Frequency, persistence and relation of disease symptoms, psychosomatic comorbidity and daily life impairment after COVID-19: a cohort study in general practice.
General practice
Medically unexplained symptoms
Primary health care
SARS-CoV-2
Somatoform disorders
Journal
BMC primary care
ISSN: 2731-4553
Titre abrégé: BMC Prim Care
Pays: England
ID NLM: 9918300889006676
Informations de publication
Date de publication:
10 Aug 2024
10 Aug 2024
Historique:
received:
17
05
2024
accepted:
30
07
2024
medline:
11
8
2024
pubmed:
11
8
2024
entrez:
10
8
2024
Statut:
epublish
Résumé
Long-lasting symptoms with a possible relation to psychosomatic comorbidity have been described following COVID-19. However, data is sparse in general practice. The trial's objective was to investigate the time-dependent frequency of disease symptoms and relation to psychosomatic comorbidity and daily life impairment (DLI). Comparative cohort study of patients reporting a previous SARS-CoV-2 infection and uninfected controls in general practice. Participants were recruited in 14 general practices in the greater Munich area. Data collection was questionnaire based with a 12 months follow-up. Descriptive statistics, multivariable regression and bivariate correlations were used for analysis. A total of n = 204 cases infected up to 42 months ago (n = 141 Omicron, n = 63 earlier variants), and n = 119 controls were included. Disease symptoms were substantially more prevalent in cases (55-79% vs. 43% within one year of infection). This difference also appeared in the multivariable analysis adjusting for socio-demographics and psychosomatic comorbidity with odds ratios (OR) of 4.15 (p < 0.001) and 3.51 (p = 0.054) for the cohorts with Omicron or earlier variants infection (vs. controls), respectively. It was persistent with earlier variants (OR 1.00 per month, p = 0.903), while a decreasing trend was observed for Omicron (OR 0.89 per month, p < 0.001). DLI was especially correlated with fatigue (r = 0.628). DLI, psychosomatic comorbidity and independently increased disease symptoms require holistic treatment of the patient in general practice according to the bio-psycho-social model. A key role in restoring the daily life capability may be attributed to the symptom fatigue.
Sections du résumé
BACKGROUND
BACKGROUND
Long-lasting symptoms with a possible relation to psychosomatic comorbidity have been described following COVID-19. However, data is sparse in general practice. The trial's objective was to investigate the time-dependent frequency of disease symptoms and relation to psychosomatic comorbidity and daily life impairment (DLI).
METHODS
METHODS
Comparative cohort study of patients reporting a previous SARS-CoV-2 infection and uninfected controls in general practice. Participants were recruited in 14 general practices in the greater Munich area. Data collection was questionnaire based with a 12 months follow-up. Descriptive statistics, multivariable regression and bivariate correlations were used for analysis.
RESULTS
RESULTS
A total of n = 204 cases infected up to 42 months ago (n = 141 Omicron, n = 63 earlier variants), and n = 119 controls were included. Disease symptoms were substantially more prevalent in cases (55-79% vs. 43% within one year of infection). This difference also appeared in the multivariable analysis adjusting for socio-demographics and psychosomatic comorbidity with odds ratios (OR) of 4.15 (p < 0.001) and 3.51 (p = 0.054) for the cohorts with Omicron or earlier variants infection (vs. controls), respectively. It was persistent with earlier variants (OR 1.00 per month, p = 0.903), while a decreasing trend was observed for Omicron (OR 0.89 per month, p < 0.001). DLI was especially correlated with fatigue (r = 0.628).
CONCLUSION
CONCLUSIONS
DLI, psychosomatic comorbidity and independently increased disease symptoms require holistic treatment of the patient in general practice according to the bio-psycho-social model. A key role in restoring the daily life capability may be attributed to the symptom fatigue.
