Alpha病毒株流行期間新冠肺炎確診病人急性後期精神健康、資源需求及生活品質之探討

Abstract

【背景】2019年底新型冠狀肺炎爆發，並在全球各國蔓今，成為近期影響力最大之新興傳染病。2020年下半年Alpha病毒株出現後，漸漸成為全球主流，2021年3月、4月曾最高達45%占比；6月，Delta病毒株占比則迅速竄升；11月，Omicron出現，12月底超過全球50%的病毒株佔比。感染COVID-19的症狀從輕微至嚴重，中重度患者有低血氧狀況，需住院使用呼吸器、抗病毒藥物、類固醇等治療。除了生理症狀外，患者也常見焦慮、憂鬱、創傷反應、認知混亂等精神症狀。近期相繼出現COVID-19急性後期症狀的相關研究，常見症狀如疲勞、呼吸困難、腦霧、憂鬱、掉髮等，Long COVID, Post-acute COVID-19 syndrome（PACS）等概念被提出且普遍探討。然而，目前此方面研究較多探討生理層面之影響，長期精神健康部分相關研究較少見。特別是在臺灣疫情相對穩定的國家中，確診者的長期精神健康問題較容易被忽視，患者回歸社區後的擔憂及需求也是極需要進一步追蹤並探討。本研究主要目的為探討Alpha病毒株流行期間新冠肺炎確診病人急性後期精神健康、資源需求及生活品質。評估其急性後期的狀態：憂鬱、焦慮、腦霧、生活品質、自評健康狀況，並深入了解患者之罹病經歷以及目前的擔憂和需求。透過本研究結果期待能提升醫療團隊對於患者更全面且連續性的高品質照護。 【方法】本研究採混合方法，於門診邀請年滿20歲、Alpha病毒株流行期間新冠肺炎確診並超過半年者參與本研究，說明後同意參與研究者將進行問卷填答，有進一步接受訪談意願者，再進行質性訪談。研究工具包含：憂鬱量表（PHQ-9）、腦霧量表（WMFI）、生活品質量表（EQ-5D-5L）、健康狀況量表（EQ-VAS）。研究訪談大綱內容包含：罹患新冠肺炎的過程與歷程、新冠肺炎的長期影響、目前的擔憂與需求。另外，研究者經授權搜集患者病歷之影像檢查結果、用藥及治療等相關資訊。收集之病歷資訊及問卷以R統計軟體進行分析，訪談錄音檔以主題分析法歸納研究有關的意義，增加資料的豐富與深度。 【結果】本研究共納入120位Alpha病毒株流行期間新冠肺炎確診者參與問卷填答（男性70人、女性50人），其中11位另外進行質性訪談（男性6人，女性5人），平均年齡為49.5±16歲，教育程度的多為大學，約半數於2021年5月確診，確診距參與研究時間平均月數為10.06±2.4個月，新冠肺炎嚴重度大多自覺為輕度（75人）。確診半年後患者憂鬱（成對T檢定=13.61, p<0.001）及腦霧（成對T檢定=5.78, p<0.001）狀況顯著改善，但仍有部分確診者受記憶力不佳（46.7%）及注意力不佳（24.2％）的急性後期症狀困擾。新冠肺炎不同嚴重度患者之染疫當時憂鬱及腦霧症狀（p<0.001）、急性後期腦霧症狀（p=0.015）以及憂鬱和腦霧復原狀況（p<0.001）有顯著差異。以多元線性回歸模型找出「染疫當時憂鬱總分」、「無老化疾病」、「年齡」、「無肺部疾病」、「住院天數」五變項為憂鬱復原狀況的重要影響因子；「染疫當時腦霧總分高」、「新冠肺炎並非重/極重度」、「入住加護病房天數長」、「距離確診時間短」、「無精神病史」五變項為腦霧復原狀況的重要影響因子。確診者染疫當時經歷極大的心理壓力，也產生憂鬱、焦慮、恐慌、害怕、低落等情緒困擾。部分確診者急性後期仍受染疫經歷影響目前的生活，至今仍有腦霧的症狀困擾。確診者經歷半年後的歷程，仍有的擔憂包含害怕再次染疫、不確定後遺症將影響多久、以及不確定現今的不適是否真的是因染疫影響。目前確診者的資源需求為經濟及醫療需求。 【結論】Alpha病毒株流行期間新冠肺炎確診者在染疫當時經歷憂鬱等情緒困擾，在認知部分有腦霧症狀，經過半年以上的復原過程，憂鬱及腦霧有顯著改善，但仍有部分患者持續受記憶力及注意力不佳問題的腦霧症狀困擾。新冠肺炎嚴重度高者，在精神健康及生活品質上較嚴重度低者差。至於憂鬱及腦霧的復原狀況，受過去病史、年齡、新冠肺炎疾病相關狀態等因子影響，值得後續規劃確診後長期復原與照護時的參考。

