• Users Online: 475
  • Home
  • Print this page
  • Email this page
Home About us Editorial board Ahead of print Current issue Search Archives Submit article Instructions Subscribe News Contacts Login 


 
 Table of Contents  
ORIGINAL ARTICLE
Year : 2022  |  Volume : 6  |  Issue : 2  |  Page : 70-74

Mental status in patients with cerebral infarction in central China at the early stage of coronavirus disease-19 pandemic


1 Department of Neurology, Zhongnan Hospital of Wuhan University, Hubei Province, Wuhan, China
2 Department of Neurology and Neuropsychiatry, Zhongnan Hospital of Wuhan University, Hubei Province, Wuhan, China
3 Department of Neurology, Fifth Hospital in Wuhan, Hubei Province, Wuhan, China
4 Department of Neurology, The Second Xiangya Hospital of Central South University, Changsha, China

Date of Submission07-Jul-2021
Date of Acceptance21-Dec-2021
Date of Web Publication18-Feb-2022

Correspondence Address:
Prof. Hong Zhang
Department of Neurology and Neuropsychiatry, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan 430071
China
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/hm.hm_40_21

Rights and Permissions
  Abstract 


Aims: The study aimed to analyze the changes in mental health and social support in patients with cerebral infarction during the recovery period at the early stage of coronavirus disease pandemic. Subjects and Methods: During January–March 2020, 98 patients with cerebral infarction during the recovery period were selected from Wuhan city. Among them, 42 patients were living alone (called the solitary group) and 56 patients lived with their spouses (called the spouse group). The Self-Rating Anxiety Scale (SAS) and Self-Rating Depression Scale (SDS) were used to evaluate anxiety and depression, respectively, and Multi-Dimensional Scale of Perceived Social Support (MSPSS), social support for patients. Statistical Analysis Used: The statistical calculations were carried out using GraphPad Prism 5.01 software (GraphPad, San Diego, California, USA). Results: At the early stage of the pandemic, patients with cerebral infarction in the solitary group and the spouse group experienced varying degrees of anxiety and depression. The SAS and SDS scores in the solitary group were significantly higher than those in the spouse group (P < 0.01). The subscale scores of MSPSS in the solitary group were lower than those in the spouse group (P < 0.01). Conclusions: It is necessary for medical staff to help the patients to overcome anxiety and depression and provide more social support to patients, especially for those patients living alone.

Keywords: Anxiety, cerebral infarction, convalescence, coronavirus disease-19 pandemic, depression, social support


How to cite this article:
Wu Y, Ma S, Zhang H, Huang X, Shu Y. Mental status in patients with cerebral infarction in central China at the early stage of coronavirus disease-19 pandemic. Heart Mind 2022;6:70-4

How to cite this URL:
Wu Y, Ma S, Zhang H, Huang X, Shu Y. Mental status in patients with cerebral infarction in central China at the early stage of coronavirus disease-19 pandemic. Heart Mind [serial online] 2022 [cited 2022 Oct 2];6:70-4. Available from: http://www.heartmindjournal.org/text.asp?2022/6/2/70/337987




  Introduction Top


The coronavirus disease (COVID-19) that was first reported in Wuhan city and Hubei province at the early stage of 2020 was a psychological event that severely disrupted the normal life and social activities of Chinese people.[1] In order to control the spread of COVID-19, the local government adopted measures such as city lockdown, traffic control, and home isolation. Most hospitals were transformed into designated hospitals for the treatment of COVID-19 pneumonia, making it difficult for patients with cerebrovascular diseases to seek medical care in hospital regularly. This situation not only caused psychological stress in people living in the affected area, but also resulted in the physical and mental burden of patients with cerebral infarction during the recovery period.[2],[3] A survey of patients with COVID-19 pneumonia at the early stage had found that the prevalence of poor mental health was 36.8%, most of them were women, younger, and single patients.[4] Another survey of medical staff at the early stage found that 44.6% were anxious, 50.4% were depressed, and 71.5% were nervous and disturbed.[5] However, there are few reports regarding the mental health of patients with cerebral infarction during the recovery period at the early stage of COVID-19 pandemic. Thus, this article aimed to analyze anxiety, depression, and social support in patients with cerebral infarction during the recovery period in Wuhan city at the early stage of COVID-19 pandemic.


