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      Psychiatric manifestations and associated risk factors among hospitalised patients with COVID-19 in Edo State, Nigeria: a cross-sectional study

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          Abstract

          Objective

          To estimate the prevalence of depression and anxiety and identify associated risk factors in hospitalised persons with confirmed COVID-19 in Edo, Nigeria.

          Design

          A multicentre cross-sectional survey.

          Setting

          Patients with COVID-19 hospitalised at the three government-designated treatment and isolation centres in Edo State, Nigeria.

          Participants

          The study was conducted from 15 April to 11 November 2020 among 489 patients with confirmed COVID-19 and in treatment and isolation centres in Edo State, Nigeria. The mean age of participants was 43.39 (SD=16.94) years. Male participants were 252 (51.5%) and female were 237 (48.5%).

          Main outcome measures

          The nine-item Patient Health Questionnaire for depression, (total score: 0–27, depression ≥10), Generalized Anxiety Disorder-7 for anxiety (total score: 0–21, anxiety ≥10), and social demographic and clinical characteristics for associated risk factors.

          Results

          Of the 489 participants, 49.1% and 38.0% had depressive and anxiety symptoms, respectively. The prevalence rates of depression, anxiety and combination of both were 16.2%, 12.9% and 9.0%, respectively. Moderate-severe symptoms of COVID-19, ≥14 days in isolation, worrying about the outcome of infection and stigma increased the risk of having depression and anxiety. Additionally, being separated/divorced increased the risk of having depression and having comorbidity increased the risk of having anxiety.

          Conclusion

          A substantial proportion of our participants experienced depression, anxiety and a combination of both especially in those who had the risk factors we identified. The findings underscore the need to address modifiable risk factors for psychiatric manifestations early in the course of the disease and integrate mental health interventions and psychosocial support into COVID-19 management guidelines.

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          Most cited references26

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          A brief measure for assessing generalized anxiety disorder: the GAD-7.

          Generalized anxiety disorder (GAD) is one of the most common mental disorders; however, there is no brief clinical measure for assessing GAD. The objective of this study was to develop a brief self-report scale to identify probable cases of GAD and evaluate its reliability and validity. A criterion-standard study was performed in 15 primary care clinics in the United States from November 2004 through June 2005. Of a total of 2740 adult patients completing a study questionnaire, 965 patients had a telephone interview with a mental health professional within 1 week. For criterion and construct validity, GAD self-report scale diagnoses were compared with independent diagnoses made by mental health professionals; functional status measures; disability days; and health care use. A 7-item anxiety scale (GAD-7) had good reliability, as well as criterion, construct, factorial, and procedural validity. A cut point was identified that optimized sensitivity (89%) and specificity (82%). Increasing scores on the scale were strongly associated with multiple domains of functional impairment (all 6 Medical Outcomes Study Short-Form General Health Survey scales and disability days). Although GAD and depression symptoms frequently co-occurred, factor analysis confirmed them as distinct dimensions. Moreover, GAD and depression symptoms had differing but independent effects on functional impairment and disability. There was good agreement between self-report and interviewer-administered versions of the scale. The GAD-7 is a valid and efficient tool for screening for GAD and assessing its severity in clinical practice and research.
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            The PHQ-9: A New Depression Diagnostic and Severity Measure

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              Validation and utility of a self-report version of PRIME-MD: the PHQ primary care study. Primary Care Evaluation of Mental Disorders. Patient Health Questionnaire.

