Psychosocial functioning of patients up to 6 months after hospitalization for COVID-19

Psychosocial functioning of patients up to 6 months after hospitalization for COVID-19 | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Psychosocial functioning of patients up to 6 months after hospitalization for COVID-19 Kamila Rachubińska, Daria Schneider-Matyka, Anna Maria Cybulska, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4650774/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract The aim of this study was to determine the associations between anxiety, insomnia, fatigue, fatigue, depression, perceived social support of patients hospitalised for SARS-CoV-2 infection not later than up to 6 months after hospitalisation. The study included 97 participants hospitalised for SARS-CoV-2 infection up to 6 months after enrollment. The study was conducted with the method of a diagnostic survey using the questionnaire technique: Modified Fatigue Impact Scale, The Patient Health Questionnaire-9, The Athens Insomnia Scale, The Generalized Anxiety Questionnaire, The Multidimensional Scale of Perceived Social Support, Self-administered questionnaire. Statistically significant: negative correlation between AIS and PHQ-9 scores (r=-0.195; p < 0.001), positive between AIS scores and MFIS (r = 0.468; p < 0.0001), negative between AIS scores and MSPSS (r=-0.267; p < 0.0081), positive between AIS and GAD-7 scores (r = 0.428; p < 0.001), positive between GAD-7 and MFIS scores (r = 0.384; p < 0.0001), negative between GAD-7 and MSPSS scores (r=-0.301; p < 0.0028), negative correlation, strong between MSPSS and MFIS scores (r=-0.201; p < 0.0484) were detected. The study presented here provides important associations and may help to assess the need for psychosocial support and provides a starting point for a larger study to determine the associations between depression, anxiety, fatigue, insomnia and social support among COVID-19 hospitalised patients. Biological sciences/Psychology Health sciences/Health care Health sciences/Health occupations Health sciences/Medical research Health sciences/Risk factors insomnia COVID-19 depressiveness anxiety perceived social support fatigue fatigue Figures Figure 1 Introduction In the first months of the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) pandemic, scientific reports, but also frontline efforts to combat it, were focused on alleviating the symptoms of acute respiratory distress syndrome [ 1 ]. Today, however, it is known that the distant symptoms of coronavirus-2 infection go far beyond persistent respiratory impairment. The psychological effects of the COVID-19 pandemic include both individual symptoms and their syndromes. They are also disorders or groups of disorders and complex psychopathological problems. All the negative psychological consequences listed can overlap. The literature lists the following psychopathological symptoms/problems/disorders as a result of the detrimental effects of pandemic stressors: lowered mood states, anxiety states, nervous tension states, somatisation, impulsivity, irritability, frustration, anxiety disorders, post-traumatic stress disorder, post-traumatic stress disorder, depressive disorders, psychotic disorders, sleep disorders, abuse/increase in alcohol, psychoactive substance abuse, increase in suicide [ 2 , 3 ]. The negative psychological consequences of COVID-19 due to the effects of the virus on the nervous system most commonly include, in addition to those mentioned, the following symptoms/problems: chronic fatigue/psychomotor slowing, cognitive impairment - difficulty concentrating, memory problems; - disorientation, reduced intellectual ability [ 4 ]. Research and clinical observations [ 5 , 6 ] suggest that during a pandemic, many people manifest anxiety-related problems, including fear of contagion, of contact with potentially contaminated objects or surfaces, of the socio-economic consequences of the pandemic (e.g. job loss), compulsive checking and reasserting themselves about possible pandemic risks, and nightmares or intrusive thoughts [ 7 , 8 ]. A number of studies have been conducted to assess the public's response to the COVID-19 pandemic, with survey data showing that coronavirus has a significant impact on psychological functioning. A Canadian survey conducted in early February 2020 found that a third of respondents were worried about the virus and 7% were very worried about it. Only four Canadians were infected at the time of the survey, but 7% of the population (2.6 million) were very concerned about the pandemic. There was also an increase in hygiene and isolation behaviour. In addition, those surveyed had doubts about the capacity of the health care system, which may also exacerbate fears about the consequences of infection. In the United States, already at the beginning of the outbreak, in late January and early February, the majority of respondents (66%) believed that coronavirus posed a real threat, and more than half (56%) were very concerned about the spread of the disease in the country [ 5 , 8 ]. The effects of the coronavirus pandemic were felt in a particular way by people hospitalised for SARS-CoV-2. For them, the uncertainty of tomorrow took on a different dimension. On the one hand, limited help in the fight for their own health, on the other hand, the loneliness associated with the new situation. The emergence of the new Covid-19 disease did not make all the other diseases known until then disappear. Many patients presented themselves to the doctor too late; rescue was impossible. Many were left on their own during the pandemic. Patients in hospitals found themselves in a difficult situation. Dependents relied solely on hospital staff, who were often overworked and did not have enough time to meet the basic needs of patients unable to live independently in time. Such patients were unable to contact their families because, for example, they did not have a telephone or were unable/unable to use it [ 9 ]. The sequelae of SARS-COV-2 infection and COVID-19 disease can result in a variety of cerebral disorders, which can be divided into two main groups. The first is severe cerebrovascular complications, characterised by acute vascular incidents such as haemorrhagic or ischaemic strokes. These involve damage to the large vessels and the occurrence of lesions in the small vessels of the brain. The second group of disorders are neuropsychiatric symptoms of varying severity, such as delirium, cognitive impairment (especially memory), severe affective disorders (depressive and anxiety) and psychotic disorders. COVID-19 patients also present with increased irritability, feelings of chronic fatigue, attention and memory impairment, incidents of impaired consciousness, often accompanied by agitation (psychomotor restlessness), and behavioural disturbances [ 10 ]. However, the neuropsychological profiles of patients are not homogeneous. Certain symptoms and types of therapies used, as well as a severe course of the disease, have been shown to be associated with a higher risk of neuropsychiatric complications. One study indicated that symptoms of diarrhoea and the need for oxygen therapy are associated with a higher risk of severe and longer-lasting cognitive dysfunction [ 11 ]. Patients with headache, sleep disturbances, loss of smell and taste and requiring oxygen therapy present a greater degree of impairment in memory, attention and executive function, compared with patients without severe clinical COVID-19 symptoms [ 12 , 13 ]. Patients with clinical hypoxia and headaches performed worse on neuropsychological tests in terms of the overall cognitive index. Dysfunctions particularly affected the areas of memory, working memory and executive function, verbal fluency (phonological and phonetic) and mental plasticity. Patients with a subjective sense of cognitive decline presented higher levels of anxiety and depressive symptoms [ 14 ]. In many patients, these dysfunctions are more persistent and persist at least six months after the illness. This necessitates an extended diagnostic workup to determine the individual profile of dysfunction present in a given patient, which facilitates the planning of appropriate therapy. This is particularly important in patients with a severe course of the disease, with more severe lung damage, in whom neuropsychiatric disorders, including cognitive dysfunction, anxiety, insomnia, depression, feelings of fatigue, fatigue, may be more severe and persist longer [ 15 , 16 ]. The aim of this study was to relate correlations between selected factors of psychosocial functioning (anxiety, insomnia, fatigue, fatigue, depressiveness, perceived social support) of patients hospitalised for SARS-CoV-2 infection. The study presented here is intended to help assess the need for psychosocial support and to enable the selection of variables affected by the pandemic phenomenon. Results Study participants characteristics There were 97 participants included. The average age of respondents was 60.41 ± 13.57 years. The majority of respondents were female (n = 57; 58.76%), in a formal relationship (n = 56; 57.70%), with higher (n = 40; 41.24%) and secondary education (n = 39; 40.20%) and living in a city of more than 100,000 inhabitants (n = 71; 73.20%). The majority of respondents (n = 67; 69.07%) rated their health. The vast majority (n = 88; 90.70%) declared that the COVID-19 pandemic had reduced their social contacts to at least small extent. More than half of the respondents (n = 52; 53.60%) indicated that they had NOT been vaccinated with all doses of COVID-19 vaccine. Psychological state of study participants The study analysed selected psychological variables (. Based on the results obtained according to the Athens Insomnia Scale (AIS), it was found that 39.20% (n = 38) of the