  Subjects and Methods Top


Participants

This study was to observe the impact of urban lockdown and traffic control on the mental health and social support of patients with cerebral infarction living in the pandemic area. In this study, 98 outpatients with cerebral infarction of the internal carotid artery system were selected based on International Classification of Diseases-10 coding standards during the recovery period, which were identified in Wuhan city through offline and online consultation during January–March, 2020. Head plain computed tomography or magnetic resonance imaging examination was carried out on all cerebral infarction patients according to the guidelines for ischemic stroke diagnosis and treatment.[6] All patients were assessed by the local medical insurance company and belonged to the recovery period of “serious” or “chronic” cerebrovascular disease. The patients were divided into two groups. There were 42 patients living alone, called the solitary group. Among them, 18 were males and 24 were females, aged 55–70 years old with an average age of 58.6 ± 5.4 years. The remaining 56 patients lived with their spouses and were called the spouse group. Among them, there were 24 males and 32 females, aged 52–69 years old with an average age of 59.8 ± 6.3 years. Patients with consciousness, intelligence or language disorders, poststroke anxiety and depression, vascular dementia, neurodegenerative diseases, other systems diseases, history of mental illness, brain trauma, and tumors were ruled out in this study. All patients were willing to participate and completed the psychological assessment. The informed consent was obtained from the patients or their family members. This study was based on the Declaration of Helsinki and approved by the local Ethics Committee [No. 2020074K].

Mental scale evaluation

In this study, the evaluation of mental health scales was completed by clinicians who participated in the training. Self-Rating Anxiety Scale (SAS) and Self-Rating Depression Scale (SDS) were used to assess anxiety and depression status of patients with cerebral infarction.[7] The Multi-Dimensional Scale of Perceived Social Support (MSPSS) was used to assess social support in patients with cerebral infarction.[8] These scales have been widely used in the Chinese population and proven to have good reliability and validity.[9],[10]

Evaluation of anxiety symptoms

The Chinese version of the SAS was used to assess anxiety symptoms and severity.[9] SAS is composed of 20 questions with their responses on a 4-point Likert scale (1 = no or very little time, 2 = sometime, 3 = most time, and 4 = all the time). The original SAS score ranges from 20 to 80 points. The standard score is equal to the original score multiplied by 1.25. It is generally believed that a standard SAS score >50 will be considered anxiety. If the standard score is 50–59 points, it indicates mild anxiety; 60–69 points, moderate anxiety; and >70 points, severe anxiety.

Evaluation of depressive symptoms

The Chinese version of the SDS was used to assess depression symptoms and severity.[9] SDS is also composed of 20 questions with their responses on a 4-point Likert scale (1 = a little time or no, 2 = sometime, 3 = most time, and 4 = all the time). The standard score is equal to the original score multiplied by 1.25. A standard SDS score >53 is generally considered to indicate depression. If the standard score is within 53–62 points, it indicates mild depression; 63–72 points, moderate depression; and >72 points, severe depression.

Evaluation of social support

The Chinese version of the MSPSS was used to assess the degree of social support perceived by patients, including support from family members, friends, and important others.[8],[10] MSPSS contains 12 questions with their responses on a 7-point Likert scale (1 = strongly disagree, 2 = very disagree, 3 = slightly disagree, 4 = neutral, 5 = slightly agree, 6 = moderately agree, and 7 = strongly agree). The total MSPSS score can range from 12 to 84 points. It is generally believed that the higher the MSPSS score, the greater the perceived social support of patients.

Statistical analysis

The statistical calculations were carried out using GraphPad Prism 5.01 software (GraphPad, San Diego, California, USA). The continuous measures were expressed as mean and standard deviation, whereas categorical variables as absolute value and percentage (%). The comparison of SAS scores, SDS scores, and subscale scores of social support between the two groups of patients was performed using the Student's t-test for the continuous variable test.


