Behavioral, Emotional Problems and Fatigue in Adolescents After COVID-19 Infection: A Cross-Sectional Study

Year 2022, Volume: 16 Issue: 6, 487 - 494, 30.11.2022

Elif Akçay , Esra Çöp , Gülser Şenses Dinç , Zeynep Göker , Aslınur Özkaya Parlakay , Müge Mutlu Betül Damla Demirel Begüm Kırmızı

https://doi.org/10.12956/tchd.1010956

Abstract

Objective: This study aimed to investigate behavioral, emotional problems and fatigue in adolescents after COVID-19 infection. Also, we examined relationships between baseline inflammation levels, fatigue, and the current behavioral and emotional problems of adolescents.

Material and Methods: A total of 110 adolescents (56 boys, 50.9%, mean age 14.72 years) and their parents were included in the study. Psychiatric assessments of the adolescents were performed 7.31±2.35 months after discharge from hospital. Behavioral and emotional problems was assessed using the Child Behavior Checklist (CBCL) 6-18 parent-rated questionnaire.

Results: We collected baseline inflammatory markers including C-reactive protein (CRP), the neutrophil/lymphocyte ratio (NLR), the monocyte/lymphocyte ratio (MLR), and the systemic immune-inflammation index (SII). The proportions of adolescents that were in the clinical range in at least one behavioral and emotional domain were as follows: 44.5% in the entire sample, 35.7% in boys, and 53.7% in girls. Thought problems were the most common problems in the entire sample (25.5%). The rates of internalizing and externalizing symptoms were 33.6% and 16.4%, respectively. Somatic and attention symptoms were more frequent in females than in males. Inflammatory marker levels did not correlate with behavioral and emotional scores. Fatigue symptoms were determined in 36.4% of all adolescents. We found that somatic and attention problems are more common in fatigued adolescents.

Conclusion: Our findings demonstrated that screening for behavioral, emotional problems, and fatigue in adolescents with COVID-19 infection is necessary. Future studies with a follow-up design are needed to determine whether a relationship exists between behavioral, emotional problems and baseline inflammation levels after COVID-19 infection.

Keywords

COVID-19, Mental health, Adolescent, Inflammation, Fatigue

Thanks

We are extremely grateful to all adolescents and their families for taking part. We would like to thank the Pediatric Infectious Diseases Unit of Ankara City Hospital and all healthcare professionals who treated the children with great devotion during the pandemic.

COVİD-19 Enfeksiyonu Sonrası Ergenlerde Davranışsal, Emosyonel Problemler ve Yorgunluk: Kesitsel Bir Çalışma

Abstract

Amaç: Bu çalışma, COVİD-19 enfeksiyonu sonrası ergenlerde davranışsal, emosyonel problemler ve yorgunluk belirtilerini araştırmayı amaçlamıştır. Ayrıca, ergenlerin başlangıç inflamasyon düzeyleri ile mevcut davranış, emosyonel problemler ve yorgunluk belirtileri arasındaki ilişkiler incelenmiştir.

Gereç ve Yöntemler: Çalışmaya toplam 110 ergen (56 erkek, %50.9, yaş ortalaması 14.72 yıl) ve ebeveynleri dahil edildi. Ergenlerin psikiyatrik değerlendirmeleri hastaneden taburcu olduktan 7.31±2.35 ay sonra yapılmıştır. Ergenlerdeki davranış, emosyonel problemler, Çocuk Davranışı Kontrol Listesi (CBCL) 6-18 ebeveyn formu kullanılarak değerlendirilmiştir.

Bulgular: COVİD-19 tanı anındaki C-reaktif protein (CRP), nötrofil/lenfosit oranı (NLR), monosit/lenfosit oranı (MLR) ve sistemik immün-enflamasyon indeksi (SII) dahil olmak üzere temel inflamatuar belirteçleri geriye dönük olarak saptanmıştır. En az bir davranışsal ve emosyonel problem alanında klinik aralıkta olan ergenlerin oranı tüm örneklemde %44.5, erkeklerde %35.7 ve kızlarda %53.7 olarak bulunmuştur. Düşünce sorunları tüm örneklemde (%25.5) en sık görülen sorunlar olarak bulunurken; içe yönelim ve dışa yönelim belirtilerinin oranları sırasıyla %33.6 ve %16.4 olarak saptanmıştır. Somatik ve dikkat belirtileri kadınlarda erkeklere göre daha sık olduğu bulunmuştur. İnflamatuar belirteç düzeyleri ile davranışsal ve emosyonel problem skorları arasında korelasyon saptanmamıştır. Tüm ergenlerin %36.4’ünde yorgunluk belirtileri saptanmıştır. Yorgunluk olan ergenlerde somatik ve dikkat problemlerin daha fazla olduğu bulunmuştur.