respondents had sleep disorders and 19.60% (n = 19) had insomnia symptoms. When examining anxiety using the Generalised Anxiety Questionnaire (GAD-7), it was observed that the vast majority of respondents experienced anxiety of varying severity: 30.80% (n = 32) had mild anxiety, 16.40% (n-17) moderate anxiety and 12.00% (n = 12) severe anxiety. Furthermore, it was shown that for depression, according to the PHQ-9, only 36.10% (n = 35)of respondents had no symptoms. As for the PHQ-9 results, severe de[pression was demonstrated in 5 (5.2%), slight in 34 (35.10)m average in 14 (14.4%) and moderate-severe in 9 (9.3%). Sesrciptive statistics of raw data are presented in Table 1 . (Scores according to the MFIS scale were used to assess fatigue levels. The mean score on the test was 23.18 ± 7.90 points. According to the Multidimensional Scale of Perceived Social Support (MSPSS), it was shown that the mean score on the test was 6.85 ± 5.93 points (Table 1 ). Table 1 Summary statistics table (N = 97) Psychological variables Min - Max M 95% CI Me 95% CI SD Q1 - Q3 GAD 7 0–21 6.848 6.109–7.587 6 5.000–7.000 5.933 2.00–11.00 AIS 1–18 6.979 6.169–7.790 6 5.000–8.000 4.020 4.00–9.00 PHQ-9 0–25 7.526 6.319–8.732 7 5.000–8.000 5.986 3.00–10.00 MSPSS 23–84 71.691 69.322–74.060 73 71.000–77.000 11.754 65.00–81.00 MFIS 8–40 23.175 21.583–24.768 22 20.000–25.628 7.901 17.00–29.00 Min - minimum, Max - maximum, M - mean, Me - median, SD - standard deviation, p -significance level, Q1 - quartile first, Q3 - quartile third, GAD-7 - Generalized Anxiety Disorder, AIS - The Athens Insomnia Scale, PHQ-9 - Patient Health Questionnaire-9, MSPSS - The Multidimensional Scale of Perceived Social Support, FSS - Fatigue Severity Scale, MFIS - Modified Fatigue Impact Scale, GAD-7 - Generalized Anxiety Disorder, AIS - The Athens Insomnia Scale, PHQ-9 - Patient Health Questionnaire-9 Associations between levels of fatigue according to MFIS, anxiety according to GAD-7, insomnia according to AIS, depression according to PHQ-9 and perceived social support according to MSPSS We correlated raw scores form all surveys given to participants. Analysis of our own results showed statistically significant associations of insomnia, fatigue, social support, anxiety,: a negative, weak correlation between insomnia according to the AIS and depression according to the PHQ-9 (r=-0.195; p < 0.001), a positive, strong correlation between insomnia according to the AIS and fatigue according to the MFIS (r = 0.468; p < 0.0001), meaning that as insomnia levels increase, fatigue levels increase; negative, weak correlation between insomnia according to AIS and perceived social support according to MSPSS (r=-0.267; p < 0.0081); positive correlation of moderate power between GAD-7 anxiety and insomnia according to the AIS (r = 0.428; p < 0.001), meaning that as anxiety increases, insomnia increases; a positive, moderate correlation between anxiety according to the GAD-7 and fatigue according to the MFIS (r = 0.384; p < 0.0001), meaning that as anxiety increases, fatigue increases; a negative moderate correlation between anxiety levels according to the GAD-7 and perceived social support according to the MSPSS (r=-0.301; p < 0.0028), meaning that as anxiety levels increase, the level of perceived social support decreases; A negative, weak correlation between perceived social support according to the MSPSS and fatigue according to the MFIS (r=-0.201; p < 0.0484) Correlogram is depicted in Fig. 1 . Discussion A great deal of attention and resources have been devoted to infection control, the search for effective drugs and vaccines, but the recognition of people whose mental state has been worsened by pandemic outbreaks has been relatively neglected [ 27 , 28 , 29 ]. This is surprising given that mass tragedies such as infectious disease pandemics cause significant disruption to the daily functioning and psychological well-being of many people [ 31 ]. Analysis of the results of our study showed that almost 40% of the respondents had sleep disturbances up to 6 months after hospitalisation for COVID-19, and almost one-fifth had insomnia symptoms. When examining anxiety using the Generalised Anxiety Questionnaire (GAD-7), it was observed that the vast majority of respondents experienced anxiety of varying severity. Furthermore, it was shown that for depression, according to the PHQ-9, only ⅓ of the respondents showed no symptoms. Similar results were obtained by other authors. For example, in a large study, more than half of the respondents showed symptoms of depression (defined as a total score ≥ 5 according to the PHQ-9), almost half showed symptoms of anxiety (defined as a total score ≥ 5 according to the GAD-7), more than ⅓ had symptoms of insomnia (defined as a total score ≥ 8 on the Insomnia Severity Scale - ISS) and almost ¾ of respondents showed stress-related symptoms (defined as a total score ≥ 9 on the Revised Event Impact Scale) [ 30 ]. Fear of the unknown and uncertainty, reduced interpersonal contact can lead to the development of a number of psychiatric disorders and adverse behaviours, such as more frequent use of stimulants. During a pandemic, the number of people with negative mental health consequences is usually greater than the number of people affected by the infection. Furthermore, the psychological consequences of an epidemic may last longer than the epidemic itself [ 31 ]. Therefore, it has been advocated that countries around the world, in addition to working to reduce the rate of SARS-CoV-2 transmission, should also conduct an analysis of the impact of COVID-19 on mental functioning [ 29 ]. In relation to the COVID-19 pandemic, both fear and anxiety are discussed. Anxiety can also be seen as a psychopathological symptom [ 32 ]. Chronic or disproportionate fear and anxiety, can cause psychiatric disorders [ 33 ]. During the COVID-19 pandemic, there was fear of infection, death and loss of a loved one, as well as fear of contact with people who may be infected [ 34 , 35 ]. The fear is due to the speed of the spread of the virus and the fact that it is invisible. People also feared serious complications of COVID-19, forced hospitalisation and long quarantine. Another reason for fear is the possibility of transmitting the infection to loved ones who may not survive the disease. Fear of the coronavirus was due to its novelty and uncertainty about how the epidemic would unfold. Therefore, the fear of COVID-19 is much greater than the fear of seasonal influenza [ 5 ]. There are a growing number of reports describing long-term neurological effects after COVID-19. The pathogenic effect of SARS-CoV-2 on the nervous system is likely to be multifactorial. Patients experience symptoms as a consequence of systemic disease, such as direct neuroinvasion of the central nervous system, peripheral nervous system involvement, and an immune-mediated post-infection mechanism. SARS-CoV-2 infection may lead to the development of Alzheimer's disease and may exacerbate Parkinson's disease in affected patients and increase the risk of stroke due to inflammatory damage to the blood vessel wall or consequent atrial fibrillation. Cytokine and autoimmunity induced by cross-reactivity between virus particles and central nervous system elements may contribute to the development of autoimmune diseases. Carda et al. distinguished two groups of patients according to the clinical sequelae resulting from COVID-19 infection: the first, in which cognitive impairment predominates, and the second, in which respiratory problems predominate. In the context of analysing the consequences of SARS-CoV-2 infection, the term post-acute COVID-19 syndrome (PC19, long-COVID) has emerged in the specialist literature to denote persistent multi-organ dysfunction after the acute phase of COVID-19. Chronic fatigue was experienced by more than half of the subjects. In comparison, in those with a severe course, this symptom appeared in 38% of the subjects. Most researchers point out an important methodological flaw in the assessment of cognitive impairment. The problem is the inhomogeneity of the study group and the lack of data on the functioning of the subjects prior to COVID-19. It should be emphasised that most of the studies considering cognitive impairment concerned subjects hospitalised as a result of the severe course of the disease. The results indicate a marked deterioration in cognitive functioning in COVID-19 survivors [ 5 ]. Increased depression, anxiety and stress are consequences of difficult situations, and such is the state of the Covid-19 pandemic and associated hospitalisations, which were often accompanied by reduced interpersonal contacts [ 36 ]. According to the results of our own study, almost ¼ of the respondents rated their health condition as very poor and the vast majority stated that the Covid-19 pandemic had reduced their social contacts. The results of our own study also showed that as the level of insomnia increases, the level of fatigue and anxiety increases and the level of perceived social support decreases. As anxiety levels increase, fatigue levels increase and levels of perceived social support decrease. Conversely, as the level of perceived social support increases, the level of fatigue decreases. A study was conducted in the Brazilian population to assess the severity of these factors. A total of 3,000 people participated in the study. It was found that the consumption of drugs, tobacco, medication and food increased in the study group (40.8%). Almost half of the respondents manifested symptoms of depression, anxiety and stress. These symptoms were more severe in women, those without children, students, patients with chronic diseases and respondents 15 who had contact with Covid-19 patients [ 36 ]. It can be concluded that the Covid-19 pandemic exacerbated existing mental