An explanatory model of depressive symptoms from anxiety, post-traumatic stress, somatic symptoms and symptom perception: The role of inflammatory markers in hospitalized COVID-19 patients

Background: The COVID-19 pandemic has caused a bigger problem for mental health in the world. The aim of this study was to propose a model of mental health variables in hospitalized patients of COVID-19 and determine which model explained best the depression symptoms in both groups with and without biological response. Method: We conducted a cross sectional study, following a simple random sampling. Data from 277 hospitalized patients with COVID-19 in Lima-Peru, were collected to assess mental health variables (i.e., depression, anxiety, post-traumatic stress, somatic symptoms), self-perception of COVID-19 related symptoms, and neutrophil/lymphocyte ratio (NLR) such as inflammatory marker. By performing a structural equation modeling analysis as a technique to evaluate a predictive model of depression. Results: : The results showed a prevalence of depressive symptoms (11.2%), anxious symptoms (7.9%), somatic symptoms (2.2%), and symptoms of post-traumatic stress (6.1%) in the overall sample. No association was found between the prevalence of these mental health problems among people with and without severe inflammatory response. The mental health indicators with the highest prevalence were sleep problems (48%), low energy (47.7%), nervousness (48.77%), worry (47.7%), irritability (43.7%) and back pain (52%) in the overall sample. The model proposed to explain depressive symptoms was able to explain more than 83.7% of the variance and presented good goodness-of-fit indices. Also, a different performance between the proposed model was found between people with and without severe inflammatory response, mainly in the relationship between anxiety and post-traumatic stress, and between the perception of COVID-19 related symptoms and somatic symptoms. Conclusions: : Results demonstrated that our model of mental health variables may explain depression in hospitalized patients of COVID-19 from a third-level hospital in Peru. In the model, perception of symptoms influences somatic symptoms, which influence both anxiety symptoms and post-traumatic stress. Thus, anxious symptoms could directly influence depressive symptoms or through post-traumatic stress. Our findings could be useful to decision-makers for the prevention of depression, using screening tools (i.e. perception of symptoms, somatic symptoms, anxiety) to identify vulnerable patients early.