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The coronavirus disease 2019 (COVID-19) has rapidly spread worldwide, leading to increased concerns about long-term patients' neuropsychiatric consequences. This study aims to describe the presence of depressive and anxiety symptoms in severe COVID-19 survivors and to identify associated baseline, in-hospital and post-discharge factors. This study is part of the MAPA longitudinal project conducted with severe COVID-19 patients admitted in Intensive Care Medicine Department (ICMD) of a University Hospital (CHUSJ) in Porto, Portugal. Patients with ICMD length of stay ≤ 24 h, terminal illness, major auditory loss or inability to communicate at follow-up assessment were excluded. All participants were assessed by telephone post-discharge (median = 101 days), with a comprehensive protocol assessing depressive and anxiety symptoms, cognition, Intensive Care Unit (ICU) memories recall and health-related quality of life. Out of a sample of 56 survivors (median age = 65; 68% males), 29% and 23% had depressive and anxiety symptoms, respectively. Depressive and anxiety symptoms were significantly more prevalent among younger survivors and were associated with cognitive complaints, emotional and delusions ICU memories and fear of having COVID-19 sequelae, sleep problems and pain after discharge (all p 0.05). An important proportion of these survivors suffers from depression and anxiety symptoms post-discharge, namely younger ones and those who reported more cognitive complaints, ICU memories, fear of having COVID-19 sequelae, sleep problems and pain. These findings highlight the importance of psychological consequences assessment and planning of appropriate and multidisciplinary follow-up care after hospitalization due to COVID-19.

Long-term health impairments are often experienced among survivors of critical illness, which may have a negative impact on their quality of life. The aim of this study was to characterize COVID-19 survivors of critical illness and to evaluate health-related quality of life and disability following hospital discharge.This is a retrospective case-series study that included COVID-19 survivors admitted to the Intensive Care Medicine Department of a University Hospital. Follow-up evaluation was performed between the 30th and the 90th day after discharge. Quality of life was explored using the five-level version of the EQ-5D instrument (EQ-5D-5L) and functionality using the 12-question World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0).Forty-five survivors were enrolled, 28 (62.2%) men, median age 63.0 years. The EQ-5D-5L questionnaire showed moderate to extreme problems in some dimension in 29 patients (64.4%): mobility in six (13.3%), self-care in seven (13.3%), usual activities in 23 (51.1%), pain/discomfort in 14 (31.1%) and anxiety/depression in 17 (37.8%). When using the 12-question WHODAS 2.0 questionnaire, moderate to extreme disability was reported in some question in 37 patients (82.2%): 19 (42.2%) in standing for long periods, 18 (40.0%) in long-distance walking; 14 (31.1%) on taking care of household responsibilities and 17 (37.8%) in their day-to-day work; 23 (51.1%) felt emotionally affected by their health problems.Based on COVID-19 survivors-reported outcomes after critical illness, mobility, pain/discomfort, and anxiety/depression were the main problems that persisted one to three months after hospital discharge.An organized follow-up structure is crucial to improve health-related quality of life in critical COVID-19 survivors.Introdução: Os sobreviventes de doença crítica apresentam frequentemente sequelas a longo prazo. O objetivo deste estudo foi caracterizar os sobreviventes da COVID-19 grave e avaliar a qualidade de vida após a alta hospitalar. Material e Métodos: Série de casos que inclui sobreviventes COVID-19 admitidos no Serviço de Medicina Intensiva de um Hospital Universitário. A consulta de seguimento foi realizada entre o 30º e o 90º dia após alta hospitalar. A qualidade de vida foi avaliada através do questionário EQ-5D com cinco níveis (EQ-5D-5L) e a funcionalidade através do instrumento World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) de 12 questões. Resultados: Foram incluídos 45 sobreviventes, 28 homens (62,2%), idade mediana de 63,0 anos. No questionário EQ-5D-5L 29 sobreviventes (64,4%) mostraram problemas moderados a extremos em alguma dimensão: seis (13,3%) na mobilidade, sete (13,3%) nos cuidados pessoais, 23 (51,1%) nas atividades habituais, 14 (31,1%) na dor/desconforto e 17 (37,8%) na ansiedade/depressão. No WHODAS 2.0 37 sobreviventes (82,2%) revelaram alterações funcionais moderadas a extremas em alguma questão: 19 (42,2%) em permanecer de pé por longos períodos, 18 (40,0%) em percorrer longas distâncias, 14 (31,1%) em cuidar das responsabilidades domésticas e 17 (37,8%) no dia-a-dia no trabalho; 23 (51,1%) mostraram-se emocionalmente afetados pelos seus problemas de saúde. Discussão: A avaliação dos sobreviventes COVID-19 após a doença crítica demonstra que a mobilidade, a dor/desconforto e a ansiedade/depressão são os principais problemas que persistem um a três meses após a alta hospitalar. Conclusão: O acompanhamento estruturado após alta poderá ter impacto significativo na qualidade de vida destes doentes.