health disorders and contributed to the occurrence of new dysfunctions. Thus, it is important to conduct further research on the trauma associated with Covid-19 and to reduce its negative social impact [ 37 , 38 ]. Covid-19 had a significant effect on changing the diurnal rhythm, quality and quantity of sleep in patients. A study by Scarpelli et al. of 5988 adults looked at sleep quality, mental health scores (according to depression, anxiety and stress scales) and frequency of dreams and nightmares, as well as related emotional aspects. It was found that Italians were more likely to have nightmares and dreams with frightening content during the pandemic. Predictive factors of frequent dream recall and nightmares were dependent on the daily experiences of the people included in the study[ 39 ]. In a period of social isolation, limited mobility and social contacts, concerns about the economic situation, a sense of fear of infection in oneself and one's loved ones, loss of health or life, anxiety, depression, stress emerge, which cause quantitative and qualitative sleep disturbances in a large part of the population, posing a major threat to the health of the population. Sleep disturbances during the pandemic are exacerbated by retinal stimulation by electronic devices, as well as prolonged and/or night shift work. Insufficient sleep or irregular sleep-wake cycles can weaken the immune system, induce a pro-inflammatory state and lead to increased susceptibility to viral infections [ 40 ]. Limitations and Recommendations for further research Based on the results of this study, some practical implications for professional practice could be proposed. A major strength of the study was the use of standardised tools adapted to Polish conditions, which greatly enriched the data presented. An important goal for therapists working in the mental health field could be the development of educational guidelines aimed at simultaneously minimising the risk of mental disorders in relation to hospitalisation. This study also shows some potential limitations that we hope future research will overcome. Firstly, the cross-sectional, correlational nature of our design, limits the ability to identify causal relationships. There is a lack of data on the prevalence of risk of psychosocial dysfunction from an earlier period before the pandemic, which could be relevant for differential effects of variables on the prevalence of risk of psychosocial dysfunction. Conducting studies taking into account different socio-cultural contexts and paying attention to other variables of interest (e.g. income level or social class) are some of the aspects to be considered in the future. Another limitation may be the problems of being able to generalise the data to other cultures. The assessment of the risk of psychosocial disorders and related factors was based solely on self-report measures of the constructs. Information from autobiographical narratives may be necessary to obtain a holistic picture of a person's behaviour. Assessment based on self-descriptive tools, may be distorted due to the desire to be perceived by society as an attractive person, i.e. with a tendency to avoid criticism and give more socially acceptable answers. This may result in overestimating health-promoting behaviours and underestimating undesirable behaviours. Despite its limitations, this study provides important findings and may provide a starting point for broader research to determine the relationships between depression, anxiety, fatigue, insomnia and social support among COVID-19 hospitalised patients. Associations between selected factors of psychosocial functioning (anxiety, insomnia, fatigue, fatigue, depression, perceived social support) were demonstrated among patients hospitalised for SARS-CoV-2 infection up to 6 months after hospitalisation. As insomnia increased, fatigue and anxiety increased and perceived social support decreased; as anxiety increased, fatigue increased and perceived social support decreased. The study presented here provides important associations and may help to assess the need for psychosocial support and provides a starting point for a larger study to determine the associations between depression, anxiety, fatigue, insomnia and social support among COVID-19 hospitalised patients. Methods The study was conducted between 01 December 2021 and 31 October 2022 in Szczecin, Poland. The study included 97 participants hospitalised for SARS-CoV-2 infection within a period of no more than six months before the date of enrollment. Group selection was random. No randomisation tool was used. It was based on participants who self-reported and met the inclusion criteria. Inclusion criteria we adopted were: age ≥18 years, history of hospitalisation for COVID-19 no later than 6 months from the date of enrolment in the study, confirmed by a positive polymerase chain reaction (PCR)-test for SARS-CoV-2, no clinically confirmed mental illness and informed consent. The study was conducted in accordance with the current version of the Declaration of Helsinki. Permission to conduct the study was obtained from the Bioethics Committee of the Pomeranian Medical University in Szczecin, resolution no. KB-0012/161/2021. Previously prepared research tool sheets were personally distributed by a trained interviewer to the participants, who were to read the above information and agree to participate. Participants were informed about the purpose of the study and anonymity, and were given the opportunity to ask questions and receive comprehensive explanations. Each patient gave written informed consent to participate in the study and to use data from their medical records. Every effort was made to protect patient privacy and anonymity. Surveys The study was carried out by means of a diagnostic survey using the questionnaire technique. Standardised tools adapted to Polish conditions were used. These included: 1. Modified Fatigue Impact Scale - (MFIS) It is a list of 21 statements that describe the impact that fatigue can have on a person. The statements address, among other things, absentmindedness, difficulties with decision-making, motivation, concentration, performance in physical activities, or the need for frequent rest. The scale consists of three parts (F-1, F-2, F-3). Part F-1 is 9 questions assessing the patient's subjective feelings about the impact of fatigue on physical functioning. F-2 consists of 10 questions relating to the impact of fatigue on cognitive function and F-3 contains two questions assessing psychosocial function. Between 9 and 45 points can be obtained for the first part of the questionnaire, between 10 and 50 points are obtained for the assessment of cognitive function and between 2 and 10 points are obtained for the assessment of psychosocial function. In the overall assessment with the MFIS questionnaire, 21 to 105 points are obtained. The higher the values obtained, the greater the impact of fatigue on the patient's functioning. The MFIS has good internal consistency - Cronbach's alpha of 0.81 and reliability of below 0.87 for the total scale and its subscales. The MFIS scale has been validated for Polish conditions [17,18,19]. 2. The Patient Health Questionnaire-9 (PHQ-9) The questionnaire is designed to screen for depression. It was developed based on the diagnostic criteria for depression contained in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). The PHQ-9 is a questionnaire consisting of nine core questions and one supplementary question. The maximum score possible is 27 and indicates the highest possible severity of depression. A score of less than five points indicates normal, five to nine points mild depression, 10 to 14 points moderate depression, 15 to 19 points moderately severe depression, and 20 to 27 points severe depression. The PHQ-9 showed significant positive internal consistency (Cronbach's alpha = 0.7) and the scores of each of its nine items positively correlated (0.31-0.68; p < 0.05) with the total score. The convergent validity was significantly positive (r = 0.58; p < 0.05) [20,21]. 3 The Athens Insomnia Scale (AIS) The Athens Insomnia Scale (AIS) is a short, eight-item scale that allows the quantitative measurement of insomnia symptoms based on ICD-10 criteria. The scale is a self-report tool, consisting of eight statements about different insomnia symptoms. Each item is rated by the respondent on a scale of 0-3 points, where 0 indicates the absence of the symptom in question, 3 its significant severity. The total scale score ranges from 0-24 points. The first five items relate to sleep-related symptoms (difficulty falling asleep, waking up during the night, waking up early in the morning, sleep duration and quality) and correspond to criterion A of the ICD-10 diagnosis of inorganic insomnia. A given symptom should be ticked if it occurred at least three times a week, for at least one month, which is consistent with the duration and frequency of symptoms required for the ICD-10 diagnosis of insomnia (criterion B). The remaining three itmes relate to daytime functioning (well-being, physical and mental performance, sleepiness) and correspond to criterion C of the ICD-10 diagnosis of insomnia, which includes complaints of daytime consequences of insomnia. The internal consistency of the Polish version measured with Cronbach's alpha was .90 and the test-retest reliability was .92 [22,23]. 4. The Generalized Anxiety Questionnaire (GAD-7) The Generalized Anxiety Questionnaire (GAD-7, Generalized Anxiety Disorder) is a screening tool used to determine feelings associated with generalized anxiety syndrome. The questionnaire consists of 7 questions. Each question has a score from 1 to 3 points, the sum of which indicates the severity of the anxiety: 0-4 points (no anxiety), 5-9 ( mild anxiety), 10-14 (moderate anxiety) and 15-21 ( severe anxiety). The internal consistency of the Polish version measured with Cronbach's alpha was .95 [24,25]. 