  Results Top


Characteristics of two groups of patients with cerebral infarction during the recovery period

In this study, there were no significant differences in age, gender, previous medical history, and medicines used between the solitary group and the spouse group patients with cerebral infarction during the recovery period at the early stage of COVID-19 pandemic [Table 1].{Table 1}

Comparison of anxiety and depression between two groups of patients with cerebral infarction during the recovery period

At the early stage of COVID-19 pandemic, the prevalence rate of mild anxiety, moderate anxiety, and severe anxiety in the solitary group were 19.0%, 57.1%, and 23.8%, respectively; while in the spouse group, they were 39.3%, 9.0%, and 0%, respectively. The prevalence rate of mild depression, moderate depression, and severe depression in the solitary group was 19.0%, 66.7%, and 14.3%, respectively; while in the spouse group, they were 46.4%, 0%, and 0%, respectively. According to the results of SAS and SDS, the scores of anxiety and depression in the solitary group were significantly higher than those in the spouse group (P < 0.01) [Table 2].{Table 2}

Comparison of social support between two groups of patients with cerebral infarction during the recovery period

At the early stage of COVID-19 pandemic, social support from family members, friends, and important others in patients with cerebral infarction during the recovery period was seriously affected. The subscale scores of social support from family members, friends, and important others in the solitary group were markedly lower than those in the spouse group (P < 0.01) [Table 3].{Table 3}


  Discussion Top


Although social distancing policy and stay at home orders have contributed to reducing the spread of COVID-19, they have resulted in people reporting a feeling of loneliness. A systematic review found that the prevalence ranges of mental health problem in health-care workers were depression (13.5%–44.7%), anxiety (12.3%–35.6%), acute stress reaction (5.2%–32.9%), posttraumatic stress disorder (7.4%–37.4%), insomnia (33.8%–36.1%), and occupational burnout (3.1%–43.0%) during the COVID-19 pandemic.[11] Another questionnaire study to investigate the psychological impact of COVID-19 pandemic on college students.[12] They showed that 0.9% college students had severe anxiety, 2.7% had moderate anxiety, and 21.3% had mild anxiety.[12] They also found that economic effects, effects on daily life, and delays in regular activities were positively associated with anxiety symptoms.[12] In this study, we analyzed the psychological changes in patients with cerebral infarction during the recovery period from Wuhan city at the early stage of COVID-19 outbreak in the beginning of 2020 and found that patients with cerebral infarction during the recovery period had a certain degree of anxiety and depression. The psychological symptoms in the solitary group were more serious than those in the spouse group.

Although the pathological mechanisms that cause psychological problems are more complicated,[13] the reasons for anxiety and depression in patients in this study may have the following aspects. First, COVID-19 outbreak was reported in 2020 Chinese New Year period. The sudden pandemic disrupted the patients' original rhythm of life and medical consultation.[14] Second, the initial cases of COVID-19 pneumonia, especially for those severe cases, were reported in elderly patients,[15] which virtually increased the psychological pressure on patients with cerebral infarction during the recovery period. Third, most general hospitals where patients originally visited or followed up were changed to designated hospitals for patients with COVID-19 pneumonia, which affected the regular follow-up for patients with cerebral infarction.[16] Fourth, some patients with cerebral infarction were unable to obtain routine medicines, causing them to worry that the shortage of medicines would worse their condition. Meanwhile, home isolation prevented patients from going to the hospital for regular check-ups.[17] Fifth, due to the implementation of urban traffic control and community control, patients could not meet and communicate with their family members and friends face-to-face. All of this inevitably increased anxiety and depression in patients. As for patients with cerebral infarction who were living with their spouse, their anxiety and depression were reduced to a certain extent due to the company of their family members. These results demonstrated that COVID-19 outbreaks appear directly and indirectly to contribute to mental health risks in patients with cerebral infarction.

It is well-known that long-term isolation and loneliness could act as a trigger for mental disorders such as depression and anxiety in some individuals. A study of older adults documented that social disconnection and perceived isolation increased the likelihood of depression and anxiety.[18] A separate study of young adults similarly suggested that social isolation can promote feelings of loneliness and a higher probability of experiencing depression.[19] Isolation from family, friends, and familiar social activities can lead to loneliness, especially in older people living alone,[20] the adequacy of social support is negatively related to the severity of psychological symptoms than those who perceive little or no support.[21],[22] In this study, we found the subscale scores of social support from family members, friends, and important others in the solitary group patients with cerebral infarction were lower than those in the spouse group during COVID-19 pandemic.