Identifiants
pubmed: 39127653
doi: 10.1186/s12875-024-02551-w
pii: 10.1186/s12875-024-02551-w
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
295Informations de copyright
© 2024. The Author(s).
Références
Lippi G, Sanchis–Gomar F, Henry BM. COVID-19 and its long-term sequelae: what do we know in 2023? Polish Archives of Internal Medicine; 2023.
Contreras S, Iftekhar EN, Priesemann V. From emergency response to long-term management: the many faces of the endemic state of COVID-19. Lancet Reg Health Eur. 2023;30:100664.
doi: 10.1016/j.lanepe.2023.100664
pubmed: 37363798
pmcid: 10217566
Koczulla AR, Ankermann T, Behrends U, et al. [German S1 Guideline Long-/Post-COVID]. Pneumologie. 2022;76(12):855–907.
doi: 10.1055/a-1946-3230
pubmed: 36479679
NICE. COVID-19 rapid guideline: managing the longterm effects of COVID-19. National Institute for Health and Care Excellence (NICE), Scottish Intercollegiate Guidelines Network (SIGN) and Royal College of General Practitioners (RCGP) 2022.
Lund LC, Hallas J, Nielsen H, et al. Post-acute effects of SARS-CoV-2 infection in individuals not requiring hospital admission: a Danish population-based cohort study. Lancet Infect Dis. 2021;21(10):1373–82.
doi: 10.1016/S1473-3099(21)00211-5
pubmed: 33984263
pmcid: 8110209
Radtke T, Ulyte A, Puhan MA, et al. Long-term symptoms after SARS-CoV-2 infection in children and adolescents. JAMA. 2021;326(9):869–71.
doi: 10.1001/jama.2021.11880
pubmed: 34264266
pmcid: 8283661
Wulf Hanson S, Abbafati C, Aerts JG, et al. Estimated global proportions of individuals with persistent fatigue, cognitive, and respiratory symptom clusters following symptomatic COVID-19 in 2020 and 2021. JAMA. 2022;328(16):1604–15.
doi: 10.1001/jama.2022.18931
pubmed: 36215063
pmcid: 9552043
Tran VT, Porcher R, Pane I, et al. Course of post COVID-19 disease symptoms over time in the ComPaRe long COVID prospective e-cohort. Nat Commun. 2022;13(1):1812.
doi: 10.1038/s41467-022-29513-z
pubmed: 35383197
pmcid: 8983754
Joffe AR, Elliott A. Long COVID as a functional somatic symptom disorder caused by abnormally precise prior expectations during bayesian perceptual processing: a new hypothesis and implications for pandemic response. SAGE Open Med. 2023;11:20503121231194400.
doi: 10.1177/20503121231194400
pubmed: 37655303
pmcid: 10467233
Blankenburg J, Wekenborg MK, Reichert J, et al. Comparison of mental health outcomes in seropositive and seronegative adolescents during the COVID19 pandemic. Sci Rep. 2022;12(1):2246.
doi: 10.1038/s41598-022-06166-y
pubmed: 35145161
pmcid: 8831534
Schneider A, Huber L, Lohse J, et al. Association between somatic symptom disorder and symptoms with daily life impairment after SARS-CoV-2 infection - results from a population-based cross-sectional study. J Psychosom Res. 2023;168:111230.
doi: 10.1016/j.jpsychores.2023.111230
pubmed: 36933364
pmcid: 10010058
Greißel A, Schneider A, Donnachie E, et al. Impact of pre-existing mental health diagnoses on development of post-COVID and related symptoms: a claims data-based cohort study. Sci Rep. 2024;14(1):2408. 2024/01/29.
doi: 10.1038/s41598-024-52656-6
pubmed: 38287108
pmcid: 10824734
Gao P, Liu J, Liu M. Effect of COVID-19 vaccines on reducing the risk of long COVID in the Real World: a systematic review and Meta-analysis. Int J Environ Res Public Health. 2022;19(19).