Sonuç: Bulgularımız, COVİD-19 enfeksiyonu olan ergenlerde davranışsal, emosyonel problemler ve yorgunluk belirtileri taramasının gerekli olduğunu göstermiştir. COVİD-19 enfeksiyonu sonrası davranışsal, emosyonel problemler ile başlangıç inflamasyon seviyeleri arasında bir ilişki olup olmadığını belirlemek için izlem çalışmalarına ihtiyaç vardır.

Keywords

COVID-19, ruh sağlığı, ergen, inflamasyon, yorgunluk

References

• World Health Organization. WHO Director‐General’s opening remarks at the media briefing on COVID‐19–11 March. 2020.
• 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;8:130-40.
• Marques de Miranda D, da Silva Athanasio B, Sena Oliveira AC, Simoes-E-Silva AC. How is COVID-19 pandemic impacting mental health of children and adolescents? Int J Disaster Risk Reduct 2020 ;51:101845.
• Rogers JP, Chesney E, Oliver D, Pollak TA, McGuire P, Fusar-Poli P, et al. Psychiatric and neuropsychiatric presentations associated with severe coronavirus infections: a systematic review and meta-analysis with comparison to the COVID-19 pandemic. Lancet Psychiatry 2020;7:611-27.
• Zhou H, Lu S, Chen J, Wei N, Wang D, Lyu H, et al. The landscape of cognitive function in recovered COVID-19 patients. J Psychiatr Res 2020;129:98-102.
• Mazza MG, De Lorenzo R, Conte C, Poletti S, Vai B, Bollettini I, et al. Anxiety and depression in COVID-19 survivors: Role of inflammatory and clinical predictors. Brain Behav Immun 2020;89:594-600.
• Liu D, Baumeister RF, Zhou Y. Mental health outcomes of coronavirus infection survivors: A rapid meta-analysis. J Psychiatr Res 2021;137:542-53.
• Townsend L, Dyer AH, Jones K, Dunne J, Mooney A, Gaffney F, et al. Persistent fatigue following SARS-CoV-2 infection is common and independent of severity of initial infection. PLoS One 2020;15:e0240784.
• 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.
• Taquet M, Geddes JR, Husain M, Luciano S, Harrison PJ. 6-month neurological and psychiatric outcomes in 236 379 survivors of COVID-19: a retrospective cohort study using electronic health records. Lancet Psychiatry 2021;8:416-27.
• Erol N AB, and Akçakın M. The adaptation and standardization of the Child Behavior Checklist among 6-18 year-old Turkish children. Zürih: Fotoratar 1995;97-113.
• Achenbach TM, Rescorla L. Manual for the ASEBA school-age forms & profiles: An integrated system of multi-informant assessment: Aseba Burlington 2001.
• Lovibond PF, Lovibond SH. The structure of negative emotional states: comparison of the Depression Anxiety Stress Scales (DASS) with the Beck Depression and Anxiety Inventories. Behav Res Ther 1995;33:335-43.
• Sarıçam H. The psychometric properties of Turkish version of Depression Anxiety Stress Scale-21 (DASS-21) in health control and clinical samples. Journal of Cognitive Behavioral Psychotherapy and Research 2018;7:19-30.
• Feng X, Li S, Sun Q, Zhu J, Chen B, Xiong M, et al. Immune-Inflammatory Parameters in COVID-19 Cases: A Systematic Review and Meta-Analysis. Frontiers in Medicine 2020;7:301.
• Xu F, Wang X, Yang Y, Zhang K, Shi Y, Xia L, et al. Depression and insomnia in COVID-19 survivors: a cross-sectional survey from Chinese rehabilitation centers in Anhui province. Sleep Med 2021; S1389-9457(21)00093-9.
• Cheng SK, Wong C, Tsang J, Wong K. Psychological distress and negative appraisals in survivors of severe acute respiratory syndrome (SARS). Psychol Med 2004;34:1187.
• Lam MH, Wing YK, Yu MW, Leung CM, Ma RC, Kong AP, et al. Mental morbidities and chronic fatigue in severe acute respiratory syndrome survivors: long-term follow-up. Arch Intern Med 2009;169:2142-7.
• Okusaga O, Yolken RH, Langenberg P, Lapidus M, Arling TA, Dickerson FB, et al. Association of seropositivity for influenza and coronaviruses with history of mood disorders and suicide attempts. J Affect Disord 2011;130:220-5.
• Mak IWC, Chu CM, Pan PC, Yiu MGC, Chan VL. Long-term psychiatric morbidities among SARS survivors. Gen Hosp Psychiatry 2009;31:318-26.