Social support is often regarded as an important compensation mechanism in buffering individual psychological responses when facing challenging environments.[23] It can not only be beneficial to individual mental health by providing the needed material and mental resources for dealing with life challenges but improve individual psychological adjustment by enhancing the individual sense of control in dealing with stressful events. Meanwhile, it is important to remember that social support is complex and can vary based on the type of support provided by significantly different figures, such as family members, friends or important others,[24] and different kinds of support can have different impacts on stress reduction.[25] In fact, support specifically from family and friends during the COVID-19 pandemic appears to have been helping people feel sustained and share their feelings.[26] Recent study showed that different levels of social support for medical staff were correlated with self-efficacy and sleep quality and negatively correlated with the degree of anxiety and stress during COVID-19 pandemic, and health-care workers with low social support were experienced more anxiety and depression during the COVID-19 pandemic,[27] and the greater levels of perceived social support have been serving as a protective factor for affected college students in China.[12] This suggests that social support serves as a buffer against the impact of COVID-19-related stressors on psychological symptoms during the COVID-19 pandemic. A possible reason might be that social support could provide enough resources in dealing with stressors and decrease the usage of avoidance coping strategies during acute, uncontrollable circumstances.[28]

Up to now, one of the most vital strategies for slowing COVID-19 pandemic is social distancing, which may clash with the deep-seated human instinct to connect with family members or other people. Social connection would help people to regulate emotions, cope with stress, and remain resilient during difficult times. By contrast, loneliness and social isolation worsen the burden of stress and often produce deleterious effects on mental health. Older adults, who are at the greatest risk of severe symptoms from COVID-19, are also highly susceptible to isolation. In this study, we firstly found that patients with cerebral infarction during the recovery period had psychological reactions such as anxiety, depression, and loneliness at the early stage of COVID-19 pandemic. These problems demand the immediate attention of medical staff and effective action to reduce the psychological burden of patients and their families. First, medical staff can use telephone or online consultation to provide psychological interventions for patients, including cognitive behavioral therapy. Through listening, sympathizing, and understanding the confusion in patients with cerebral infarction, medical staff can provide patients relevant knowledge and preventive measures for COVID-19 pneumonia to alleviate the patients' bad mood. Second, measures have to be taken to solve the practical problems faced by patients including the timely supply of medicines and daily necessities. Third, social support has to be provided to patients with cerebral infarction through the use of telephone and video by family members or through community staff and volunteers, especially for those patients who are living alone. Fourth, appropriate antianxiety or antidepressant medicines have to be prescribed for those patients with serious psychological problems to relieve their symptoms. At present, most teaching hospitals have established network hospitals to provide free online consultation services for patients with any psychological problems, including those with cardiovascular and cerebrovascular diseases. For detailed intervention methods and techniques, please refer to the “Novel Coronavirus Pneumonia Psychological Intervention Guide” edited and published by the Mental Health Branch of the China Health Care Association in February 2020. It was found that after taking these measures, all patients in this study passed the difficult period smoothly, and no patient was infected with COVID-19 pneumonia. Of course, there were some limitations in this study. The sample size was small; all patients were selected from Wuhan city at the early stage of COVID-19 pandemic, which cannot represent all patients with cerebral infarction. The psychological rating scales used in this research were based on foreign countries, although they have good reliability and validity in China, there may be deviations due to different cultural backgrounds. Further studies in multiple communities with large numbers of subjects are warranted.


  Conclusions Top


This study firstly found that at the early stage of COVID-19 pandemic, patients with cerebral infarction during the recovery period in Wuhan city showed obvious symptoms of anxiety and depression, while the social support was significantly limited, especially in patients who were living alone. These results suggest that local governments and medical institutions should pay attention to the physical and mental health of patients with cerebral infarction at the early stage of COVID-19 pandemic. Psychological counseling, social support, and symptomatic treatment drugs should be provided to patients with cerebral infarction if necessary, all of which may contribute to the recovery of their physical and mental health.

