Association between self-perceived physical functional capacity and mental health of patients after hospitalization for covid-19
Associação entre a autopercepção da capacidade funcional física e a saúde mental de pacientes após hospitalização por covid-19
Thalya Adryane Pereira de Lima Ueda, Valéria Amorim Pires Di Lorenzo, Marcela Maria Carvalho da Silva, Heloíse Cazangi Borges, Daiane Roberta Viana, Juliano Ferreira Arcuri
Abstract
Background: The post-acute phase of COVID-19 frequently leads to persistent physical and psychological sequelae. However, the relationship between psychological problems, such as anxiety and depression, and functional capacity remains unclear. Aim: To verify the association between anxiety and depression symptoms and the loss of self-perceived functional capacity in patients after COVID-19–related hospital admission. Methods: This is an observational analytical cross-sectional study conducted in individuals after hospital discharge due to COVID-19. Participants completed the Short Form-36 Health Survey (SF-36) and the Hospital Anxiety and Depression Scale (HADS) via online videoconference. Correlation analyses and multiple linear regression models were performed to explore associations between HADS and SF-36 domains. Group comparisons were conducted between participants with and without anxiety or depressive symptoms. Results: The sample was composed by 88 patients who were hospitalized for 12.88±10.82 days, and 42% required intensive care. Anxiety symptoms were present in 45.45% of participants, while depressive symptoms were identified in 43.18%. Physical functioning was independently associated with anxiety (p<0.001; R2=0.25), whereas energy/fatigue was independently associated with both anxiety and depression (p<0.05; R2=0.31). Participants with anxiety showed significantly worse physical functioning, pain, vitality, general health, and emotional well-being scores. Those with depressive symptoms exhibited worse physical functioning, vitality, role limitations, pain, emotional well-being and social functioning. Conclusion: Anxiety symptoms were associated with lower physical functional capacity and worse scores in multiple quality-of-life domains. Although depressive symptoms were not independently associated with functional capacity, they were associated with worse scores in vitality, pain, and social and emotional functioning.
Keywords
Resumo
Introdução: A fase pós-aguda da COVID-19 frequentemente resulta em prejuízos físicos e psicológicos persistentes. Contudo, a relação entre problemas psicológicos, como ansiedade e depressão, e a capacidade funcional permanece pouco clara. Objetivo: Verificar a associação entre sintomas de ansiedade e depressão e a perda da capacidade funcional autopercebida em pacientes após hospitalização por COVID-19. Métodos: Estudo transversal observacional realizado em indivíduos avaliados após a alta hospitalar por COVID-19. Os participantes responderam ao SF-36 e à HADS por videoconferência. Foram realizadas correlações e regressões lineares múltiplas para explorar associações entre os escores da HADS e os domínios do SF-36. Comparações entre grupos com e sem sintomas de ansiedade ou depressão foram feitas. Resultados: A amostra incluiu 88 pacientes, hospitalizados por 12,88±10,82 dias; 42% necessitaram de cuidados intensivos. Sintomas de ansiedade estavam presentes em 45,45% dos participantes, e sintomas de depressão em 43,18%. A capacidade funcional associou-se de forma independente à ansiedade (p<0.001; R2=0.25), enquanto energia/fadiga associou-se independentemente tanto à ansiedade quanto à depressão (p<0.05; R2=0.31). Pacientes com ansiedade apresentaram pior capacidade funcional, dor, vitalidade, saúde geral e bem-estar emocional. Aqueles com sintomas de depressão apresentaram pior capacidade funcional, menor vitalidade, maiores limitações, mais dor, pior bem-estar emocional e pior funcionamento social. Conclusão: Sintomas de ansiedade foram associados à menor capacidade funcional e a piores escores em vários domínios de qualidade de vida. Embora os sintomas de depressão não tenham se associado de forma independente à capacidade funcional, estiveram relacionados a piores escores de vitalidade, dor e funcionamento social e emocional.
Palavras-chave
Referências
1. Pavli A, Theodoridou M, Maltezou HC. Post-COVID syndrome: incidence, clinical spectrum, and challenges for primary healthcare professionals. Arch Med Res. 2021;52(6):575-81. PMid:33962805.
