A great deal of attention and resources have been devoted to infection control, the search for effective drugs and vaccines, but the recognition of people whose mental state has been worsened by pandemic outbreaks has been relatively neglected [27, 28, 29]. This is surprising given that mass tragedies such as infectious disease pandemics cause significant disruption to the daily functioning and psychological well-being of many people [31].
Analysis of the results of our study showed that almost 40% of the respondents had sleep disturbances up to 6 months after hospitalisation for COVID-19, and almost one-fifth had insomnia symptoms. When examining anxiety using the Generalised Anxiety Questionnaire (GAD-7), it was observed that the vast majority of respondents experienced anxiety of varying severity. Furthermore, it was shown that for depression, according to the PHQ-9, only ⅓ of the respondents showed no symptoms. Similar results were obtained by other authors. For example, in a large study, more than half of the respondents showed symptoms of depression (defined as a total score ≥ 5 according to the PHQ-9), almost half showed symptoms of anxiety (defined as a total score ≥ 5 according to the GAD-7), more than ⅓ had symptoms of insomnia (defined as a total score ≥ 8 on the Insomnia Severity Scale - ISS) and almost ¾ of respondents showed stress-related symptoms (defined as a total score ≥ 9 on the Revised Event Impact Scale) [30]. Fear of the unknown and uncertainty, reduced interpersonal contact can lead to the development of a number of psychiatric disorders and adverse behaviours, such as more frequent use of stimulants. During a pandemic, the number of people with negative mental health consequences is usually greater than the number of people affected by the infection. Furthermore, the psychological consequences of an epidemic may last longer than the epidemic itself [31]. Therefore, it has been advocated that countries around the world, in addition to working to reduce the rate of SARS-CoV-2 transmission, should also conduct an analysis of the impact of COVID-19 on mental functioning [29].
In relation to the COVID-19 pandemic, both fear and anxiety are discussed. Anxiety can also be seen as a psychopathological symptom [32]. Chronic or disproportionate fear and anxiety, can cause psychiatric disorders [33]. During the COVID-19 pandemic, there was fear of infection, death and loss of a loved one, as well as fear of contact with people who may be infected [34, 35]. The fear is due to the speed of the spread of the virus and the fact that it is invisible. People also feared serious complications of COVID-19, forced hospitalisation and long quarantine. Another reason for fear is the possibility of transmitting the infection to loved ones who may not survive the disease. Fear of the coronavirus was due to its novelty and uncertainty about how the epidemic would unfold. Therefore, the fear of COVID-19 is much greater than the fear of seasonal influenza [5].
There are a growing number of reports describing long-term neurological effects after COVID-19. The pathogenic effect of SARS-CoV-2 on the nervous system is likely to be multifactorial. Patients experience symptoms as a consequence of systemic disease, such as direct neuroinvasion of the central nervous system, peripheral nervous system involvement, and an immune-mediated post-infection mechanism. SARS-CoV-2 infection may lead to the development of Alzheimer's disease and may exacerbate Parkinson's disease in affected patients and increase the risk of stroke due to inflammatory damage to the blood vessel wall or consequent atrial fibrillation. Cytokine and autoimmunity induced by cross-reactivity between virus particles and central nervous system elements may contribute to the development of autoimmune diseases. Carda et al. distinguished two groups of patients according to the clinical sequelae resulting from COVID-19 infection: the first, in which cognitive impairment predominates, and the second, in which respiratory problems predominate. In the context of analysing the consequences of SARS-CoV-2 infection, the term post-acute COVID-19 syndrome (PC19, long-COVID) has emerged in the specialist literature to denote persistent multi-organ dysfunction after the acute phase of COVID-19. Chronic fatigue was experienced by more than half of the subjects. In comparison, in those with a severe course, this symptom appeared in 38% of the subjects. Most researchers point out an important methodological flaw in the assessment of cognitive impairment. The problem is the inhomogeneity of the study group and the lack of data on the functioning of the subjects prior to COVID-19. It should be emphasised that most of the studies considering cognitive impairment concerned subjects hospitalised as a result of the severe course of the disease. The results indicate a marked deterioration in cognitive functioning in COVID-19 survivors [5].
