-19 symptoms may predispose individuals to depressive, anxiety and post-traumatic symptoms after the acute phase of the disease. These patients should be monitored for the development of mental health disorders after COVID-19 treatment discharge. Early interventions, such as brief interventions of psychoeducation on coping strategies, could benefit these individuals. Funding The city health department of São Caetano do Sul ( Secretaria Municipal de Saúde da Prefeitura de São Caetano do Sul ) funded the establishment and implementation of the COVID-19 platform. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement The city health department of Sao Caetano do Sul (Secretaria Municipal de Saude da Prefeitura de Sao Caetano do Sul) funded the establishment and implementation of the COVID-19 platform. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The present study was approved by the local ethics committee (Comissao de Etica para Analise de Projeto de Pesquisa - CAPPesq, protocol No. 32293020.9.0000.5510, approved on July 13th, 2020). All necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable. Yes All the data associated with this paper has been included in the results and supplementary files.