2. Brasil. Ministério da Saúde. Covid-19 no Brasil. 2023 [citado em 2023 Ago 11]. Disponível em: https://infoms.saude.gov.br/ extensions/covid-19
3. Barbosa LNF, Melo MCBD, Cunha MCV, Albuquerque EM, Costa JM, Silva EFF. Brazilian’s frequency of anxiety, depression and stress symptoms in the COVID-19 pandemic. Rev Bras Saude Mater Infant. 2021;21:413-9. https:// doi.org/10.1590/1806-9304202100S200005.
4. Carvalho MCT, Jesus BMB, Castro VL, Trindade LMD. O impacto na qualidade de vida nos indivíduos pós Covid-19: o que mudou? RSD. 2021;10:e219101421769. https:// doi.org/10.33448/rsd-v10i14.21769.
5. Deng J, Zhou F, Hou W, Silver Z, Wong CY, Chang O, et al. The prevalence of depression, anxiety, and sleep disturbances in COVID‐19 patients: a meta‐analysis. Ann N Y Acad Sci. 2021;1486(1):90-111. PMid:33009668.
6. Menezes ADS Jr, Barbosa VA, Laranjeira TDA, D’Dalarponio PAT, Dutra MBF, Gomes JMPF, et al. Alterações da ressonância magnética cardíaca em atletas na era pós-covid: uma revisão de literatura. RSD. 2023;12:e7212943242. https://doi.org/10.33448/rsd-v12i9.43242
7. National Institute for Health and Care Excellence (Great Britain), editor. COVID-19 rapid guideline: Managing the long-term effects of COVID-19. London: National Institute for Health and Care Excellence (NICE); 2020.
8. OPAS: Organização Pan-Americana da Saúde. OPAS apoia países em estudo da condição pós-COVID-19 e na elaboração de diretrizes para atenção aos pacientes. 2022 [citado em 2023 Ago 16]. Disponível em: https://www.paho.org/ pt/noticias/23-6-2022-opas-apoia-paises-em-estudo-da-condicao-pos-covid-19-e-na-elaboracao-diretrizes
9. Fernández-de-las-Peñas C, Palacios-Ceña D, Gómez- Mayordomo V, Cuadrado ML, Florencio LL. Defining Post-COVID Symptoms (Post-Acute COVID, Long COVID, Persistent Post-COVID): an integrative classification. IJERPH. 2021;18(5):2621. PMid:33807869.
10. Silva MMC, Viana DR, Colucci MG, Gonzaga LA, Arcuri JF, Frade MC, et al. Effects of a cardiopulmonary telerehabilitation using functional exercises in individuals after COVID-19 hospital discharge: a randomized controlled trial. J Telemed Telecare. 2023;31(3):311-9. https:// doi.org/10.1177/1357633X231188394. PMid:37559399.
11. Hill EL, Mehta HB, Sharma S, Mane K, Singh SK, Xie C, et al. Risk factors associated with post-acute sequelae of SARS-CoV-2: an N3C and NIH RECOVER study. BMC Public Health. 2023;23(1):2103. PMid:37880596.
12. Ware JE Jr, Sherbourne CD. The MOS 36-ltem Short-Form Health Survey (SF-36): I. Conceptual framework and item selection. Med Care. 1992;30(6):473-83. PMid:1593914.
13. Laguardia J, Campos MR, Travassos C, Najar AL, Anjos LA, Vasconcellos MM. Brazilian normative data for the Short Form 36 questionnaire, version 2. Rev Bras Epidemiol. 2013;16(4):889-97. PMid:24896594.
14. Botega NJ, Bio MR, Zomignani MA, et al. Transtornos do humor em enfermaria de clínica médica e validação de escala de medida (HAD) de ansiedade e depressão. Rev Saude Publica. 1995;29:359-63.
15. Faro A. Análise Fatorial Confirmatória e Normatização da Hospital Anxiety and Depression Scale (HADS). Psicol Teor Pesqui. 2015;31:349-53.
16. Browner WS, Newman TB, Pletcher MJ. Estimativa do tamanho da amostra: aplicações e exemplos. In: Hulley SB, Cummings SR, Browner WS, Grady DG, Newman TB. Delineando a pesquisa clínica. Porto Alegre: Artmed; 2003. p. 108-9.
