A worldwide public health crisis was announced on 30 January 2020, by the World Health Organization, which then formally recognized the SARS-CoV-2 epidemic as a pandemic [29].. On 19 June 2020, the WHO documented more than 80 million SARS-CoV-2 patients from impacted nations [30]. Scientists tend to link COVID-19 to various psychiatric problems in many populations, including the infected people and the physicians who treat them [31, 32]. This would be daunting for doctors; consequently, psychological and social services are essential to alleviate physical and mental health issues in the medical community [33, 34].
Few papers investigate the psychological impact of COVID-19 on infected patients; nonetheless, none of them has demonstrated the effect of isolation on these patients. Our study is the first in Egypt to determine the psychiatric problems in home-isolated and hospital-isolated patients suffering from COVID-19 and compare them. The current research showed that most patients had initial responses of anxiety, fear, and sadness with a more negative attitude about their prognosis, with most believing that their illness will affect their future. Negative emotional responses to the disease can be illustrated by the prevalent reported data on the disease and the rapidly increasing number of deaths caused by it. Some patients [19] experienced thoughts of suicide after being infected, which was clinically more prevalent in patients in home isolation than hospital isolation (six patients).
Due to challenges caused by the pandemic, such as economic hardship, social alienation, decreased access to public medical and mental health services, and the stigma caused by infection with COVID-19, suicide rates could be elevated among home-isolated patients [35, 36].
Our results reported a statistically significant increase in the abnormal scores of HADS–Depression in the home-isolated group (69.7%) compared to the hospital-isolated group (32.6%). Moreover, we detected that 32.6% from group A and 39.1% from group B had abnormal scores of HADS–Anxiety, which means that the patients had considerable symptoms of anxiety or depression. We found 66.7% and 87.2% scored positive by the Davidson Trauma Scale (DTS) in the home-isolated group and group B, respectively, indicating the presence of post-traumatic stress symptoms.
Zhang, J and his colleagues documented a study-sized sample of 144 cases, in which they found severe anxiety (34%) and depression (28%) for patients admitted to isolation wards. Whereas other research included 26 patients, it found higher anxiety and depressive symptoms in hospital admitted patients. The third study that recruited 57 patients with COVID-19 observed that depression in recently cured (COVID-19) patients were 30% [37]. A significant sample size study (n = 714) of hospitalized COVID-19 patients found post-traumatic stress symptoms in 96.2% of them [6].
In a recently released meta-analysis and systematic review that incorporated 1963 studies and 87 preprints, the number of coronavirus cases was about 3559 from different countries. In contrast, there were 47 studies of SARS-CoV involving 2068 subjects, 13 studies involving MERS-CoV, and 12 reviews documenting SARS-CoV-2 (976 cases). During acute illness, the most frequent symptoms of patients diagnosed with SARS or MERS were confusion (27.9%), depression (32.6%), anxiety (35.7%), and poor memory (34.1%). By comparing the data obtained on COVID-19 patients, there was evidence of dementia (confusion 65%). After discharge from the hospital, 33% of assessed COVID-19 met the requirements for the dysexecutive syndrome [38].
Pathology of different symptoms can be distinct due to inflammation, as some studies indicate that the central nervous system may be affected by COVID-19, increasing the inflammatory immune response. In subjects with COVID-19, there is an elevation in serum C-reactive protein and high levels of pro-inflammatory cytokines and decreased total blood lymphocyte counts [38]. Neurotropic SARS-CoV-2 infection hypoxia, cerebrovascular events, and steroid therapy have impact on neurological status. These various biological mechanisms have been proposed to function as mediators of psychological impairment in COVID-19; however, there is insufficient evidence [39]. Similarly, like other physical disorders, social influences can directly intensify the psychiatric effects of exposure to COVID-19. Moreover, quarantine procedures can contribute to insomnia and psychological distress [40].
The current findings regarding the impact of the isolation setting type on presenting the patients’ psychiatric symptoms can be illustrated from various perspectives. First, hospitalized patients may have elevated post-traumatic stress levels related to the transition to a new environment. Since the human and physical hospital setting is often psychologically unhealthy, it can be loud, sensory-deprived, and disorienting. These environmental factors inhibit mobility, intensify disorientation, disturb sleep, and lead to social isolation, in addition to anxiety and apprehension. Furthermore, the deterioration of the physical condition, along with the inability to communicate with their family, fear of mortality, knowledge of the medical status of relatives and colleagues, as well as knowledge of other infected patients who died or were admitted to ICU [38, 39] can lead to increased post-traumatic symptoms in these patients. Isolation at home makes patients feel relaxed and safe with their familiar social surroundings; however, other factors may lead to adverse psychological effects, including the emergence of instantaneous stigma as a significant defect of infection due to individuals’ discrimination quarantine. This stigma may be prevalent when isolated at home and shunned by local neighbors, besides being afraid of transmitting the disease to their relatives and fear of sudden complications without receiving instant medical aid while in home isolation.
Moreover, after being discharged from the hospital, several patients treated for COVID-19 reported discrimination [40].
We found that the medical occupation has a protective effect against having abnormal HADS–Depression scores in COVID-19 patients; nevertheless, it increases the risk of having positive scores in the DTS. Some literature investigated the psychological harm caused by pandemics to medical staff who suffered from psychiatric symptoms like anxiety, depression, terror, and trauma. They reported that multiple factors, including having respiratory or digestive symptoms, negative coping style, and job burnout, participate in the anxiety or depression of healthcare workers [41]. We found that lower education levels (primary, preparatory, and secondary) were found to be risk factors for having abnormal HADS–Anxiety scores in COVID-19 patients. That was consistent with the study of Bjelland and his collaborates who found that low educational levels were significantly associated with both anxiety and depression [42].
The limitations of the current analysis must be considered when analyzing the results, which involve a limited sample size. Participants of the current research had mild to moderate cases of COVID-19 infection, in addition to the lack of appropriate reference groups to compare them with the current participants. Finally, we did not include quantitative biochemical tests, such as blood markers, to measure the inflammatory immune response.
