Impact of dengue fever on depression, anxiety and stress symptoms in Esmeraldas Province, Ecuador: a prospective cohort study

Abstract Physical symptoms of dengue have been documented extensively, but knowledge gaps on dengue-associated mental health hazards remain. We investigated the frequency of psychiatric symptoms (depression, anxiety and stress) and neurocognitive performance during the first year after a dengue episode. Using DASS-21 scores at 3, 6 and 12 months, we assessed depression, anxiety and stress in anti-dengue IgM-positive adults and matched controls during the 2021 dengue season in Esmeraldas Province, Ecuador. Patients with DASS-21 scores ≤4 were considerednormal; those with scores of 5-7, 8-10 and ≥11 indicatedmild, moderate and severe depression, respectively; cutoff scores for anxiety and stress were ≥5 and ≥9, respectively. We also assessed ‘delayed matching to sample’ (DMS) and ‘spatial working memory’ (SWM) using the Cambridge Neuropsychological Test Automated Battery. We enrolled 102 cases and 78 controls. At 3 months,90 cases and 70 controls were available for follow-up, among these 40/90 (44.4%) cases and 12/70 (17.1%) controls had DASS-21 scores ≥5 (RR 2.7, 95% CI [1.5-4.7]). Dengue remained a predictor for depression after adjusting for age, sex, and COVID-19 status. We observed no difference inanxiety between the groups, but stress scores increased at month three (RR 1.87, 95% CI [1.01-3.4]). DASS-21 scores normalized during follow-up. DMS and SWM did not differ between groups at 3 and 6 months. At month 12, cases had lower SWM than controls did (p value <0.001). Care providers should be aware of dengue-associated mood disorders and facilitate timely referral to mental health services. Future longitudinal studies are warranted to validate our observations regarding the impact of dengue on mental health and neurocognitive status in affected patients.