              The Primary Care Evaluation of Mental Disorders (PRIME-MD) was developed as a screening instrument but its administration time has limited its clinical usefulness. To determine if the self-administered PRIME-MD Patient Health Questionnaire (PHQ) has validity and utility for diagnosing mental disorders in primary care comparable to the original clinician-administered PRIME-MD. Criterion standard study undertaken between May 1997 and November 1998. Eight primary care clinics in the United States. Of a total of 3000 adult patients (selected by site-specific methods to avoid sampling bias) assessed by 62 primary care physicians (21 general internal medicine, 41 family practice), 585 patients had an interview with a mental health professional within 48 hours of completing the PHQ. Patient Health Questionnaire diagnoses compared with independent diagnoses made by mental health professionals; functional status measures; disability days; health care use; and treatment/referral decisions. A total of 825 (28%) of the 3000 individuals and 170 (29%) of the 585 had a PHQ diagnosis. There was good agreement between PHQ diagnoses and those of independent mental health professionals (for the diagnosis of any 1 or more PHQ disorder, kappa = 0.65; overall accuracy, 85%; sensitivity, 75%; specificity, 90%), similar to the original PRIME-MD. Patients with PHQ diagnoses had more functional impairment, disability days, and health care use than did patients without PHQ diagnoses (for all group main effects, P<.001). The average time required of the physician to review the PHQ was far less than to administer the original PRIME-MD (<3 minutes for 85% vs 16% of the cases). Although 80% of the physicians reported that routine use of the PHQ would be useful, new management actions were initiated or planned for only 117 (32%) of the 363 patients with 1 or more PHQ diagnoses not previously recognized. Our study suggests that the PHQ has diagnostic validity comparable to the original clinician-administered PRIME-MD, and is more efficient to use.
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                Author and article information

                Journal
                BMJ Open
                BMJ Open
                bmjopen
                bmjopen
                BMJ Open
                BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                2044-6055
                2022
                6 May 2022
                6 May 2022
                : 12
                : 5
                : e058561
                Affiliations
                [1 ]departmentDepartment of Mental Health , Irrua Specialist Teaching Hospital , Irrua, Edo State, Nigeria
                [2 ]departmentDepartment of Mental Health , Ambrose Alli University College of Medicine , Ekpoma, Edo State, Nigeria
                [3 ]Institute of Lassa Fever Research and Control, Irrua Specialist Teaching Hospital , Irrua, Edo State, Nigeria
                [4 ]departmentDepartment of Mental Health , University of Benin Teaching Hospital , Benin City, Edo State, Nigeria
                [5 ]departmentDepartment of Mental Health , Edo University Iyamho , Iyamho, Edo State, Nigeria
                [6 ]departmentDepartment of Child Health , Irrua Specialist Teaching Hospital , Irrua, Edo State, Nigeria
                [7 ]departmentDepartment of Child Health , Ambrose Alli University College of Medicine , Ekpoma, Edo State, Nigeria
                [8 ]departmentDepartment of Clinical Services , Federal Neuro Psychiatric Hospital , Benin City, Edo State, Nigeria
                [9 ]departmentDepartment of Internal Medicine , Irrua Specialist Teaching Hospital , Irrua, Edo State, Nigeria
                [10 ]departmentDepartment of Obstetrics and Gynaecology , Irrua Specialist Teaching Hospital , Irrua, Edo State, Nigeria
                [11 ]departmentDepartment of Obstetrics and Gynaecology , Ambrose Alli University College of Medicine , Ekpoma, Edo State, Nigeria
                [12 ]departmentCommunity Health , Ambrose Alli University College of Medicine , Ekpoma, Edo State, Nigeria
                Author notes
                [Correspondence to ] Dr Esther Osemudiamen Okogbenin; eokogbenin@ 123456gmail.com
                Author information
                http://orcid.org/0000-0003-1028-0520
                Article
                bmjopen-2021-058561
                10.1136/bmjopen-2021-058561
                9082729
                35523500
                67cd30d6-7dd3-4495-af3b-979f92f6e6ea
                © Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

                This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:  http://creativecommons.org/licenses/by-nc/4.0/.

                History
                : 20 October 2021
                : 04 March 2022
                Categories
                Mental Health
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                Original research
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                Medicine
                covid-19,psychiatry,depression & mood disorders
                Medicine
                covid-19, psychiatry, depression & mood disorders

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