Increased depression, anxiety and stress are consequences of difficult situations, and such is the state of the Covid-19 pandemic and associated hospitalisations, which were often accompanied by reduced interpersonal contacts [36]. According to the results of our own study, almost ¼ of the respondents rated their health condition as very poor and the vast majority stated that the Covid-19 pandemic had reduced their social contacts. The results of our own study also showed that as the level of insomnia increases, the level of fatigue and anxiety increases and the level of perceived social support decreases. As anxiety levels increase, fatigue levels increase and levels of perceived social support decrease. Conversely, as the level of perceived social support increases, the level of fatigue decreases. A study was conducted in the Brazilian population to assess the severity of these factors. A total of 3,000 people participated in the study. It was found that the consumption of drugs, tobacco, medication and food increased in the study group (40.8%). Almost half of the respondents manifested symptoms of depression, anxiety and stress. These symptoms were more severe in women, those without children, students, patients with chronic diseases and respondents 15 who had contact with Covid-19 patients [36]. It can be concluded that the Covid-19 pandemic exacerbated existing mental health disorders and contributed to the occurrence of new dysfunctions. Thus, it is important to conduct further research on the trauma associated with Covid-19 and to reduce its negative social impact [37, 38].
Covid-19 had a significant effect on changing the diurnal rhythm, quality and quantity of sleep in patients. A study by Scarpelli et al. of 5988 adults looked at sleep quality, mental health scores (according to depression, anxiety and stress scales) and frequency of dreams and nightmares, as well as related emotional aspects. It was found that Italians were more likely to have nightmares and dreams with frightening content during the pandemic. Predictive factors of frequent dream recall and nightmares were dependent on the daily experiences of the people included in the study[39]. In a period of social isolation, limited mobility and social contacts, concerns about the economic situation, a sense of fear of infection in oneself and one's loved ones, loss of health or life, anxiety, depression, stress emerge, which cause quantitative and qualitative sleep disturbances in a large part of the population, posing a major threat to the health of the population. Sleep disturbances during the pandemic are exacerbated by retinal stimulation by electronic devices, as well as prolonged and/or night shift work. Insufficient sleep or irregular sleep-wake cycles can weaken the immune system, induce a pro-inflammatory state and lead to increased susceptibility to viral infections [40].
Limitations and Recommendations for further research
Based on the results of this study, some practical implications for professional practice could be proposed. A major strength of the study was the use of standardised tools adapted to Polish conditions, which greatly enriched the data presented. An important goal for therapists working in the mental health field could be the development of educational guidelines aimed at simultaneously minimising the risk of mental disorders in relation to hospitalisation. This study also shows some potential limitations that we hope future research will overcome. Firstly, the cross-sectional, correlational nature of our design, limits the ability to identify causal relationships. There is a lack of data on the prevalence of risk of psychosocial dysfunction from an earlier period before the pandemic, which could be relevant for differential effects of variables on the prevalence of risk of psychosocial dysfunction. Conducting studies taking into account different socio-cultural contexts and paying attention to other variables of interest (e.g. income level or social class) are some of the aspects to be considered in the future. Another limitation may be the problems of being able to generalise the data to other cultures. The assessment of the risk of psychosocial disorders and related factors was based solely on self-report measures of the constructs. Information from autobiographical narratives may be necessary to obtain a holistic picture of a person's behaviour. Assessment based on self-descriptive tools, may be distorted due to the desire to be perceived by society as an attractive person, i.e. with a tendency to avoid criticism and give more socially acceptable answers. This may result in overestimating health-promoting behaviours and underestimating undesirable behaviours. Despite its limitations, this study provides important findings and may provide a starting point for broader research to determine the relationships between depression, anxiety, fatigue, insomnia and social support among COVID-19 hospitalised patients.
Associations between selected factors of psychosocial functioning (anxiety, insomnia, fatigue, fatigue, depression, perceived social support) were demonstrated among patients hospitalised for SARS-CoV-2 infection up to 6 months after hospitalisation. As insomnia increased, fatigue and anxiety increased and perceived social support decreased; as anxiety increased, fatigue increased and perceived social support decreased. The study presented here provides important associations and may help to assess the need for psychosocial support and provides a starting point for a larger study to determine the associations between depression, anxiety, fatigue, insomnia and social support among COVID-19 hospitalised patients.