5. The Multidimensional Scale of Perceived Social Support (MSPSS) A tool proposed by Gregory Zimet and colleagues (The Multidimensional Scale of Perceived Social Support - MSPSS) takes into account the multidimensionality of perceived social support, considering three primary sources of support: significant other, family and friends. The scale consists of 12 statements to which the interviewee refers using a seven-point Likert scale [26]. 6. Self-administered questionnaire The self-administered survey questionnaire included closed and semi-open questions to obtain selected socio-demographic data for the participants, i.e. age, education level, marital status, place of residence and professional activity. Statistical analyses The normality of the distribution of continuous variables was verified using the Shapiro-Wilk test. Due to due to significant deviations from a normal distribution, the following were used to describe continuous variables: medians and interquartile ranges. Qualitative variables were reported presented by number and percentage. Continuous variables were correlated using the Spearman rank method. The significance level was taken as two-sided p=0.05. Analyses were performed using MedCalc, version 22.013 (Ostend, Belgium). Declarations Author Contributions : Conceptualisation, K.R.; methodology, A.M.C.; software, E.G; validation, J.S.P. formal analysis, K.R. investigation, D.S.M.; resources, K.R.; data curation, E.G.; writing—original draft preparation, K.R.; writing—review and editing, K.R; visualisation, A.M.C.; supervision, K.S; project administration, E.G.; funding acquisition, K.R. All authors have read and agreed to the published version of the manuscript. Funding: This research received no external funding. Institutional Review Board Statement: Not applicable Informed Consent Statement: Informed consent was obtained from all subjects involved in the study. Data Availability Statement: The datasets used and/or analysed during the current study available from the corresponding author on reasonable request.. Acknowledgments: We thank all participants for their participation and all the staff of the survey team for their efforts that made this study possible. 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G. & Paparrigopoulos T. J. The diagnostic validity of the Athens Insomnia Scale. Journal of Psychosomatic Research. 55 , 263-268 (2003). Spitzer, R. L., Kroenke, K., Williams, J. B., & Löwe, B. A brief measure for assessing generalized anxiety disorder: the GAD-7. Archives of internal medicine. 166, 1092-1097 (2006). Basińska, B. A., & Kwissa-Gajewska, Z. Psychometric Properties Of The Polish Version Of The Generalized Anxiety Disorder 7-Item Scale (Gad-7) In A Non-Clinical Sample Of Employees During Pandemic Crisis. International Journal of Occupational Medicine and Environmental Health, 36 (4), 493 (2023). Zimet, G. D., Dahlem, N. W., Zimet, S. G., & Farley, G. K. The multidimensional scale of perceived social support. Journal of personality assessment. 52 , 30-41 (1988). Walicka-Marek, H., & Marek, E. Psychophysiological effects of pandemic COVID-19 in documentary research: theoretical considerations. Badania dokumentów. Teoria i praktyka (2023). Qi, R. Psychological morbidities and fatigue in patients with confirmed COVID-19 during disease outbreak: prevalence and associated biopsychosocial risk factors. medRxiv. (2020). Ahorsu, D.K., Lin, C.Y. & Imani, V. The fear of COVID-19 scale: development and initial validation. Int J Ment Health Addict. 27 , 1-9 (2020).. Liu, S., Yang, L. & Zhang, C. Online mental health services in China during the COVID-19 outbreak. Lancet Psychiatry. 7 : e17-e18 (2020). Shigemura, J., Ursano, R.J. & Morganstein, J.C. Public responses to the novel 2019 coronavirus (2019-nCoV) in Japan: Mental health consequences and target populations. Psychiatry Clin Neurosci. 74 , 281-282 (2020). Satan, M. Fear and anxiety as seen in the humanities. Studia Gdańskie. 31 , 325-342 (2012). Garcia, R. Neurobiology of fear and specific phobias. Learning and memory (Cold Spring Harbor, N.Y.). 24 , 462-471 (2017). Fardin, M.A. COVID-19 and anxiety: a review of psychological impacts of infectious disease outbreaks. Arch Clin Infect Dis. 15 (2020). Cipora, E. & Mielnik, A. Selected medical and social aspects of the Covid-19 pandemic. Journal of Education, Health and Sport. 12 (1), 11-20 (2022). Serafim, A.P., Durães, R.S.S., Rocca, C.C.A., Gonçalves, P,D., Saffi, F., Cappellozza, A., Paulino, M., Dumas-Diniz, R., Brissos, S., Brites, R., Alho, L., Lotufo-Neto, F. Exploratory study on the psychological impact of COVID-19 on the general Brazilian population. PLoS One. 16 (2), e0245868 (2021). Horesh, D., Brown, A.D. Traumatic stress in the age of COVID-19: A call to close critical gaps and adaptation wrealities. Psychol Trauma. 12 , 331-335 (2020). Zoumpourlis, V., Goulielmaki, M., Rizos, E., Baliou, S., Spandidos, D.A. The COVID-19 pandemic a scientific and social challenge in the 21 st century. MolMedRep. 22 , 3035-3048 (2020). Scarpelli, S., Alfonsi, V., Mangiaruga, A., Musetti, A., Quattropani, M.C., Lenzo, V., Freda, M.F., Lemmo, D., Vegni, E., Borghi, L., Saita, E., Cattivelli, R., Castelnuovo, G., Plazzi, G., De Gennaro L., Franceschini, C. Pandemic nightmares: Effects on dream activity of the COVID-19 lockdownin Italy. J Sleep Res. 30 (5), e13300 (2021). Mello, M.T., Silva, A., Guerreiro, R.C., da-Silva, F.R., Esteves, A.M., Poyares, D., Piovezan, R., Treptow, E., Starling, M., Rosa, D.S., Pires, G. N., Andersen, M.L., Tufik, S. Sleep and COVID-19: considerations about immunity, pathophysiology, and treatment. Sleep Sci. 13 , 199-209 (2020). Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4650774","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":328637748,"identity":"e96994c2-bdb8-44be-a937-0d4edede3808","order_by":0,"name":"Kamila Rachubińska","email":"","orcid":"","institution":"Pomeranian Medical University","correspondingAuthor":false,"prefix":"","firstName":"Kamila","middleName":"","lastName":"Rachubińska","suffix":""},{"id":328637749,"identity":"7dd0b7bf-ac43-4e7e-bd3d-d18f84aa7536","order_by":1,"name":"Daria Schneider-Matyka","email":"data:image/png;base64,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","orcid":"","institution":"Pomeranian Medical University","correspondingAuthor":true,"prefix":"","firstName":"Daria","middleName":"","lastName":"Schneider-Matyka","suffix":""},{"id":328637750,"identity":"5a35d55a-487d-46d3-a74e-29982b622ab0","order_by":2,"name":"Anna Maria Cybulska","email":"","orcid":"","institution":"Pomeranian Medical University","correspondingAuthor":false,"prefix":"","firstName":"Anna","middleName":"Maria","lastName":"Cybulska","suffix":""},{"id":328637751,"identity":"4433d770-d1f3-4175-95f8-ccc6ddb5fa49","order_by":3,"name":"Karolina Skonieczna-Żydecka","email":"","orcid":"","institution":"Pomeranian Medical University in Szczecin","correspondingAuthor":false,"prefix":"","firstName":"Karolina","middleName":"","lastName":"Skonieczna-Żydecka","suffix":""},{"id":328637752,"identity":"383117c7-f589-43f2-95af-10e2d26cff20","order_by":4,"name":"Joanna Sołek-Pastuszka","email":"","orcid":"","institution":"Pomeranian Medical University","correspondingAuthor":false,"prefix":"","firstName":"Joanna","middleName":"","lastName":"Sołek-Pastuszka","suffix":""},{"id":328637753,"identity":"38c2aad5-e62f-410c-9b63-716ada58ae82","order_by":5,"name":"Elżbieta Grochans","email":"","orcid":"","institution":"Pomeranian Medical University","correspondingAuthor":false,"prefix":"","firstName":"Elżbieta","middleName":"","lastName":"Grochans","suffix":""}],"badges":[],"createdAt":"2024-06-27 19:53:21","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4650774/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4650774/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":60852876,"identity":"5df339b8-609f-4e18-a62f-ded91b4fed49","added_by":"auto","created_at":"2024-07-22 21:13:24","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":44941,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003eCorrelations? between levels of fatigue according to MFIS, anxiety according to GAD-7, insomnia according to AIS, depression according to PHQ-9 and perceived social support according to MSPSS\u003c/em\u003e\u003c/p\u003e","description":"","filename":"1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4650774/v1/20361b95921dce421b1fb12d.jpg"},{"id":72461390,"identity":"67f2860a-fe59-407f-811c-9a79c25251a6","added_by":"auto","created_at":"2024-12-27 11:16:43","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":470037,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4650774/v1/e2007195-e851-4f7a-877b-e1cf315755a8.