【Background】At the end of 2019, COVID-19 emerged, then spread around the world, also caused a serious pandemic in 2020. After the Alpha variant appeared in the second half of 2020, it gradually became the global mainstream. In March and April 2021, it accounted for up to 45%; in June, the proportion of Delta variant soared rapidly; in November, Omicron variant appeared, and by the end of December exceeded 50% of the virus strains globally. Clinical spectrum of COVID-19 infection range from mild to severe. Patients with moderate to severe condition may be hypoxic and need hospitalization with ventilator, antiviral drugs, steroids, and other treatments. In addition to physical symptoms, patients also commonly have psychiatric symptoms such as anxiety, depression, trauma reaction, and confusion. Recently, there have been related studies on symptoms after the acute phase of COVID-19. Common symptoms included fatigue, dyspnea, brain fog, depression, hair loss, etc. Concepts such as Long COVID, Post-acute COVID-19 syndrome (PACS) have also been proposed and constantly being discussed. However, at present, post-acute COVID-19 studies mostly explored the impact of the physiological level, studies related to long-term mental health are rare. Especially in countries, such as Taiwan, where the epidemic situation is relatively stable, the long-term mental health problems of COVID-19 patients may tend to be ignored. In addition, the concerns and needs of patients after returning to the community also need to be further tracked and discussed.The main purpose of this study was to investigate the mental health, general resource needs and quality of life among post-acute COVID patients during the SARS-CoV-2 Alpha variant epidemic. We assess post-acute syndromes such as depression, anxiety, brain fog, quality of life, self-rate health status. Besides, we would like to investigate the patient's lived experiences and current concerns and needs. Through the results of this study, it is expected that the medical team can provide more comprehensive and continuous high-quality care for patients. 【Methods】This study adopts a mixed-method design. Patients who are aged over 20 years, diagnosed with COVID-19 and had discharged from hospital for more than half year were invited to participate in this study. After the explanation of this study, patients who agreed to participate completed the questionnaire, and those who were willing to accept further interviews were provided one-to-one qualitative interviews. Research questionnaire instruments included: PHQ-9, WMFI, EQ-5D-5L, EQ-VAS. The attentions of the qualitative interviews included: the lived experiences with COVID-19, the long-term impact of COVID-19, and current concerns and needs. In addition, clinical data of the subjects were collected by reviewing their electronic medical records. The R statistical software was used to analyze quantitative data, and the qualitative data was reviewed and analyzed by thematic analysis method to summarize the significance related to this research topics, in order to provide fruitful results. 【Results】A total of 120 subjects were included in this study to participate in the questionnaire investigation, and 13 of them underwent qualitative interviews. There are 70 males and 50 females, with an average age of 49.5±16 years old. Half of them were diagnosed in May 2021, and the average length from the time of diagnosis to this study was 10.06±2.4 months. The severity of COVID-19 was mostly mild (75 people). Depression (independent T test = 13.61, p<0.001) and brain fog (independent T test = 5.78, p<0.001) of those diagnosed after more than half year were significantly improved, but some patients still suffer from poor memory (46.7%). and poor concentration (24.2%). The symptoms of depression and brain fog at the time of infection (p<0.001), the symptoms of brain fog in the post-acute phase (p=0.015), and the recovery of depression and brain fog (p<0.001) were significantly different in patients with different severity of COVID-19. The multiple linear regression model was used to find out the factors associated with depression recovery, including 'depression score at the time of infection', 'no aging disease', 'age', 'no lung disease' and 'hospital days'. The associated variables for brain fog recovery included 'high total brain fog score at the time of infection', 'low severity levels of COVID-19', 'long stay in ICU', 'short time since diagnosis', and 'no history of mental illness' The patients experienced great psychological distress at the time of infection, and also suffered from depression, anxiety, panic, fear, depression and other emotional distress. Some of the patients are still affected by the infection experience at post-acute phase, and their current life are still affected by the symptoms of brain fog. The current concerns of those diagnosed include fear of re-infection, uncertainty about how long the after-effects will be affected, and uncertainty about whether the current discomfort is really due to the infection. At present, the resource needs of patients are economic and medical needs. 【Conclusion】Patients diagnosed with COVID-19 experienced depression and other emotional distress at the time of infection, and had symptoms of brain fog afterwards. After more than half a year of recovery, depression and brain fog were significantly improved, but some patients still suffered from memory and attention problem. Brain fog symptoms plagued by poor strength problems. People with higher severity of COVID-19 have poorer mental health and quality of life than those with lower severity. As for the recovery of depression and brain fog, it is affected by factors such as medical history, age, and COVID-19 status.