COVID-19 survivors: the link between C-reactive protein and psychopathologies

OBJECTIVE: To investigate several psychiatric implications in survivors of coronavirus disease 2019 (COVID-19), while also exploring its correlation with C-reactive protein (CRP), an important non-specific acute phase reactant in infection and in the presence of psychopathologies. METHODS: This study was conducted in February–June 2021 at Universitas Sumatera Utara Hospital and Haji General Hospital, Medan, Indonesia. In total, 182 patients with COVID-19 admitted for hospital treatment were screened for psychiatric symptoms. Sociodemographic and clinical data, including CRP level, were screened. Anxiety and depression scores were measured using the Beck Anxiety Inventory (BAI) and the Beck Depression Inventory-II (BDI-II), respectively. The same screening was repeated 4 weeks after hospital discharge. Unpaired t-test was used to assess gender differences in clinical data and psychiatric symptoms, and Pearson's correlation test was used to investigate the link between CRP level and the symptoms of anxiety and depression. RESULTS: In terms of psychopathological symptoms, patient-reported rates of insomnia, anxiety and depression were 94%, 78% and 34%, respectively. Females had significantly higher baseline scores for both anxiety (mean ± standard deviation: 23.79 ± 5.44 vs 20.56 ± 4.90 in males) and depression (20.04 ± 5.29 vs 18.56 ± 3.90 in males) (P=0.000). Interestingly, 4 weeks after hospital discharge, female COVID-19 survivors still had higher anxiety scores than male COVID-19 survivors (8.02 ± 4.72 vs 5.20 ± 2.98, respectively) (P=0.0001). During the interview, patients reported that they were worried about experiencing COVID-19 symptoms again (89%), re-infection (56%), and not having proper first aid at home (64%). A higher CRP level was significantly correlated with higher anxiety and depression scores (baseline CRP–BAI: r=0.623; baseline CRP–BDI-II: r=0.680; follow-up CRP–BAI: r=0.632; follow-up CRP-BDI-II: r=0.621; P=0.001). CONCLUSION: This study found that worse inflammation fostered worse psychiatric symptoms. Therefore, psychiatric liaison is important not only for patients with COVID-19 but also for COVID-19 survivors. Early assessment of COVID-19-related psychopathology is recommended so that treatment can be tailored as early as possible.