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Psychosocial functioning of patients up to 6 months after hospitalization for COVID-19","fulltext":[{"header":"Introduction","content":"\u003cp\u003eIn the first months of the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) pandemic, scientific reports, but also frontline efforts to combat it, were focused on alleviating the symptoms of acute respiratory distress syndrome [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Today, however, it is known that the distant symptoms of coronavirus-2 infection go far beyond persistent respiratory impairment. The psychological effects of the COVID-19 pandemic include both individual symptoms and their syndromes. They are also disorders or groups of disorders and complex psychopathological problems. All the negative psychological consequences listed can overlap. The literature lists the following psychopathological symptoms/problems/disorders as a result of the detrimental effects of pandemic stressors: lowered mood states, anxiety states, nervous tension states, somatisation, impulsivity, irritability, frustration, anxiety disorders, post-traumatic stress disorder, post-traumatic stress disorder, depressive disorders, psychotic disorders, sleep disorders, abuse/increase in alcohol, psychoactive substance abuse, increase in suicide [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. The negative psychological consequences of COVID-19 due to the effects of the virus on the nervous system most commonly include, in addition to those mentioned, the following symptoms/problems: chronic fatigue/psychomotor slowing, cognitive impairment - difficulty concentrating, memory problems; - disorientation, reduced intellectual ability [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eResearch and clinical observations [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e] suggest that during a pandemic, many people manifest anxiety-related problems, including fear of contagion, of contact with potentially contaminated objects or surfaces, of the socio-economic consequences of the pandemic (e.g. job loss), compulsive checking and reasserting themselves about possible pandemic risks, and nightmares or intrusive thoughts [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. A number of studies have been conducted to assess the public's response to the COVID-19 pandemic, with survey data showing that coronavirus has a significant impact on psychological functioning. A Canadian survey conducted in early February 2020 found that a third of respondents were worried about the virus and 7% were very worried about it. Only four Canadians were infected at the time of the survey, but 7% of the population (2.6\u0026nbsp;million) were very concerned about the pandemic. There was also an increase in hygiene and isolation behaviour. In addition, those surveyed had doubts about the capacity of the health care system, which may also exacerbate fears about the consequences of infection. In the United States, already at the beginning of the outbreak, in late January and early February, the majority of respondents (66%) believed that coronavirus posed a real threat, and more than half (56%) were very concerned about the spread of the disease in the country [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe effects of the coronavirus pandemic were felt in a particular way by people hospitalised for SARS-CoV-2. For them, the uncertainty of tomorrow took on a different dimension. On the one hand, limited help in the fight for their own health, on the other hand, the loneliness associated with the new situation. The emergence of the new Covid-19 disease did not make all the other diseases known until then disappear. Many patients presented themselves to the doctor too late; rescue was impossible. Many were left on their own during the pandemic. Patients in hospitals found themselves in a difficult situation. Dependents relied solely on hospital staff, who were often overworked and did not have enough time to meet the basic needs of patients unable to live independently in time. Such patients were unable to contact their families because, for example, they did not have a telephone or were unable/unable to use it [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe sequelae of SARS-COV-2 infection and COVID-19 disease can result in a variety of cerebral disorders, which can be divided into two main groups. The first is severe cerebrovascular complications, characterised by acute vascular incidents such as haemorrhagic or ischaemic strokes. These involve damage to the large vessels and the occurrence of lesions in the small vessels of the brain. The second group of disorders are neuropsychiatric symptoms of varying severity, such as delirium, cognitive impairment (especially memory), severe affective disorders (depressive and anxiety) and psychotic disorders. COVID-19 patients also present with increased irritability, feelings of chronic fatigue, attention and memory impairment, incidents of impaired consciousness, often accompanied by agitation (psychomotor restlessness), and behavioural disturbances [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. However, the neuropsychological profiles of patients are not homogeneous. Certain symptoms and types of therapies used, as well as a severe course of the disease, have been shown to be associated with a higher risk of neuropsychiatric complications. One study indicated that symptoms of diarrhoea and the need for oxygen therapy are associated with a higher risk of severe and longer-lasting cognitive dysfunction [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Patients with headache, sleep disturbances, loss of smell and taste and requiring oxygen therapy present a greater degree of impairment in memory, attention and executive function, compared with patients without severe clinical COVID-19 symptoms [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Patients with clinical hypoxia and headaches performed worse on neuropsychological tests in terms of the overall cognitive index. Dysfunctions particularly affected the areas of memory, working memory and executive function, verbal fluency (phonological and phonetic) and mental plasticity. Patients with a subjective sense of cognitive decline presented higher levels of anxiety and depressive symptoms [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. In many patients, these dysfunctions are more persistent and persist at least six months after the illness. This necessitates an extended diagnostic workup to determine the individual profile of dysfunction present in a given patient, which facilitates the planning of appropriate therapy. This is particularly important in patients with a severe course of the disease, with more severe lung damage, in whom neuropsychiatric disorders, including cognitive dysfunction, anxiety, insomnia, depression, feelings of fatigue, fatigue, may be more severe and persist longer [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. The aim of this study was to relate correlations between selected factors of psychosocial functioning (anxiety, insomnia, fatigue, fatigue, depressiveness, perceived social support) of patients hospitalised for SARS-CoV-2 infection. The study presented here is intended to help assess the need for psychosocial support and to enable the selection of variables affected by the pandemic phenomenon.\u003c/p\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy participants characteristics\u003c/h2\u003e \u003cp\u003eThere were 97 participants included. The average age of respondents was 60.41\u0026thinsp;\u0026plusmn;\u0026thinsp;13.57 years. The majority of respondents were female (n\u0026thinsp;=\u0026thinsp;57; 58.76%), in a formal relationship (n\u0026thinsp;=\u0026thinsp;56; 57.70%), with higher (n\u0026thinsp;=\u0026thinsp;40; 41.24%) and secondary education (n\u0026thinsp;=\u0026thinsp;39; 40.20%) and living in a city of more than 100,000 inhabitants (n\u0026thinsp;=\u0026thinsp;71; 73.20%). The majority of respondents (n\u0026thinsp;=\u0026thinsp;67; 69.07%) rated their health. The vast majority (n\u0026thinsp;=\u0026thinsp;88; 90.70%) declared that the COVID-19 pandemic had reduced their social contacts to at least small extent. More than half of the respondents (n\u0026thinsp;=\u0026thinsp;52; 53.60%) indicated that they had NOT been vaccinated with all doses of COVID-19 vaccine.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003ePsychological state of study participants\u003c/h2\u003e \u003cp\u003eThe study analysed selected psychological variables (. Based on the results obtained according to the Athens Insomnia Scale (AIS), it was found that 39.20% (n\u0026thinsp;=\u0026thinsp;38) of the respondents had sleep disorders and 19.60% (n\u0026thinsp;=\u0026thinsp;19) had insomnia symptoms. When examining anxiety using the Generalised Anxiety Questionnaire (GAD-7), it was observed that the vast majority of respondents experienced anxiety of varying severity: 30.80% (n\u0026thinsp;=\u0026thinsp;32) had mild anxiety, 16.40% (n-17) moderate anxiety and 12.00% (n\u0026thinsp;=\u0026thinsp;12) severe anxiety. Furthermore, it was shown that for depression, according to the PHQ-9, only 36.10% (n\u0026thinsp;=\u0026thinsp;35)of respondents had no symptoms. As for the PHQ-9 results, severe de[pression was demonstrated in 5 (5.2%), slight in 34 (35.10)m average in 14 (14.4%) and moderate-severe in 9 (9.3%). Sesrciptive statistics of raw data are presented in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. (Scores according to the MFIS scale were used to assess fatigue levels. The mean score on the test was 23.18\u0026thinsp;\u0026plusmn;\u0026thinsp;7.90 points. According to the Multidimensional Scale of Perceived Social Support (MSPSS), it was shown that the mean score on the test was 6.85\u0026thinsp;\u0026plusmn;\u0026thinsp;5.93 points (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSummary statistics table (N\u0026thinsp;=\u0026thinsp;97)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePsychological variables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMin - Max\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eM\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e95% CI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eMe\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e95% CI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eSD\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eQ1 - Q3\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGAD 7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u0026ndash;21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6.848\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e6.109\u0026ndash;7.587\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e5.000\u0026ndash;7.