Acknowledgment

The authors would like to thank all patients and family members who participated in this study. We also thank Mr. John Coon and Editage (www.editage.com) for English language editing.

Financial support and sponsorship

This work was supported by the Key Projects of Scientific Research Funds (JX5A04) from Health Department of Hubei Province, China.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Troyer EA, Kohn JN, Hong S. Are we facing a crashing wave of neuropsychiatric sequelae of COVID-19? Neuropsychiatric symptoms and potential immunologic mechanisms. Brain Behav Immun 2020;87:34-9.  Back to cited text no. 1
    
2.
Kang C, Yang S, Yuan J, Xu L, Zhao X, Yang J. Patients with chronic illness urgently need integrated physical and psychological care during the COVID-19 outbreak. Asian J Psychiatr 2020;51:102081.  Back to cited text no. 2
    
3.
Chang MC, Boudier-Revéret M. Usefulness of telerehabilitation for stroke patients during the COVID-19 pandemic. Am J Phys Med Rehabil 2020;99:582.  Back to cited text no. 3
    
4.
Smith L, Jacob L, Yakkundi A, McDermott D, Srmstrong NC, Barnett Y, et al. Correlates of symptoms of anxiety and depress and mental wellbeing associated with COVID-19: A cross-sectional study of UK-based respondents. Psychiatry Res 2020;291:113138.  Back to cited text no. 4
    
5.
Lai J, Ma S, Wang Y, Cai Z, Hu J, Wei N, et al. Factors associated with mental health outcomes among health care workers exposed to Coronavirus disease 2019. JAMA Netw Open 2020;3:e203976.  Back to cited text no. 5
    
6.
Chinese Medical Association's Neuropathy Credits. Acute ischemic stroke diagnosis and treatment guidelines' in China. Chin J Neurol 2010;43:146-53.  Back to cited text no. 6
    
7.
Shunmugasundaram C, Rutherford C, Butow PN, Sundaresan P, Dhillon HM. What are the optimal measures to identify anxiety and depression in people diagnosed with head and neck cancer (HNC): A systematic review. J Patient Rep Outcomes 2020;4:26.  Back to cited text no. 7
    
8.
Huang XQ, Zhang H, Chen S. Neuropsychiatric symptoms, parenting stress and social support in Chinese mothers of children with autism spectrum disorder. Curr Med Sci 2019;39:291-7.  Back to cited text no. 8
    
9.
Gong Y, Han T, Chen W, Dib HH, Yang G, Zhuang R, et al. Prevalence of anxiety and depressive symptoms and related risk factors among physicians in China: A cross-sectional study. PLoS One 2014;9:e103242.  Back to cited text no. 9
    
10.
Zhang H, Xiong RH, Hujiken S, Zhang JJ, Zhang XQ. Psychological distress, family functioning, and social support in family caregivers for patients with dementia in the mainland of China. Chin Med J (Engl) 2013;126:3417-21.  Back to cited text no. 10
    
11.
Sanghera J, Pattani N, Hashmi Y, Varley KF, Cheruvu MS, Bradley A, et al. The impact of SARS-CoV-2 on the mental health of healthcare workers in a hospital setting-a systematic review. J Occup Health 2020;62:e12175.  Back to cited text no. 11
    
12.
Cao W, Fang Z, Hou G, Han M, Xu X, Dong J, et al. The psychological impact of the COVID-19 epidemic on college students in China. Psychiatry Res 2020;287:112934.  Back to cited text no. 12
    
13.
Tsamakis K, Triantafyllis AS, Tsiptsios D, Spartalis E, Mueller C, Tsamakis C. COVID-19 related stress exacerbates common physical and mental pathologies and affects treatment (Review). Exp Ther Med 2020;20:159-62.  Back to cited text no. 13
    
