Early post-COVID-19 common psychiatric complications: role of basic inflammatory, coagulation, and clinical risk factors
Authors: Sabry Walaa , El Dien Maged Bhai , Elsherbiny Ahmed Ibrahim Zakie , El Nagar Zeinab Mohamed 
Published: December 2023

Abstract
Background
The infection caused by the SARS-CoV-2 virus has led to the emergence of a novel diagnostic entity known as “post-COVID syndrome” (PCS). It is characterized by a constellation of medical and psychiatric symptoms that occur and persist for variable duration following the COVID infection. Among these post-COVID psychiatric symptoms are depressive and anxiety disorders, which were found to be the highest prevalence in the post-COVID period. The frequency and severity of post-COVID symptoms are correlated with the severity of the infection. Many inflammatory and coagulation markers have been involved in the severity of post-COVID symptoms and hence the development of post-COVID psychiatric symptoms/disorders. Limited research has been conducted to examine the psychological challenges experienced by individuals in the early stages of post-COVID recovery in Egypt, specifically within a timeframe of 1 to 3 months. The current study aims to estimate the occurrence rate of early post-COVID psychiatric symptoms/disorders such as depression and anxiety and to detect its association with clinical and severity parameters of COVID-19 infection.

Methods
The current study was a comparative cross-sectional approach, from the chest department’s “post-COVID-19 follow-up” outpatient clinic at Kobri ElKoba Medical Complex in Cairo, Egypt. A convenient sample of adult Egyptian patients were recruited between October 2021 and June 2022. They were subjected to the following: a pre-designed questionnaire to collect the patients’ demographic characteristics, Arabic version of General Health Questionnaire (GHQ) to identify potential cases, Arabic version of Structured Clinical Interview for DSM-IV (SCID I) Clinician Version (SCID-CV) and retrieval of essential related clinical and laboratory data like C-reactive protein (CRP), systemic immune-inflammation index (SII): (neutrophils × platelets)/lymphocytes), neutrophil/lymphocyte ratio (NLR) and platelet/lymphocyte ratio (PLR), and D-dimer and COVID-19 treatment lines together with a liker scale questionnaire to assess the severity of COVID-19 infection.

Results
Depression was found to be the most prevalent psychiatric disorder (45.6%) among the study participants, followed by generalized anxiety disorder (42.1%). Subthreshold GAD and depression were found in 17.5% and 14% of patients respectively. COVID was a major predictor of GAD (p 0.000), while being on antibiotics (p = 0.033), having cardiac illnesses (p = 0.007), and an increased D dimer (p = 0.022) were the most predictive factors for depression.

Conclusion
COVID-19 infection has demonstrated an increased risk of mental health problems in multiple domains. It was evident that depression was the most presenting psychiatric illness among the studied sample (45.6%), while generalized anxiety disorder was the second most prevalent disorder (42.1%). And suicide was found in 9.6% of the study sample. It is worth noting that our results displayed a high prevalence of subthreshold psychiatric symptoms. These findings emphasize the utmost need for mental health assessments for all survivors.