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e5.933\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e2.00\u0026ndash;11.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAIS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u0026ndash;18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6.979\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e6.169\u0026ndash;7.790\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e5.000\u0026ndash;8.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e4.020\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e4.00\u0026ndash;9.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePHQ-9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u0026ndash;25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7.526\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e6.319\u0026ndash;8.732\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e5.000\u0026ndash;8.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e5.986\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e3.00\u0026ndash;10.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMSPSS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e23\u0026ndash;84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e71.691\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e69.322\u0026ndash;74.060\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e71.000\u0026ndash;77.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e11.754\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e65.00\u0026ndash;81.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMFIS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8\u0026ndash;40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e23.175\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e21.583\u0026ndash;24.768\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e20.000\u0026ndash;25.628\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e7.901\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e17.00\u0026ndash;29.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eMin - minimum, Max - maximum, M - mean, Me - median, SD - standard deviation, p -significance level, Q1 - quartile first, Q3 - quartile third, GAD-7 - Generalized Anxiety Disorder, AIS - The Athens Insomnia Scale, PHQ-9 - Patient Health Questionnaire-9, MSPSS - The Multidimensional Scale of Perceived Social Support, FSS - Fatigue Severity Scale, MFIS - Modified Fatigue Impact Scale, GAD-7 - Generalized Anxiety Disorder, AIS - The Athens Insomnia Scale, PHQ-9 - Patient Health Questionnaire-9\u003c/p\u003e \u003cp\u003e \u003cem\u003eAssociations between levels of fatigue according to MFIS, anxiety according to GAD-7, insomnia according to AIS, depression according to PHQ-9 and perceived social support according to MSPSS\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003eWe correlated raw scores form all surveys given to participants.\u003c/em\u003e Analysis of our own results showed statistically significant associations of insomnia, fatigue, social support, anxiety,:\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003ea negative, weak correlation between insomnia according to the AIS and depression according to the PHQ-9 (r=-0.195; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001),\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003ea positive, strong correlation between insomnia according to the AIS and fatigue according to the MFIS (r\u0026thinsp;=\u0026thinsp;0.468; p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001), meaning that as insomnia levels increase, fatigue levels increase;\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003enegative, weak correlation between insomnia according to AIS and perceived social support according to MSPSS (r=-0.267; p\u0026thinsp;\u0026lt;\u0026thinsp;0.0081);\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003epositive correlation of moderate power between GAD-7 anxiety and insomnia according to the AIS (r\u0026thinsp;=\u0026thinsp;0.428; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), meaning that as anxiety increases, insomnia increases;\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003ea positive, moderate correlation between anxiety according to the GAD-7 and fatigue according to the MFIS (r\u0026thinsp;=\u0026thinsp;0.384; p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001), meaning that as anxiety increases, fatigue increases;\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003ea negative moderate correlation between anxiety levels according to the GAD-7 and perceived social support according to the MSPSS (r=-0.301; p\u0026thinsp;\u0026lt;\u0026thinsp;0.0028), meaning that as anxiety levels increase, the level of perceived social support decreases;\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eA negative, weak correlation between perceived social support according to the MSPSS and fatigue according to the MFIS (r=-0.201; p\u0026thinsp;\u0026lt;\u0026thinsp;0.0484)\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003eCorrelogram is depicted in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eA great deal of attention and resources have been devoted to infection control, the search for effective drugs and vaccines, but the recognition of people whose mental state has been worsened by pandemic outbreaks has been relatively neglected [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. This is surprising given that mass tragedies such as infectious disease pandemics cause significant disruption to the daily functioning and psychological well-being of many people [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAnalysis of the results of our study showed that almost 40% of the respondents had sleep disturbances up to 6 months after hospitalisation for COVID-19, and almost one-fifth had insomnia symptoms. When examining anxiety using the Generalised Anxiety Questionnaire (GAD-7), it was observed that the vast majority of respondents experienced anxiety of varying severity. Furthermore, it was shown that for depression, according to the PHQ-9, only ⅓ of the respondents showed no symptoms. Similar results were obtained by other authors. For example, in a large study, more than half of the respondents showed symptoms of depression (defined as a total score\u0026thinsp;\u0026ge;\u0026thinsp;5 according to the PHQ-9), almost half showed symptoms of anxiety (defined as a total score\u0026thinsp;\u0026ge;\u0026thinsp;5 according to the GAD-7), more than ⅓ had symptoms of insomnia (defined as a total score\u0026thinsp;\u0026ge;\u0026thinsp;8 on the Insomnia Severity Scale - ISS) and almost \u0026frac34; of respondents showed stress-related symptoms (defined as a total score\u0026thinsp;\u0026ge;\u0026thinsp;9 on the Revised Event Impact Scale) [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. Fear of the unknown and uncertainty, reduced interpersonal contact can lead to the development of a number of psychiatric disorders and adverse behaviours, such as more frequent use of stimulants. During a pandemic, the number of people with negative mental health consequences is usually greater than the number of people affected by the infection. Furthermore, the psychological consequences of an epidemic may last longer than the epidemic itself [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. Therefore, it has been advocated that countries around the world, in addition to working to reduce the rate of SARS-CoV-2 transmission, should also conduct an analysis of the impact of COVID-19 on mental functioning [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn relation to the COVID-19 pandemic, both fear and anxiety are discussed. Anxiety can also be seen as a psychopathological symptom [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. Chronic or disproportionate fear and anxiety, can cause psychiatric disorders [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. During the COVID-19 pandemic, there was fear of infection, death and loss of a loved one, as well as fear of contact with people who may be infected [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. The fear is due to the speed of the spread of the virus and the fact that it is invisible. People also feared serious complications of COVID-19, forced hospitalisation and long quarantine. Another reason for fear is the possibility of transmitting the infection to loved ones who may not survive the disease. Fear of the coronavirus was due to its novelty and uncertainty about how the epidemic would unfold. Therefore, the fear of COVID-19 is much greater than the fear of seasonal influenza [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThere are a growing number of reports describing long-term neurological effects after COVID-19. The pathogenic effect of SARS-CoV-2 on the nervous system is likely to be multifactorial. Patients experience symptoms as a consequence of systemic disease, such as direct neuroinvasion of the central nervous system, peripheral nervous system involvement, and an immune-mediated post-infection mechanism. SARS-CoV-2 infection may lead to the development of Alzheimer's disease and may exacerbate Parkinson's disease in affected patients and increase the risk of stroke due to inflammatory damage to the blood vessel wall or consequent atrial fibrillation. Cytokine and autoimmunity induced by cross-reactivity between virus particles and central nervous system elements may contribute to the development of autoimmune diseases. Carda et al. distinguished two groups of patients according to the clinical sequelae resulting from COVID-19 infection: the first, in which cognitive impairment predominates, and the second, in which respiratory problems predominate. In the context of analysing the consequences of SARS-CoV-2 infection, the term post-acute COVID-19 