Preprint Depressive disorder; clinical correlates and Tumor Necrosis Factor alpha among post COVID-19 patients, 2024, Sakr et al

forestglip

forestglip

Senior Member (Voting Rights)
Staff member
Depressive disorder; clinical correlates and Tumor Necrosis Factor alpha among post COVID-19 patients

Aya Mohamed Khaled Sakr, Tarek Ahmed Okasha, Marwa Abd El-Meguid, Maha Mohamed Sayed, Mariam Yehia Mohamed

Background
COVID-19 infection is known to trigger a significant inflammatory response in the body. This response, characterized by elevated levels of cytokines including TNF-α that has proven to play a pivotal role in the severity and long-term effects of the disease. Paucity of the regional studies exploring the interplay between clinical and biochemical markers of post COVID-19 depression; creates a strong motive to shed light on this relationship in depth. Here, we estimated the rate of post-COVID depression, explored the clinical correlates of post-COVID depression, and examined the serum Tumor Necrosis factor alfa (TNF-α).

Methods
A group of 197 patients with post COVID-19 infection were randomly recruited and screened using general health questionnaire (GHQ). Then, SCID-I and Beck depression inventory were applied to confirm the diagnosis and assess the severity of major depressive disorder (MDD). Serum Tumor Necrosis factor alfa (TNF–α) was measured in depressed and non-depressed post COVID-19 patients.

Results
The rate of post-COVID depression was 27.8%; predominately, mild MDD (47.6%), followed by moderate MDD (38.1%) then, severe MDD (14.3%). There was a statistically significant difference between cases and control group regarding severity of COVID-19 (p = 0.001), number of vaccine doses received (p = 0.043), and TNF-alpha (p < 0.001). There was a statistically significant difference between severity of depression and both severity of COVID-19 infection (p = 0.003) and TNF-alpha (p < 0.001). Using regression analysis; TNF-α was the only predictive factor to post-COVID-19 depression (OR = 1.030, p < 0.001).

Conclusion
Our results suggest a strong link between serum TNF-alpha level and post-COVID depression, highlighting its pivotal role in refining the management outcome.

Link | PDF (Preprint)
 
Exploring TNF-alpha is an interesting idea. From what I understand, its a pretty important pro-inflammatory cytokine that could be responsible for a lot of bad shit.

My worry in this piece is that those methods for assessing/diagnosing depression are probably not valid for this population. They include things like disturbed sleep and loss of concentration, so some people could meet depression criteria spuriously, because of their long COVID alone.

So in other words, the conclusion might come down to: People with long covid have elevated TNF-alpha, and those with more severe symptoms have higher levels of it than those with milder symptoms.

Here are the "depressive symptoms" that were linked to TNF-alpha levels:
  • feeling sad
  • loss of pleasure
  • guilt feeling
  • loss of interest
  • loss of energy
  • loss of concentration
  • easy fatigability (yes, you read that right!)
Click to expand...
Here are the ones that weren't linked to TNF-alpha
  • pessimism
  • previous failure
  • feeling of punishment
  • self confidence
  • self blame
  • death wishes/suicidal thought
  • spontaneous crying
  • easily provocation
  • ambivalence
  • worthlessness
  • anger and irritability
  • loss of libido
Click to expand...
I rest my case.
 
Woolie said:
My worry in this piece is that those methods for assessing/diagnosing depression are probably not valid for this population. They include things like disturbed sleep and loss of concentration, so some people could meet depression criteria spuriously, because of their long COVID alone.

So in other words, the conclusion might come down to: People with long covid have elevated TNF-alpha, and those with more severe symptoms have higher levels of it than those with milder symptoms.
Click to expand...

Good points. Since it's a preprint, it might be worth contacting the authors to ask they add that to the limitations.

I don't think I have the energy to do that right now, unless you're okay with me quoting most of your post in the email. Or feel free to email them if you want.


Edit: Nevermind, I summoned the energy and wrote something up and sent it to the author:
It was interesting to see the differences in TNF-a that you found in your recent paper, "Depressive disorder; clinical correlates and Tumor Necrosis Factor alpha among post COVID-19 patients".

A comment was made on the S4ME forum that I wanted to relay to you as it may be important.

It seems possible that the differences in TNF between groups with different depression severity may simply be showing differences in TNF related to long COVID severity. The aspects of the Beck scale that the participants are scoring highly on may be describing long COVID symptoms.

For example, if these aspects of depression that are listed as not correlated with infection severity are also not correlated with TNF levels, then it seems that the relationship is about long COVID severity more so than depression.

"there was no statistically signicant difference between severity of COVID-19 infection and depressive symptoms of pessimism (p = 0.147), loss of pleasure (p = 0.319), feeling of punishment (p = 0.421), self condence (p = 0.364), self blame (p = 0.095), death wishes/suicidal thought (p = 0.396), spontaneous crying (p = 0.650), easily provocation (p = 1.000), ambivalence (P = 0.666), worthlessness (p = 0.589), anger and irritability (p =0.057), easy fatigability (p = 0.123) and loss of libido (p = 1.000)."

Many of these other "depression" aspects more closely align with standard long COVID symptoms:

"There was a statistically signicant difference between severity of COVID-19 infection
and depressive symptoms of loss of interest (p = 0.019), loss of energy (p = 0.012), loss of concentration (p =0.036), change in appetite (p = 0.006), guilt feeling (p = 0.012), and previous failure (p = 0.012)."

May I suggest that the above suggestion be added to the limitations section of your paper? If you have the data, it would also be interesting to include a test of correlation between long COVID severity and TNF.
Click to expand...


Also, @Woolie, you wrote "Here are the "depressive symptoms" that were linked to TNF-alpha levels:", but I don't think they claim they are linked to TNF. All I saw is that these individual aspects are associated with initial infection severity.
 
Last edited:
@forestglip, thanks for checking. Its really unclear, but there are two different places where they mention depression symptoms. The list I posted on was the one from the top paragraph on page 11, and here, they do seem to be comparing TNF-alpha levels for those with and without the specified symptom (no summary data is given for these analyses, so its really hard to tell what they are actually doing ).

Its not very well explained.
 
You must log in or register to reply here.
Back
Top Bottom