Fatigue, cognitive complaints, dyspnea, anxiety, and depression as post-COVID syndrome: a cross-sectional study in […] Southern Tunisia, 2025, Mallek+

[SNT Gatchaman]

Fatigue, cognitive complaints, dyspnea, anxiety, and depression as post-COVID syndrome: a cross-sectional study in Sfax, Southern Tunisia

Spoiler: Authors

Zeineb Mallek; Rahma Gargouri; Hanen Maamri; Maissa Ben Jmeaa; Mouna Baklouti; Mohamed Amine HadjSassi; Eya Ayadi; Feiza Kallel; Najla Bahloul; Rim Khmekhem; Nessrine Kallel; Jihen Jedidi; Imen Sboui; Yosra Mejdoub; Nedia Moussa; Sourour Yaich; Sami Kammoun

INTRODUCTION
post-COVID refers to symptoms and health problems that continue or develop after the initial phase of a COVID-19 infection has resolved. It represents a huge public health issue, leading to considerable illness and lowering the quality of life for those affected. Our study aimed first to provide a general description of post-COVID conditions and then to examine the specific aspects of fatigue, cognitive complaints, dyspnea, anxiety, and depression in patients followed up in the pulmonology department of CHU Hedi Chaker, Sfax.

METHODS
we conducted a cross-sectional study in the pulmonology department of CHU Hedi Chaker, Sfax in 2024 using an anonymous self-questionnaire with 4 validated scales to assess cognitive complaint, fatigue, dyspnea, as well as anxiety, and depression.

RESULTS
overall, 75 participants were included, with a sex ratio of 0.63 and a median age of 45 years (interquartile range (IQR= [35-66 years]). The evaluation of the impact of COVID-19 symptoms on daily life showed that 45.3% of the participants (n= 34) reported that fatigue had a severe impact on daily life, while 33.3% (n= 25) reported severe impacts from stress and negative emotions. The prevalences of fatigue, cognitive complaints, very severe dyspnea, anxiety, and depression based on the scale used were 88% (n= 66), 80% (n= 60), 14.7% (n= 11), 44% (n= 33) and 28.6% (n= 21), respectively. The factor most associated with fatigue in the population was cognitive complaints (OR= 25.3, p<0.001), while the factor most associated with dyspnea was age between 70 and 95 (OR= 12.85; p= 0.006). Furthermore, the factor most significantly associated with cognitive complaints was anxiety with an OR of 25.3 and p<0.001. As for anxiety and depression, the most associated factors were cognitive complaints and depression (OR=25.3; p<0.001) vs (OR= 27.1; p<0.001), respectively.

CONCLUSION
our study shows significant prevalences of post-COVID symptoms, such as fatigue, cognitive complaints, severe dyspnea, anxiety, and depression. Thus, post-COVID syndrome poses a significant public health challenge due to its wide array of symptoms that continue to affect individuals health.

Web | The Pan African Medical Journal | Open Access

 

[Hutan]

Sadly, the Chalder Fatigue Scale seems to continue to dominate the field.

Assessment of fatigue: the validated Chalder Fatigue Scale (CFQ-11) was used to assess the fatigue. It contains 11 items: seven related to physical fatigue and four to psychological fatigue. Answers were measured using a Likert scale from 0 (Less than usual) to 3 (Much more than usual) [14]. CFQ-11 also featured a bimodal scoring algorithm where each item response was dichotomized : 0 (0 to 1) out of a total of 0 to 11. By convention, fatigue status was classified using this bimodal scale with a threshold of < 4 vs. = 4 [14].

overall, 75 participants were included, with a sex ratio of 0.63

Females accounted for 61% of the sample (46 out of 75).

 

[Hutan]

The analysis of factors associated with depression revealed that it was more common among non-workers. One possible explanation is that non-workers might have fewer regular social contacts. Work often provides a daily structure, personal goals structure, and social interaction, which can help maintain mental health. Plus, Anxiety levels were shown to be higher among people who were depressed.

The fact that COVID-19 can affect the brain and the neurobiological systems that regulate emotions may assist in explaining this. Disrupting these systems may increase the risk of anxiety and depression [29]. In general, pathological psychiatric issues observed after the COVID-19 infection might be intensified by fear of death or serious illness, concerns about spreading the virus to others, the effects of social isolation, and the inflammatory and immune responses triggered by the virus [6]. This observation underscores the importance of considering mental health as a key element in assessing the long-term impacts of COVID-19.

They note that depression was more common in non-workers and that people who were depressed were also likely to be more anxious.

The reasons they suggest are

• non-workers have fewer social contacts
• the routine of work is protective for mental health
• Covid-19 has affected the brain's capacity to regulate emotions
• people have pathological psychiatric issues that have been exacerbated by a fear of death and serious illness, a fear of spreading the illness to others, social isolation and the biological responses to the virus

They talk about disabling symptoms that seriously affect people's ability to carry out their daily tasks. And yet they seem to have missed the very obvious conclusion that people who are struggling or unable to carry out their tasks of daily living are likely to be feeling sad and worried about the future. In particular people who were working, probably supporting their family with their income, will be particularly sad and worried if they can no longer do that. How can that have escaped the notice of the authors?

They also missed the problems of the HADS measure of depression and anxiety when applied to a chronically ill population. The rates of depression and anxiety are surely inflated by questions such as 'do you no longer enjoy the things you used to?'.