syndrome (PC19, long-COVID) has emerged in the specialist literature to denote persistent multi-organ dysfunction after the acute phase of COVID-19. Chronic fatigue was experienced by more than half of the subjects. In comparison, in those with a severe course, this symptom appeared in 38% of the subjects. Most researchers point out an important methodological flaw in the assessment of cognitive impairment. The problem is the inhomogeneity of the study group and the lack of data on the functioning of the subjects prior to COVID-19. It should be emphasised that most of the studies considering cognitive impairment concerned subjects hospitalised as a result of the severe course of the disease. The results indicate a marked deterioration in cognitive functioning in COVID-19 survivors [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIncreased depression, anxiety and stress are consequences of difficult situations, and such is the state of the Covid-19 pandemic and associated hospitalisations, which were often accompanied by reduced interpersonal contacts [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. According to the results of our own study, almost \u0026frac14; of the respondents rated their health condition as very poor and the vast majority stated that the Covid-19 pandemic had reduced their social contacts. The results of our own study also showed that as the level of insomnia increases, the level of fatigue and anxiety increases and the level of perceived social support decreases. As anxiety levels increase, fatigue levels increase and levels of perceived social support decrease. Conversely, as the level of perceived social support increases, the level of fatigue decreases. A study was conducted in the Brazilian population to assess the severity of these factors. A total of 3,000 people participated in the study. It was found that the consumption of drugs, tobacco, medication and food increased in the study group (40.8%). Almost half of the respondents manifested symptoms of depression, anxiety and stress. These symptoms were more severe in women, those without children, students, patients with chronic diseases and respondents 15 who had contact with Covid-19 patients [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. It can be concluded that the Covid-19 pandemic exacerbated existing mental health disorders and contributed to the occurrence of new dysfunctions. Thus, it is important to conduct further research on the trauma associated with Covid-19 and to reduce its negative social impact [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eCovid-19 had a significant effect on changing the diurnal rhythm, quality and quantity of sleep in patients. A study by Scarpelli et al. of 5988 adults looked at sleep quality, mental health scores (according to depression, anxiety and stress scales) and frequency of dreams and nightmares, as well as related emotional aspects. It was found that Italians were more likely to have nightmares and dreams with frightening content during the pandemic. Predictive factors of frequent dream recall and nightmares were dependent on the daily experiences of the people included in the study[\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]. In a period of social isolation, limited mobility and social contacts, concerns about the economic situation, a sense of fear of infection in oneself and one's loved ones, loss of health or life, anxiety, depression, stress emerge, which cause quantitative and qualitative sleep disturbances in a large part of the population, posing a major threat to the health of the population. Sleep disturbances during the pandemic are exacerbated by retinal stimulation by electronic devices, as well as prolonged and/or night shift work. Insufficient sleep or irregular sleep-wake cycles can weaken the immune system, induce a pro-inflammatory state and lead to increased susceptibility to viral infections [\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eLimitations and Recommendations for further research\u003c/p\u003e \u003cp\u003eBased on the results of this study, some practical implications for professional practice could be proposed. A major strength of the study was the use of standardised tools adapted to Polish conditions, which greatly enriched the data presented. An important goal for therapists working in the mental health field could be the development of educational guidelines aimed at simultaneously minimising the risk of mental disorders in relation to hospitalisation. This study also shows some potential limitations that we hope future research will overcome. Firstly, the cross-sectional, correlational nature of our design, limits the ability to identify causal relationships. There is a lack of data on the prevalence of risk of psychosocial dysfunction from an earlier period before the pandemic, which could be relevant for differential effects of variables on the prevalence of risk of psychosocial dysfunction. Conducting studies taking into account different socio-cultural contexts and paying attention to other variables of interest (e.g. income level or social class) are some of the aspects to be considered in the future. Another limitation may be the problems of being able to generalise the data to other cultures. The assessment of the risk of psychosocial disorders and related factors was based solely on self-report measures of the constructs. Information from autobiographical narratives may be necessary to obtain a holistic picture of a person's behaviour. Assessment based on self-descriptive tools, may be distorted due to the desire to be perceived by society as an attractive person, i.e. with a tendency to avoid criticism and give more socially acceptable answers. This may result in overestimating health-promoting behaviours and underestimating undesirable behaviours. Despite its limitations, this study provides important findings and may provide a starting point for broader research to determine the relationships between depression, anxiety, fatigue, insomnia and social support among COVID-19 hospitalised patients.\u003c/p\u003e \u003cp\u003eAssociations between selected factors of psychosocial functioning (anxiety, insomnia, fatigue, fatigue, depression, perceived social support) were demonstrated among patients hospitalised for SARS-CoV-2 infection up to 6 months after hospitalisation. As insomnia increased, fatigue and anxiety increased and perceived social support decreased; as anxiety increased, fatigue increased and perceived social support decreased. The study presented here provides important associations and may help to assess the need for psychosocial support and provides a starting point for a larger study to determine the associations between depression, anxiety, fatigue, insomnia and social support among COVID-19 hospitalised patients.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eThe study was conducted between 01 December 2021 and 31 October 2022 in Szczecin, Poland. The study included 97 participants hospitalised for SARS-CoV-2 infection within a period of no more than six months before the date of enrollment.\u003c/p\u003e\n\u003cp\u003eGroup selection was random. No randomisation tool was used. It was based on participants who self-reported and met the inclusion criteria. Inclusion criteria we adopted were:\u0026nbsp;\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003eage \u0026ge;18 years,\u0026nbsp;\u003c/li\u003e\n \u003cli\u003ehistory of hospitalisation for COVID-19 no later than 6 months from the date of enrolment in the study, confirmed by a positive polymerase chain reaction (PCR)-test for SARS-CoV-2,\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eno clinically confirmed mental illness and\u003c/li\u003e\n \u003cli\u003e\u0026nbsp;informed consent.\u0026nbsp;\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eThe study was conducted in accordance with the current version of the Declaration of Helsinki. Permission to conduct the study was obtained from the Bioethics Committee of the Pomeranian Medical University in Szczecin, resolution no. KB-0012/161/2021. Previously prepared research tool sheets were personally distributed by a trained interviewer to the participants, who were to read the above information and agree to participate. Participants were informed about the purpose of the study and anonymity, and were given the opportunity to ask questions and receive comprehensive explanations. Each patient gave written informed consent to participate in the study and to use data from their medical records. Every effort was made to protect patient privacy and anonymity.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eSurveys\u003c/p\u003e\n\u003cp\u003eThe study was carried out by means of a diagnostic survey using the questionnaire technique. Standardised tools adapted to Polish conditions were used. These included:\u003c/p\u003e\n\u003cp\u003e1. Modified Fatigue Impact Scale - (MFIS)\u003c/p\u003e\n\u003cp\u003eIt is a list of 21 statements that describe the impact that fatigue can have on a person. The statements address, among other things, absentmindedness, difficulties with decision-making, motivation, concentration, performance in physical activities, or the need for frequent rest. The scale consists of three parts (F-1, F-2, F-3). Part F-1 is 9 questions assessing the patient\u0026apos;s subjective feelings about the impact of fatigue on physical functioning. F-2 consists of 10 questions relating to the impact of fatigue on cognitive function and F-3 contains two questions assessing psychosocial function. Between 9 and 45 points can be obtained for the first part of the questionnaire, between 10 and 50 points are obtained for the assessment of cognitive function and between 2 and 10 points are obtained for the assessment of psychosocial function. In the overall assessment with the MFIS questionnaire, 21 to 105 points are obtained. The higher the values obtained, the greater the impact of fatigue on the patient\u0026apos;s functioning. The MFIS has good internal consistency - Cronbach\u0026apos;s alpha of 0.81 and reliability of below 0.87 for the total scale and its subscales. The MFIS scale has been validated for Polish conditions [17,18,19].