Fatores relacionados aos sintomas de depressão e ansiedade em pacientes internados com AVC durante a pandemia de Covid-19

Abstract

Stroke is one of the main causes of disability in the world. Patients who experience this event tend to have high rates of mental disorders. The COVID-19 pandemic brought a series of psychosocial stressors and further contributed to the increased burden of anxiety and depression in these individuals. The aim of this study was to assess factors related to depression and anxiety symptoms in hospitalized patients with acute episode of stroke during the COVID-19 pandemic. This is an analytical cross-sectional study. The data was collected from november 2021 to july 2022 in a public hospital in Federal District, Brazil. The research was approved by the Research Ethics Committees (CEP) of the Pontifical Catholic University of Goiás (PUC Goiás) and the Health Sciences Teaching and Research Foundation (FEPCS). Patients diagnosed with stroke, aged 18 years or older and hospitalized for more than 48 hours were included. Patients with Glasgow Coma Scale with pupils score (GCS-P) < 15, severe aphasia, previous diagnosis of dementia and previous stroke with Modified Rankin Scale (mRS) score ranging from 3 to 6 were excluded. The sociodemographic and clinical profile and the experience of the pandemic were obtained by completing specific questionnaires. Stroke severity was assessed using the National Institute of Health Stroke Scale (NIHSS) and symptoms of anxiety and depression using the Hospital Anxiety and Depression Scale (HADS). Comparison between participants with and without symptoms of anxiety and depression with the sample profile was performed using Pearson's chi-square test and Student's t test. Variables with p < 0.20 were selected for multivariate linear regression. The final sample consisted of 51 participants. The mean age was 67.7 (± 11.3) years. Most patients had an ischemic stroke, 25.5% had stroke previously and 21.6% reported previous COVID-19. Anxiety and depression symptoms were present in 52.9% and 51% of the subjects, respectively. The mean score for the anxiety subscale was 7.75 (± 4.26) and for depression, 9.00 (± 5.35). Regarding to anxiety, the variables that differed between the groups were sex, obesity and previous COVID-19; for depression the variables were color/race, previous stroke, vertigo and ataxia. Finally, multivariate linear regression analysis showed female gender and previous COVID-19 as predictors of anxiety; and previous stroke and higher NIHSS scores as predictors of depression. This study highlighted the psychological consequences of stroke during the pandemic. Damage to mental health is often underdiagnosed, which implies late treatment. The results obtained can guide strategies to intervene earlier in the mental health of this population, which suffers a great impact in emergency health situations. Improving psychosocial support offered to these patients will directly reflect on functional recovery and, consequently, on quality of life