Fumagalli C, Zocchi C, Tassetti L, et al. Factors associated with persistence of symptoms 1 year after COVID-19: a longitudinal, prospective phone-based interview follow-up cohort study. Eur J Intern Med. 2022;97:36–41.
doi: 10.1016/j.ejim.2021.11.018
pubmed: 34903448
Miyazato Y, Morioka S, Tsuzuki S, et al. Prolonged and late-onset symptoms of Coronavirus Disease 2019. Open Forum Infect Dis. 2020;7(11):ofaa507.
doi: 10.1093/ofid/ofaa507
pubmed: 33230486
pmcid: 7665672
Kroenke K, Spitzer RL, Williams JB. The PHQ-15: validity of a new measure for evaluating the severity of somatic symptoms. Psychosom Med. 2002 Mar-Apr;64(2):258–66.
Löwe B, Wahl I, Rose M, et al. A 4-item measure of depression and anxiety: validation and standardization of the Patient Health Questionnaire-4 (PHQ-4) in the general population. J Affect Disord. 2010;122(1–2):86–95.
doi: 10.1016/j.jad.2009.06.019
pubmed: 19616305
Toussaint A, Murray AM, Voigt K, et al. Development and validation of the somatic Symptom Disorder-B criteria scale (SSD-12). Psychosom Med. 2016;78(1):5–12.
doi: 10.1097/PSY.0000000000000240
pubmed: 26461855
De Vries J, Michielsen H, Van Heck GL, et al. Measuring fatigue in sarcoidosis: the fatigue Assessment Scale (FAS). Br J Health Psychol. 2004;9(Pt 3):279–91.
doi: 10.1348/1359107041557048
pubmed: 15296678
Fletcher CM. The clinical diagnosis of pulmonary emphysema; an experimental study. Proc R Soc Med. 1952;45(9):577–84.
pubmed: 13003946
Bestall JC, Paul EA, Garrod R, et al. Usefulness of the Medical Research Council (MRC) dyspnoea scale as a measure of disability in patients with chronic obstructive pulmonary disease. Thorax. 1999;54(7):581–6.
doi: 10.1136/thx.54.7.581
pubmed: 10377201
pmcid: 1745516
Soriano JB, Murthy S, Marshall JC, et al. A clinical case definition of post-COVID-19 condition by a Delphi consensus. Lancet Infect Dis. 2022;22(4):e102–7.
doi: 10.1016/S1473-3099(21)00703-9
pubmed: 34951953
RKI. Weekly situation report of the RKI on the coronavirus disease 2019. Wöchentlicher Lagebericht Des RKI Zur Coronavirus-Krankheit-2019 (COVID-19) 03.02.2022 –. AKTUALISIERTER STAND FÜR DEUTSCHLAND; 2022.
Shuey MM, Huang S, Levinson RT, et al. Exploration of an alternative to body mass index to characterize the relationship between height and weight for prediction of metabolic phenotypes and cardiovascular outcomes. Obes Sci Pract. 2022;8(1):124–30.
doi: 10.1002/osp4.543
pubmed: 35127128
Zeileis A. Object-oriented computation of Sandwich estimators. J Stat Softw. 2006;08(15):1–16.
Zeileis A, Köll S, Graham N. Various versatile variances: an object-oriented implementation of clustered covariances in R. J Stat Softw. 2020;10(07):1–36.
Schafer JO-RR, Zuber V, Ahdesmaki M, Silva APD. Strimmer. K. corpcor: Efficient Estimation of Covariance and (Partial) Correlation_. R package version 1.6.10,. 2021.
RKI. Weekly situation report of the RKI on the coronavirus disease 2019. Wöchentlicher Lagebericht Des RKI Zur Coronavirus-Krankheit-2019 (COVID-19) 08.06.2023 –. AKTUALISIERTER STAND FÜR DEUTSCHLAND; 2023.
