Physical, cognitive and mental health impacts of COVID-19 following hospitalisation: a multi-centre prospective cohort study, 2021, Evans et al.

[arewenearlythereyet]

Moved post

https://www.medrxiv.org/content/10.1101/2021.03.22.21254057v1

Abstract

Background The impact of COVID-19 on physical and mental health, and employment following hospitalisation is poorly understood.

Methods PHOSP-COVID is a multi-centre, UK, observational study of adults discharged from hospital with a clinical diagnosis of COVID-19 involving an assessment between two- and seven-months later including detailed symptom, physiological and biochemical testing. Multivariable logistic regression was performed for patient-perceived recovery with age, sex, ethnicity, body mass index (BMI), co-morbidities, and severity of acute illness as co-variates. Cluster analysis was performed using outcomes for breathlessness, fatigue, mental health, cognition and physical function.

Findings We report findings of 1077 patients discharged in 2020, from the assessment undertaken a median 5 [IQR4 to 6] months later: 36% female, mean age 58 [SD 13] years, 69% white ethnicity, 27% mechanical ventilation, and 50% had at least two co-morbidities. At follow-up only 29% felt fully recovered, 20% had a new disability, and 19% experienced a health-related change in occupation. Factors associated with failure to recover were female, middle-age, white ethnicity, two or more co-morbidities, and more severe acute illness. The magnitude of the persistent health burden was substantial and weakly related to acute severity. Four clusters were identified with different severities of mental and physical health impairment: 1) Very severe (17%), 2) Severe (21%), 3) Moderate with cognitive impairment (17%), 4) Mild (46%), with 3%, 7%, 36% and 43% feeling fully recovered, respectively. Persistent systemic inflammation determined by C-reactive protein was related to cluster severity, but not acute illness severity.

Interpretation We identified factors related to recovery from a hospital admission with COVID-19 and four different phenotypes relating to the severity of physical, mental, and cognitive health five months later. The implications for clinical care include the potential to stratify care and the need for a pro-active approach with wide-access to COVID-19 holistic clinical services.

Funding: UKRI and NIHR


Shows similarities to ME profile?

 

[MeSci]

Merged thread

Middle-aged women 'worst affected by long Covid', studies find - BBC News

By Philippa Roxby

Health reporter

Middle-aged women experience the most severe, long-lasting symptoms after being treated in hospital for Covid-19, two UK studies suggest.

Five months on, 70% of patients studied were still affected by everything from anxiety to breathlessness, fatigue, muscle pain and "brain fog".

But the researchers say there is no obvious link with how ill people originally became.

How women's bodies fight off illness could explain their poorer recovery.

The larger study - led by the University of Leicester - which is yet to be peer-reviewed, followed up more than 1,000 patients who had been admitted to hospital with Covid-19 in the UK last year. It found that up to 70% had not fully recovered, an average of five months after leaving hospital, with women most affected.

More than 400,000 people have been admitted to hospital with Covid in the UK since the start of the pandemic.

A separate smaller pre-print study, led by University of Glasgow, found women under 50 were seven times more likely to be more breathless, and twice as likely to report worse fatigue than men of the same age who had had the illness, seven months after hospital treatment.

More at link

 

[rogerblack]

I've currently been commenting on twitter and in other places, and mailing the involved professors about the severe problems (shared with many CFS papers) in measuring mental health of fatigued patients.
Email to the lead investigators.

I write with severe concerns on the preprint with the mental health scales used.
I feel these are severe enough to make the mental health claims on the preprint unsafe.

To quote from a comment now posted on the preprint:
'This studies depression and anxiety measures assume a healthy patient.

'little energy', 'trouble concentrating' 'moving slowly' = a minimum score of 3 due to physical symptoms of longcovid/fatigue. If very exhausted, this can easily rise into the 'severely depressed' range.

It is not unreasonable to use the PHQ-9 or similar as a screening measure of disease severity.

To use it in a patient population suffering from fatigue, concentration problems, ... is guaranteed to cross-read between those symptoms and anxiety - it is useless without a careful assessment of each question to find if you are measuring MH, or physical symptoms, and finding an appropriate threshold for the MH scale for each physical symptom group.

It absolutely cannot justify sentances such as "The physical, cognitive and mental health burden experienced by COVID-19 survivors was considerable. This included symptoms of anxiety and depression in a quarter" without much more work, as it will lead to the conclusion that treating depression may benefit the patient when there is no depression, and it's a scale artifact.

PHQ9 and similar scales are designed for patients without significant physical comorbidities to the mental state they are trying to measure. The normal scale cuts are only valid for this purpose.I have not investigated the particular PTSD scale used, but similar concerns arise.

I note similar concerns to those raised with the C-MORE paper.'

I feel this is more than a purely technical issue.I am a patient with me/cfs, a possibly related fatiguing condition and this class of error has been usual in many papers, and has lead in part to ( the now removed in draft NICE guidance)

CBT/GET/lightning process being offered for that condition, as the argument is made that treating the anxiety and depression (which is at least in part a scale artifact) will be curative.



I posted at study outset on this, which was either unnoticed or ignored.



Thank you.​

It is depressing this class of error is very, very common in ME/CFS and other fatiguing conditions.

 

[rogerblack]

I've currently been commenting on twitter and in other places, and mailing the involved professors about the severe problems (shared with many CFS papers) in measuring mental health of fatigued patients.
...
It is depressing this class of error is very, very common in ME/CFS and other fatiguing conditions.

https://www.bmj.com/content/372/bmj.n829/rapid-responses Response to BMJ article.

Mental Health Mismeasurement.

Dear Editor
In common with an unfortunately many papers on physically debilitating conditions, this paper uses standard mental health tools (PHQ9,...) with the normal recommended cuts for a healthy patient.

At the same time as measuring significant physical disability to the point many patients have had to give up work, or reduce work, the scales used uncritically ask patients 'Do you enjoy the things you used to do' and 'Are you worried about your health'.
These answers supposedly inform on mental health.

All of the MH tools used need careful thought to see what the appropriate baseline that would be expected given the persons physical condition.

Using the standard cuts makes as much sense as concluding that people with one leg are at high risk of low blood pressure following asking them 'do you wobble when you standup'.

This is more than an academic issue. This mismeasurement gets swallowed into meta analysis, where it is even further distanced from verification, and then may be used to drive treatment policy based on the fact that anxiety/depression is a meaningful component of the illness.

The 5 day old email to the three apparent lead authors has not been answered or acknowledged.
At a week in, barring changes to the paper, or an acknowledgement, I'll try a reminder.