14.
Khera A, Baum SJ, Gluckman TJ, Gulati M, Martin SS, Michos ED, et al. Continuity of care and outpatient management for patients with and at high risk for cardiovascular disease during the COVID-19 pandemic: A scientific statement from the American Society for Preventive Cardiol. Am J Prev Cardiol 2020;1:100009.  Back to cited text no. 14
    
15.
Fan H, Tang X, Song Y, Liu P, Chen Y. Influence of COVID-19 on cerebrovascular disease and its possible mechanism. Neuropsychiatr Dis Treat 2020;16:1359-67.  Back to cited text no. 15
    
16.
Tsivgoulis G, Palaiodimou L, Katsanos AH, Caso V, Köhrmann M, Molina C, et al. Neurological manifestations and implications of COVID-19 pandemic. Ther Adv Neurol Disord 2020; 13:1756286420932036.  Back to cited text no. 16
    
17.
Montaner J, Barragán-Prieto A, Pérez-Sánchez S, Escudero-Martíne I, Monich F, Sánchez-Miur JA, et al. Break in the stroke chain of survival due to COVID-19. Stroke 2020;51:2307-14.  Back to cited text no. 17
    
18.
Usher K, Bhullar N, Durkin J, Gyamfi N, Jackson D. Family violence and COVID-19: Increased vulnerability and reduced options for support. Int J Ment Health Nurs 2020;29:549-52.  Back to cited text no. 18
    
19.
Matthews T, Danese A, Wertz J, Odgers CL, Ambler A, Moffitt TE, et al. Social isolation, loneliness and depression in young adulthood: A behavioural genetic analysis. Soc Psychiatry Psychiatr Epidemiol 2016;51:339-48.  Back to cited text no. 19
    
20.
Ivbijaro G, Brooks C, Kolkiewicz L, Sunkel C, Long A. Psychological impact and psychosocial consequences of the COVID 19 pandemic resilience, mental well-being, and the Coronavirus pandemic. Indian J Psychiatry 2020;62:S395-403.  Back to cited text no. 20
    
21.
Hawryluck L, Gold WL, Robinson S, Pogorski S, Styra R. SARS control and psychological effects of quarantine, Toronto, Canada. Emerg Infect Dis 2004;10:1206-12.  Back to cited text no. 21
    
22.
Sheets RL, Mohr JJ. Perceived social support from friends and family and psychosocial functioning in bisexual young adult college students. J Couns Psychol 2009;56:152-63.  Back to cited text no. 22
    
23.
Romero DH, Riggs SA, Ruggero C. Coping, family social support, and psychological symptoms among student veterans. J Couns Psychol 2015;62:242-52.  Back to cited text no. 23
    
24.
Wang Q, Hay M, Clarke D, Menahem S. The prevalence and predictors of anxiety and depression in adolescents with heart disease. J Pediatr 2012;161:943-6.  Back to cited text no. 24
    
25.
Shumaker SC, Frazier SK, Moser DK, Chung ML. Psychometric properties of the multidimensional scale of perceived social support in patients with heart failure. J Nurs Meas 2017;25:90-102.  Back to cited text no. 25
    
26.
Zhang Y, Ma ZF. Impact of the COVID-19 pandemic on mental health and quality of life among local residents in Liaoning province, China: A cross-sectional study. Int J Environ Res Public Health 2020;17:2381.  Back to cited text no. 26
    
27.
Xiao H, Zhang Y, Kong D, Li S, Yang N. The effects of social support on sleep quality of medical staff treating patients with Coronavirus disease 2019 (COVID-19) in January and February 2020 in China. Med Sci Monit 2020;26:e923549.  Back to cited text no. 27
    
28.
Li X, Wu H, Meng F, Li L, Wang Y, Zhou M. Relations of COVID-19-related stressors and social support with Chinese college students' psychological response during the COVID-19 pandemic. Front Psychiatry 2020;11:551315.  Back to cited text no. 28
    




 

Top
 
 
  Search
 
Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

 
  In this article
Abstract
Introduction
Subjects and Methods
Results
Discussion
Conclusions
References

 Article Access Statistics
    Viewed684    
    Printed46    
    Emailed0    
    PDF Downloaded43    
    Comments [Add]    

Recommend this journal


[TAG2]
[TAG3]
[TAG4]