Background:The coronavirus disease 2019 (COVID-19) has rapidly spread worldwide, leading to increased concerns about long-term patients’ neuropsychiatric morbidity. Currently, there is still few data regarding mental health after hospital discharge of severe COVID-19 elderly patients. Considering this, the present study aims to characterize the neuropsychiatric morbidity in old severe COVID-19 patients.Methods:In the context of an ongoing multidisciplinary research project, this study analyzed a subsample of patients aged ≥60 years, admitted due to COVID-19, during the first wave, in the Intensive Care Medicine Department (ICMD) of a University Hospital in Porto, Portugal. ICMD length of stay (LoS) ≤24h, terminal illness, major auditory loss or inability to communicate at the time of follow- up were used as exclusion criteria. Participants were evaluated by telephone in average 99 (±32) days after being discharged from the hospital, with Six-item Cognitive Impairment Test, PatientHealth Questionnaire and Generalized Anxiety Disorder Scale. Sociodemographic and relevant clinicaldata were obtained from hospital electronic records and clinical interview.Results:A sample of 39 survivors with a mean age of 70 (±6.3) years old were assessed. The majority were male (62%), married (64%), retired (77%), with low educational level (59%), and 15% lived alone. The average number of comorbidities and the daily medications per patient were 4.7 (±1.7) and 5.5 (±3.5), respectively.During ICMD stay, 69% had nosocomial infections and 56% delirium. Deep sedation was used in 74% of the patients (mean=30 days) and 74% needed Invasive Mechanical Ventilation. ICMD mean LoS was33 (±28.3) days. Based on follow-up assessment, 18% of survivors had cognitive impairment, whereas23% and 15% had depressive and anxiety symptoms, respectively. A positive and high correlation between depression and anxiety was found (rs=0.792; pConclusions:The presence of this symptomatology may hinder a successful recovery once the patient is discharged back home. This is particularly relevant accruing the strong relationship between depressive and anxious symptoms found in this sample. Therefore, early screening and timely multidisciplinary support interventions to minimize these neuropsychiatric symptoms after discharge should be considered in order to achieve positive health outcomes.

Patients with systemic lupus erythematosus (SLE) experience chronic symptoms that negatively impact their quality of life (QoL). This study analyzed the variables that contributed to QoL in patients with SLE, including the mediating role of psychological morbidity and disease activity. This study used a transversal design and included 104 women with SLE. Participants answered several instruments assessing fatigue, psychological morbidity (depression and anxiety), body image, disease activity, and quality of life. The results showed that disease activity, fatigue severity, psychological morbidity and body image were associated with all domains of QoL. Additionally, psychological morbidity and disease activity mediated the relationship between body image and psychological morbidity. Also, disease activity mediated the relationship between body image and fatigue severity. According to the results, intervention in patients with SLE should focus on patients' psychological morbidity, particularly in the active phase of the disease. Body image, fatigue severity and psychological morbidity should be monitored in patients with SLE in order to promote QoL.