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e2. The Patient Health Questionnaire-9 (PHQ-9)\u003c/p\u003e\n\u003cp\u003eThe questionnaire is designed to screen for depression. It was developed based on the diagnostic criteria for depression contained in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). The PHQ-9 is a questionnaire consisting of nine core questions and one supplementary question. The maximum score possible is 27 and indicates the highest possible severity of depression. A score of less than five points indicates normal, five to nine points mild depression, 10 to 14 points moderate depression, 15 to 19 points moderately severe depression, and 20 to 27 points severe depression. The PHQ-9 showed significant positive internal consistency (Cronbach\u0026apos;s alpha = 0.7) and the scores of each of its nine items positively correlated (0.31-0.68; \u003cem\u003ep\u0026nbsp;\u003c/em\u003e\u0026lt; 0.05) with the total score. The convergent validity was significantly positive (r = 0.58; \u003cem\u003ep\u0026nbsp;\u003c/em\u003e\u0026lt; 0.05) [20,21].\u003c/p\u003e\n\u003cp\u003e3 The Athens Insomnia Scale (AIS)\u003c/p\u003e\n\u003cp\u003eThe Athens Insomnia Scale (AIS) is a short, eight-item scale that allows the quantitative measurement of insomnia symptoms based on ICD-10 criteria. The scale is a self-report tool, consisting of eight statements about different insomnia symptoms. Each item is rated by the respondent on a scale of 0-3 points, where 0 indicates the absence of the symptom in question, 3 its significant severity. The total scale score ranges from 0-24 points. The first five items relate to sleep-related symptoms (difficulty falling asleep, waking up during the night, waking up early in the morning, sleep duration and quality) and correspond to criterion A of the ICD-10 diagnosis of inorganic insomnia. A given symptom should be ticked if it occurred at least three times a week, for at least one month, which is consistent with the duration and frequency of symptoms required for the ICD-10 diagnosis of insomnia (criterion B). The remaining three itmes relate to daytime functioning (well-being, physical and mental performance, sleepiness) and correspond to criterion C of the ICD-10 diagnosis of insomnia, which includes complaints of daytime consequences of insomnia. The internal consistency of the Polish version measured with Cronbach\u0026apos;s alpha was .90 and the test-retest reliability was .92 [22,23].\u003c/p\u003e\n\u003cp\u003e4. The Generalized Anxiety Questionnaire (GAD-7)\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe Generalized Anxiety Questionnaire (GAD-7, Generalized Anxiety Disorder) is a screening tool used to determine feelings associated with generalized anxiety syndrome. The questionnaire consists of 7 questions. Each question has a score from 1 to 3 points, the sum of which indicates the severity of the anxiety: 0-4 points (no anxiety), 5-9 ( mild anxiety), 10-14 (moderate anxiety) and 15-21 ( severe anxiety). The internal consistency of the Polish version measured with Cronbach\u0026apos;s alpha was .95 [24,25].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e5. The Multidimensional Scale of Perceived Social Support (MSPSS)\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eA tool proposed by Gregory Zimet and colleagues (The Multidimensional Scale of Perceived Social Support - MSPSS) takes into account the multidimensionality of perceived social support, considering three primary sources of support: significant other, family and friends. The scale consists of 12 statements to which the interviewee refers using a seven-point Likert scale [26].\u003c/p\u003e\n\u003cp\u003e6. Self-administered questionnaire\u003c/p\u003e\n\u003cp\u003eThe self-administered survey questionnaire included closed and semi-open questions to obtain selected socio-demographic data for the participants, i.e. age, education level, marital status, place of residence and professional activity.\u003c/p\u003e\n\u003cp\u003eStatistical analyses\u003c/p\u003e\n\u003cp\u003eThe normality of the distribution of continuous variables was verified using the Shapiro-Wilk test. Due to due to significant deviations from a normal distribution, the following were used to describe continuous variables: medians and interquartile ranges. Qualitative variables were reported presented by number and percentage. Continuous variables were correlated using the Spearman rank method. The significance level was taken as two-sided p=0.05. Analyses were performed using MedCalc, version 22.013 (Ostend, Belgium).\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAuthor Contributions\u003c/strong\u003e: Conceptualisation, K.R.; methodology, A.M.C.; software, E.G; validation, J.S.P. formal analysis, K.R. investigation, D.S.M.; resources, K.R.; data curation, E.G.; writing\u0026mdash;original draft preparation, K.R.; writing\u0026mdash;review and editing, K.R; visualisation, A.M.C.; supervision, K.S; project administration, E.G.; funding acquisition, K.R. All authors have read and agreed to the published version of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u0026nbsp;\u003c/strong\u003eThis research received no external funding.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInstitutional Review Board Statement:\u0026nbsp;\u003c/strong\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInformed Consent Statement:\u0026nbsp;\u003c/strong\u003eInformed consent was obtained from all subjects involved in the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability Statement:\u0026nbsp;\u003c/strong\u003eThe datasets used and/or analysed during the current study available from the corresponding author on reasonable request..\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments:\u003c/strong\u003e We thank all participants for their participation and all the staff of the survey team for their efforts that made this study possible.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflicts of Interest:\u0026nbsp;\u003c/strong\u003eThe authors declare no conflicts of interest.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eBodnar, B., Patel, K., Ho, W., Luo, J.J. \u0026amp; Hu, W. 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Sleep Sci. \u003cstrong\u003e13\u003c/strong\u003e, 199-209 (2020).\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"insomnia, COVID-19, depressiveness, anxiety, perceived social support, fatigue, fatigue","lastPublishedDoi":"10.21203/rs.3.rs-4650774/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4650774/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eThe aim of this study was to determine the associations between anxiety, insomnia, fatigue, fatigue, depression, perceived social support of patients hospitalised for SARS-CoV-2 infection not later than up to 6 months after hospitalisation. The study included 97 participants hospitalised for SARS-CoV-2 infection up to 6 months after enrollment. The study was conducted with the method of a diagnostic survey using the questionnaire technique: Modified Fatigue Impact Scale, The Patient Health Questionnaire-9, The Athens Insomnia Scale, The Generalized Anxiety Questionnaire, The Multidimensional Scale of Perceived Social Support, Self-administered questionnaire. Statistically significant: negative correlation between AIS and PHQ-9 scores (r=-0.195; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), positive between AIS scores and MFIS (r\u0026thinsp;=\u0026thinsp;0.468; p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001), negative between AIS scores and MSPSS (r=-0.267; p\u0026thinsp;\u0026lt;\u0026thinsp;0.0081), positive between AIS and GAD-7 scores (r\u0026thinsp;=\u0026thinsp;0.428; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), positive between GAD-7 and MFIS scores (r\u0026thinsp;=\u0026thinsp;0.384; p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001), negative between GAD-7 and MSPSS scores (r=-0.301; p\u0026thinsp;\u0026lt;\u0026thinsp;0.0028), negative correlation, strong between MSPSS and MFIS scores (r=-0.201; p\u0026thinsp;\u0026lt;\u0026thinsp;0.0484) were detected. The study presented here provides important associations and may help to assess the need for psychosocial support and provides a starting point for a larger study to determine the associations between depression, anxiety, fatigue, insomnia and social support among COVID-19 hospitalised patients.\u003c/p\u003e","manuscriptTitle":"Psychosocial functioning of patients up to 6 months after hospitalization for COVID-19","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-07-22 21:13:19","doi":"10.21203/rs.3.rs-4650774/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"8c5c4765-30fa-44c9-a0b4-94da2a89fa8b","owner":[],"postedDate":"July 22nd, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":34784242,"name":"Biological sciences/Psychology"},{"id":34784243,"name":"Health sciences/Health care"},{"id":34784244,"name":"Health sciences/Health occupations"},{"id":34784245,"name":"Health sciences/Medical research"},{"id":34784246,"name":"Health sciences/Risk factors"}],"tags":[],"updatedAt":"2025-06-30T06:38:32+00:00","versionOfRecord":[],"versionCreatedAt":"2024-07-22 21:13:19","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4650774","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4650774","identity":"rs-4650774","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}