• Chen F, Zheng D, Liu J, Gong Y, Guan Z, Lou D. Depression and anxiety among adolescents during COVID-19: A cross-sectional study. Brain Behav Immun 2020;88:36-8.
• Zhou S-J, Zhang L-G, Wang L-L, Guo Z-C, Wang J-Q, Chen J-C, et al. Prevalence and socio-demographic correlates of psychological health problems in Chinese adolescents during the outbreak of COVID-19. Eur Child Adolesc Psychiatry 2020;29:749-58.
• Xie X, Xue Q, Zhou Y, Zhu K, Liu Q, Zhang J, et al. Mental Health Status Among Children in Home Confinement During the Coronavirus Disease 2019 Outbreak in Hubei Province, China. JAMA pediatrics 2020;174:898-900.
• Jiao WY, Wang LN, Liu J, Fang SF, Jiao FY, Pettoello-Mantovani M, et al. Behavioral and Emotional Disorders in Children during the COVID-19 Epidemic. J Pediatr 2020;221:264-6.e1.
• Hurtig T, Taanila A, Ebeling H, Miettunen J, Moilanen I. Attention and behavioral problems of Finnish adolescents may be related to the family environment. Eur Child Adolesc Psychiatry 2005;14:471-8.
• Crijnen AA, Achenbach TM, Verhulst FC. Problems reported by parents of children in multiple cultures: the Child Behavior Checklist syndrome constructs. Am J Psychiatry 1999;156:569-74.
• Swing EL, Gentile DA, Anderson CA, Walsh DA. Television and video game exposure and the development of attention problems. Pediatrics 2010;126:214-21.
• ter Wolbeek M, van Doornen LJ, Kavelaars A, Heijnen CJ. Predictors of persistent and new-onset fatigue in adolescent girls. Pediatrics 2008;121:e449-e57.
• Ter Wolbeek M, Van Doornen LJ, Kavelaars A, Heijnen CJ. Severe fatigue in adolescents: a common phenomenon? Pediatrics 2006;117:e1078-e86.
• Tansey CM, Louie M, Loeb M, Gold WL, Muller MP, de Jager J, et al. One-Year Outcomes and Health Care Utilization in Survivors of Severe Acute Respiratory Syndrome. Arch Intern Med 2007;167:1312-20.
• Qi R, Chen W, Liu S, Thompson PM, Zhang LJ, Xia F, et al. Psychological morbidities and fatigue in patients with confirmed COVID-19 during disease outbreak: prevalence and associated biopsychosocial risk factors. medRxiv : the preprint server for health sciences 2020:2020.05.08.20031666.
• Ghandour RM, Overpeck MD, Huang ZJ, Kogan MD, Scheidt PC. Headache, stomachache, backache, and morning fatigue among adolescent girls in the United States: associations with behavioral, sociodemographic, and environmental factors. Arch Pediatr Adolesc Med 2004;158:797-803.
• Hadlandsmyth K, Dailey DL, Rakel BA, Zimmerman MB, Vance CGT, Merriwether EN, et al. Somatic symptom presentations in women with fibromyalgia are differentially associated with elevated depression and anxiety. J Health Psychol 2017;25:819-29.
• Martin A, Chalder T, Rief W, Braehler E. The relationship between chronic fatigue and somatization syndrome: a general population survey. J Psychosom Res 2007;63:147-56.
• Schwarz R, Krauss O, Hinz A. Fatigue in the general population. Onkologie 2003;26:140-4.
• Pedraz-Petrozzi B, Neumann E, Sammer G. Pro-inflammatory markers and fatigue in patients with depression: A case-control study. Sci Rep 2020;10:9494.
• Pallanti S, Grassi E, Makris N, Gasic GP, Hollander E. Neurocovid-19: A clinical neuroscience-based approach to reduce SARS-CoV-2 related mental health sequelae. J Psychiatr Res 2020;130:215-7.
• Miller BJ, Buckley P, Seabolt W, Mellor A, Kirkpatrick B. Meta-analysis of cytokine alterations in schizophrenia: clinical status and antipsychotic effects. Biol Psychiatry 2011;70:663-71.
• Renna ME, O’Toole MS, Spaeth PE, Lekander M, Mennin DS. The association between anxiety, traumatic stress, and obsessive–compulsive disorders and chronic inflammation: A systematic review and meta‐analysis. Depress Anxiety 2018;35:1081-94.
• Najjar S, Pearlman DM, Alper K, Najjar A, Devinsky O. Neuroinflammation and psychiatric illness. J Neuroinflammation 2013;10:1-24.
• Zhou Z, Kang H, Li S, Zhao X. Understanding the neurotropic characteristics of SARS-CoV-2: from neurological manifestations of COVID-19 to potential neurotropic mechanisms. J Neurol 2020;267:2179-84.