Post COVID-19 Mental Health Challenges

Particularly among the most seriously ill COVID-19 patients who spent time in an intensive care unit (ICU) and underwent intubation, there exists the possibility of post-intensive care syndrome (PICS), which can manifest as a combination of physical, cognitive and mental health impairments after an ICU stay for a critical illness. In both the short and long term, PICS can affect a patient’s quality of life, according to Sapna Kudchadkar, MD, PhD, an associate professor of anesthesiology and critical care medicine at the Johns Hopkins University School of Medicine in Baltimore.

PICS can result in a patient’s difficulty in resuming activities of daily life or struggling to return to work. Physically, patients may suffer from muscle weakness and chronic pain. Cognitively, patients may experience difficulty with concentration and memory, with particularly obvious symptoms in those with a history of dementia. PICS may also prompt experiences with anxiety, depression, post-traumatic stress disorder (PTSD), or sleep difficulties. Even patients who previously were healthy before an ICU hospitalization for COVID-19 or any other critical illness, are at risk for PICS, according to Kudchadkar.

“For COVID survivors, we are already starting to observe many of these impairments, and the muscle weakness can be profound,” Kudchadkar said. “We have also observed a high incidence of persistent delirium, even in patients who were only mechanically ventilated or in the ICU for a few days. These issues are augmented due to visitor restrictions and a loss of human touch and familiar faces in the era of PPE and isolation rooms,” she added.

Care during the COVID-19 pandemic has transformed treatment of ICU patients, removing the factors that previously contributed to helping patients feel safe and grounded, according to Jessica Gold, MD, MS, an assistant professor in the department of psychiatry at Washington University in St. Louis. “You don’t have family at the bedside, reorienting you or making you feel like you belong in some capacity,” she said. “You don’t have family getting you up and walking, which happens if you’re in the ICU and can move. You don’t have a lot of staff coming in and checking on you as much--there's a lot less in and out movements of people. And yet there’s more codes and beeping and noise and worry and stress—[the patient] might not understand what’s going on.”

Patients recovering from a severe case of COVID-19 may experience trouble sleeping, emotional instability, depression, nightmares, appetite changes and a loss of interest. Those who were intubated may experience flashbacks of real or imagined trauma. Kudchadkar suggested that patients being discharged from the hospital after a long siege with COVID-19 may have mixed feelings. “It can be overwhelming to go home back to normal after such a long and stressful road in the hospital, not just for the patient but the caregivers as well,” she said. “It’s a happy time but can be a hard one as well. Acknowledging that is important, and providing resources [is] key.”

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