COVID-19 Treatment Guidelines Panel. Coronavirus Disease 2019 (COVID-19) Treatment Guidelines. National Institutes of Health. [Internet]. 2024 [cited 22.07.2024]. https://www.covid19treatmentguidelines.nih.gov/
Peter RS, Nieters A, Kräusslich HG, et al. Post-acute sequelae of covid-19 six to 12 months after infection: population based study. BMJ. 2022;379:e071050.
doi: 10.1136/bmj-2022-071050
pubmed: 36229057
Green LA, Fryer GE Jr., Yawn BP, et al. The ecology of medical care revisited. N Engl J Med. 2001;344(26):2021–5.
doi: 10.1056/NEJM200106283442611
pubmed: 11430334
Lemogne C, Gouraud C, Pitron V, et al. Why the hypothesis of psychological mechanisms in long COVID is worth considering. J Psychosom Res. 2023;165:111135.
doi: 10.1016/j.jpsychores.2022.111135
pubmed: 36623391
pmcid: 9825049
Matta J, Robineau O, Wiernik E et al. Depression and anxiety before and at the beginning of the COVID-19 pandemic and incident persistent symptoms: a prospective population-based cohort study. Mol Psychiatry. 2023 Jul 19.
Selvakumar J, Havdal LB, Drevvatne M, et al. Prevalence and characteristics Associated with Post-COVID-19 Condition among Nonhospitalized adolescents and Young adults. JAMA Netw Open. 2023;6(3):e235763.
doi: 10.1001/jamanetworkopen.2023.5763
pubmed: 36995712
pmcid: 10064252
Donnachie E, Schneider A, Enck P. Comorbidities of patients with functional somatic syndromes before, during and after first diagnosis: a Population-based study using bavarian Routine Data. Sci Rep. 2020;10(1):9810.
doi: 10.1038/s41598-020-66685-4
pubmed: 32555301
pmcid: 7299983
Donnachie E, Schneider A, Mehring M, et al. Incidence of irritable bowel syndrome and chronic fatigue following GI infection: a population-level study using routinely collected claims data. Gut. 2018;67(6):1078–86.
doi: 10.1136/gutjnl-2017-313713
pubmed: 28601847
Ceban F, Kulzhabayeva D, Rodrigues NB, et al. COVID-19 vaccination for the prevention and treatment of long COVID: a systematic review and meta-analysis. Brain Behav Immun. 2023;111:211–29.
doi: 10.1016/j.bbi.2023.03.022
pubmed: 36990297
pmcid: 10067136
RKI. SARS-CoV-2. Basic virological data and virus variants in the period 2020–2022. SARS-CoV-2: Virologische Basisdaten Sowie Virusvarianten Im Zeitraum Von 2020–2022. 2023.
Wonca. The european definition of gGeneral practice / family medicine. wonca europe 2023 edition. 2023.
Hawke LD, Nguyen ATP, Ski CF, et al. Interventions for mental health, cognition, and psychological wellbeing in long COVID: a systematic review of registered trials. Psychol Med. 2022;52(13):2426–40.
doi: 10.1017/S0033291722002203
pubmed: 35768406
Brown K, Yahyouche A, Haroon S, et al. Long COVID and self-management. Lancet. 2022;399(10322):355.
doi: 10.1016/S0140-6736(21)02798-7
pubmed: 35065779
pmcid: 8776283
Greenhalgh T, Sivan M, Delaney B, et al. Long covid-an update for primary care. BMJ. 2022;378:e072117.
doi: 10.1136/bmj-2022-072117
pubmed: 36137612
Samper-Pardo M, León-Herrera S, Oliván-Blázquez B, et al. Effectiveness of a telerehabilitation intervention using ReCOVery APP of long COVID patients: a randomized, 3-month follow-up clinical trial. Sci Rep. 2023;13(1):7943.
doi: 10.1038/s41598-023-35058-y
pubmed: 37193738
pmcid: 10187508