17. WHO: World Health Organization. Depression and Other Common Mental Disorders. Geneva: WHO; 2024 [citado em 2023 Ago 16]. Disponível em: https://www.who.int/ publications/i/item/depression-global-health-estimates
18. Nochaiwong S, Ruengorn C, Thavorn K, Hutton B, Awiphan R, Phosuya C, et al. Global prevalence of mental health issues among the general population during the coronavirus disease-2019 pandemic: a systematic review and meta-analysis. Sci Rep. 2021;11(1):10173. PMid:33986414.
19. Kibria MG, Kabir R, Rahman US, Ahmed S, Amin SS, Rahman MM, et al. Prevalence and factors associated with depression and anxiety among COVID-19 survivors in Dhaka city. Front Psychiatry. 2024;15:1280245. PMid:38322144.
20. Ferrando SJ, Lynch S, Ferrando N, Dornbush R, Shahar S, Klepacz L. Anxiety and posttraumatic stress in post-acute sequelae of COVID-19: prevalence, characteristics, comorbidity, and clinical correlates. Front Psychiatry. 2023;14:1160852. PMid:37333906.
21. Shahar S, Lynch S, Dornbush R, Klepacz L, Smiley A, Ferrando SJ. Frequency and characteristics of depression and its association with diminished quality of life in a Cohort of individuals with post-acute sequelae of COVID-19. Neuropsychiatr Dis Treat. 2023;19:2069-79. PMid:37810951.
22. Laskovski L, Felcar JM, Fillis MMA, Trelha CS. Risk factors associated with limited functional status among out-of-hospital patients 30 days and one year after a diagnosis of COVID-19: a cohort study. Sci Rep. 2023;13(1):3584. PMid:36869060.
23. Liu K, Zhang W, Yang Y, Zhang J, Li Y, Chen Y. Respiratory rehabilitation in elderly patients with COVID-19: a randomized controlled study. Complement Ther Clin Pract. 2020;39:101166. PMid:32379637.
24. Manning K, Eades ND, Kauffman BY, Long LJ, Richardson AL, Garey L, et al. Anxiety sensitivity moderates the impact of COVID-19 perceived stress on anxiety and functional impairment. Cognit Ther Res. 2021;45(4):689-96. PMid:33500595.
25. Sudre CH, Murray B, Varsavsky T, Graham MS, Penfold RS, Bowyer RC, et al. Attributes and predictors of long COVID. Nat Med. 2021;27(4):626-31. PMid:33692530.
26. Milaneschi Y, Kappelmann N, Ye Z, Lamers F, Moser S, Jones PB, et al. Association of inflammation with depression and anxiety: evidence for symptom-specificity and potential causality from UK Biobank and NESDA cohorts. Mol Psychiatry. 2021;26(12):7393-402. PMid:34135474.
27. Soares MN, Eggelbusch M, Naddaf E, Gerrits KHL, van der Schaaf M, van den Borst B, et al. Skeletal muscle alterations in patients with acute Covid‐19 and post‐acute sequelae of Covid‐19. J Cachexia Sarcopenia Muscle. 2022;13(1):11-22. PMid:34997689.
28. Taquet M, Luciano S, Geddes JR, Harrison PJ. Bidirectional associations between COVID-19 and psychiatric disorder: retrospective cohort studies of 62 354 COVID-19 cases in the USA. Lancet Psychiatry. 2021;8(2):130-40. PMid:33181098.
29. Mazza MG, Palladini M, De Lorenzo R, Magnaghi C, Poletti S, Furlan R, et al. Persistent psychopathology and neurocognitive impairment in COVID-19 survivors: effect of inflammatory biomarkers at three-month follow-up. Brain Behav Immun. 2021;94:138-47. PMid:33639239.
30. Pereira MD, Oliveira LCD, Costa CFT, et al. A pandemia de COVID-19, o isolamento social, consequências na saúde mental e estratégias de enfrentamento: uma revisão integrativa. RSD. 2020;9:e652974548.
31. Greenhalgh T, Knight M, A’Court C, Buxton M, Husain L. Management of post-acute covid-19 in primary care. BMJ. 2020;370:m3026. PMid:32784198.
Submetido em:
25/03/2025
Aceito em:
11/03/2026
Facebook
LinkedIn
Mendeley
Reddit
Email