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In patients with post-acute sequelae of COVID-19 (PASC), depression has been associated with symptom severity, the duration since infection and ongoing functional impairment. However, the interconnections between these factors remain inadequately understood.
This study aimed to explore the roles of depressive symptoms in moderating and mediating the relationships between post-COVID-19 conditions and functional capacity.
The PERCEIVE study recruited 1794 participants from Victoria and Tasmania through online advertisements based on possible PASC for a cross-sectional study. Of these, 461 participated in the longitudinal study. Post-COVID-19 duration and symptoms were recorded, and depressive symptoms and functional capacity were self-reported using the 9-item Patient Health Questionnaire and the Duke Activity Status Index (DASI), respectively. The association of depression with functional capacity was explored using ordinary least squares (OLS) regression, with companion OLS models, Sobel-Goodman tests and 1000 bootstrap iterations to assess mediation. Longitudinal data were analysed to assess changes in functional capacity and depressive symptoms over time, with mediation analysis using mixed models to explore depression as a mediator.
Participants had a mean DASI score of 35 (SD 21). Fatigue (18%), shortness of breath (11%) and chest pain (6%) were common symptoms, with severe depression linked to fatigue (93%) and shortness of breath (66%). The severity of post-COVID-19 symptoms was associated with severe depression (β=6.31, 95% CI 5.42 to 7.21) and reduced functional capacity (β=–6.40, 95% CI –9.20 to –3.61), with depression mediating 36% of the association between post-COVID-19 symptom severity and functional capacity. PASC was associated with higher depression scores (β=2.06, 95% CI 1.15 to 2.97) and lower functional capacity (β=–3.99, 95% CI –6.21 to –1.77), with depression mediating 51% of the association between PASC and reduced functional capacity. The longitudinal analysis suggested that depression is associated with the relationship between PASC and changes in functional capacity over time (unstandardised estimate=–5.16, p
Depression plays a key role in exacerbating post-COVID-19 functional impairment. This observation underscores the need for targeted physical and mental health interventions to enhance long-term recovery for those with severe conditions.
Health care workers (HCW) with post-COVID condition (PCC) are frequently reported to suffer from mental health impairment. Given HCW above-average risk for mental health, research is necessary and risk factors need to be assessed.
To compare mental health and health of German HCW with and without PCC and to identify associated psychological and social factors.
Cross-sectional study.
Overall, 2816 German HCW participated (332 reported PCC). Measures were post-COVID condition symptom sum score (PCSS), symptoms of depression (Patient Health Questionnaire-2), anxiety (Generalised Anxiety Disorder-2) and post-traumatic stress disorder (PTSD) symptoms (Impact of Event Scale-6), work–family conflict (Work–Family Conflict Scale), social support (ENRICHD Social Support Inventory), sense of coherence (Sense Of Coherence-3 Scale) and working conditions. Group differences of HCW with and without PCC were investigated. Multiple linear regression analysis was performed for HCW with PCC. PCSS was the dependent variable. Independent variables were a.m. measures and age, gender, occupational group and migration background.
HCW with PCC exhibited higher values, with medium effect sizes, for symptoms of depression, anxiety and PTSD. Small effect sizes were observed for work–family conflict, social support, sense of coherence and working conditions. Higher PCSS scores were associated with higher depression, anxiety, PTSD and work–family conflict levels, lower social support and sense of coherence and migration background. Being a physician was associated with lower PCSS.
Lower mental health, social factors and resources may play a role in reporting severe post-COVID symptoms. Further research is necessary to investigate these interactions using the biopsychosocial theory.
This study can help to understand PCC in HCW to design adjusted treatments and protect HCW from PCC and minimise their risk of PCC.
This study complies with the Journal article reporting standards for quantitative research in psychology: The APA Publications and Communications Board task force report (Data S1).
Caregivers are the sample group.
To examine symptoms of depression and generalised anxiety among nurses over 2 years during the pandemic and compare them to the general population.
The COVID-19 pandemic has led to a significant increase in mental stress among the population worldwide. Nursing staff have been identified as being under remarkable strain.
A multicentre prospective longitudinal study.
Symptoms of depression and generalised anxiety in 507 nurses were examined at four different time points (T1: April–July 2020, T2: November 2020–January 2021, T3: May–July 2021, T4: February–May 2022). Results were compared with values of the German general population, presence of gender-specific differences was analysed and frequencies of clinically relevant levels of depression and anxiety were determined.
Throughout the study (T1–T4), a significant increase in depressive and anxiety symptoms was observed. At all four measurement time points, nurses showed significantly higher prevalence for depression and anxiety compared to the German general population. No significant gender differences were found. Frequencies for probable depression and generalised anxiety disorder among nurses were: 21.6% and 18.5% (T1), 31.4% and 29.2% (T2), 29.5% and 26.2% (T3), 33.7% and 26.4% (T4).
During the pandemic, symptoms of depression and generalised anxiety among nurses increased significantly and remained elevated. Their symptom levels were permanently higher than in the general population. These findings strongly suggest that the circumstances of the pandemic severely affected nurses´ mental health.
The COVID-19 pandemic caused a great mental strain on caregivers. This study was able to demonstrate the significant increase in depression and anxiety among nurses during the pandemic. It highlights the urgent need for prevention, screening and support systems in hospitals.
Supportive programmes and preventive services should be developed, not least to prevent the growing shortage of nurses in the health care systems.
The study adhered to relevant EQUATOR guidelines. The STROBE checklist for cohort study was used as the reporting method.
Five hundred and seven nurses completed the questionnaire and provided data for analysis.
The study was registered with the German Clinical Trials Register (https://drks.de/search/en) under the following ID: DRKS00021268.
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