حافظ صفری

Covid-19 has the potential to trigger heightened health anxiety and concerns about health repercussions. This study aimed to investigate the prevalence of illness anxiety disorder among individuals who have recovered from Covid-19 following hospitalization.

This cross-sectional descriptive study targeted individuals who had previously been hospitalized for Covid-19 at Shohada Hospital in Sarpol-e-Zahab city, with a minimum of six months elapsed since discharge. A total of 479 participants were randomly selected from the hospital's records and assessed face-to-face for levels of health anxiety and the presence of illness anxiety disorder using the short health anxiety inventory. Socio-economic status was determined using the Ghodrat-Nama’s  questionnaire. Data analysis was conducted using Chi-square test, one-way ANOVA, and Tukey test.

The study revealed that 50.93% of participants exhibited moderate to high levels of health anxiety, while the prevalence of illness anxiety disorder among all participants was 23.38%. Significant associations were found between illness anxiety disorder and gender, age, education level, marital status, and socio-economic status.

The findings indicate a high prevalence of illness anxiety disorder among individuals who have recovered from Covid-19 following hospitalization. Moreover, the prevalence of illness anxiety disorder was found to vary across different socio-economic statuses.

 From the beginning of the Covid-19 epidemic, a number of recommendations were made by health organizations, such as maintaining social distance, using masks, and hand hygiene. Hand washing with soap or alcohol-based disinfectants and high hygiene as a precautionary measure to prevent the spread of this emerging virus is widely promoted, and almost all people follow these recommendations. Although hand washing and hygiene are more serious than ever before, and is certainly helpful in preventing the spread of Covid-19, but there is the question of how this can affect different people who have not previously had obsessive-compulsive disorder, and also peoples with mild and sub-threshold symptoms (1,6). The Covid-19 epidemic in the late winter of 2019 / spring 2020 became a global crisis and spread widely and rapidly across borders and continues to this day (3). Covid-19 disease may have different effects on people with different socioeconomic status, as shown in several studies (11,9,8,20,21,22). Very little is known about the impact of the emerging Covid-19 disease on the prevalence or development of mental disorders, and little research has been done in this area. The aim of this study was to evaluate the prevalence of obsessive-compulsive disorder in recovered hospitalized patients with Covid-19 six months after discharge from the hospital, evaluate the existence of a statistically significant relationship between the prevalence of obsessive-compulsive disorder, socioeconomic status and demographic variables such as gender, age, level of education and marital status.

In this cross-sectional study, 479 patients with a history of definitive diagnosis of Covid-19 and subsequent hospitalization were studied. The participation of all sample members in this study was completely voluntary and the present study has been approved by the ethics committee of Kermanshah University of Medical Sciences, Iran. The sample members were selected using random number generation software and through a completely random selection from the list of hospitalized patients. After selecting the sample, they were invited to participate in the study by telephone. After initial satisfaction, research questionnaires were provided to the sample members face to face. In this study, Maudsley Obsessional Compulsive inventory (MOCI), Ghodrat Nama et al. Socio-Economic Status Questionnaire (GHSESQ) were used. The validity and reliability of these questionnaires have been studied in Iran and both of them are valid and reliable. Also, after completing the questionnaires, each member of the sample was examined through a short face-to-face supplementary interview (maximum 10 minutes) for the presence of DSM5 diagnostic criteria for obsessive-compulsive disorder and the results were recorded. After data collection, the overall point prevalence of obsessive-compulsive disorder was calculated.   Also, the point prevalence of obsessive-compulsive disorder were obtained based on each of the classes of demographic variables in the study. Descriptive statistics, chi-square test, one-way analysis of variance and Tukey test were used in this study. SPSS 21 statistical software was used for data analysis.

After reviewing and analyzing the completed questionnaires and the results of the supplementary interview, 92 members of the sample were diagnosed with obsessive-compulsive disorder. The overall prevalence of obsessive-compulsive disorder in all samples was 19.20%. According to the results of statistical analysis, there was a significant relationship between gender and obsessive-compulsive disorder and this disorder was more common in women than men (χ2 = 5.3793; P-value = 0.020378; p≤0.05). There was a significant relationship between age variable and obsessive-compulsive disorder and the prevalence of this disorder was more common in other age groups of 38-58 and 18-38, respectively (χ2 = 10.3501; P-value = 0.015813 ; p≤0.05). There was no significant relationship between education and disorder (χ2 = 2.9693; P-value = 0.562976; p≤0.05). Finally, in the case of marital status, there was no significant relationship between marital status and obsessive-compulsive disorder (χ2 = 4.4587; P-value = 0.107601; p≤0.05). The prevalence of obsessive-compulsive disorder was 12.16% in very low socio-economic status, 15.16% in low socio-economic status, 18.12% in medium socio-economic status, 35.84% in high socio-economic status and 40.00% in very high socio-economic status. The results of this study showed that there was a significant relationship between socioeconomic status and obsessive-compulsive disorder in recovered hospitalized patients with Covid-19 (χ2 = 20.7756; P-value = 0.000351; p≤0.05). The prevalence of obsessive-compulsive disorder has increased with increasing in level of socioeconomic status. The highest prevalence of disorders was in very high and high socio-economic status. One-way analysis of variance (one-way ANOVA) was performed to compare the mean scores of obsessive-compulsive disorder in different socioeconomic statuses and the value of F was 4.67467, Which shows that there is a significant difference in the mean scores of obsessive-compulsive disorder between socio-economic statuses. The results of Tukey test on the mean scores of obsessive-compulsive disorder in different socioeconomic statuses showed that the differences between very low and high socioeconomic status (p = 0.00597), very low and very high socioeconomic status (p = 0.00179), low and high socioeconomic status (p = 0.03153) were statistically significant.

Evidence from research to date suggests that anxiety and fear of being infected by a person or family member, as well as fear of death and threat to life at the time of infection, especially in hospitalized cases, can lead to or the trigger for mental disorders such as obsessive-compulsive disorder. Hospitalized people who have experienced a severe illness and whose life and health are seriously threatened can be one of the groups with the highest rates of mental disorders caused by this epidemic. It is suggested that institutions and organizations related to the maintenance and promotion of mental health in the community take the necessary plans and measures to prevent the occurrence or exacerbation of mental disorders and reduce the psychological consequences of this epidemic in the general population and especially high-risk populations, like people who have experienced the intense and critical state of Covid-19. Considering that the prevalence of obsessive-compulsive disorder in recovered hospitalized patients with Covid-19 is much higher than the prevalence of this disorder in the general population, it can be concluded that covid-19 infection and subsequent hospitalization can lead to obsessive-compulsive disorder. prevalence of Covid-19 exacerbates obsessive-compulsive behaviors and thoughts related to cleanliness and avoidance of the virus. In addition to threatening people's physical health, Covid-19 also threatens their mental health.

Health anxiety is one of the common mental problems during the Covid-19 epidemic. Considering the physical vulnerability of the elderly and their awareness of this issue, this problem can be more common in this age group and affect their mental health. The present study was conducted with the purpose of determining the level of Health anxiety and related factors to it in recovered hospitalized elderly patients with COVID-19.

This study was a descriptive-correlational research and the statistical population was all elderly people with a history of being infected with Covid-19 and subsequent hospitalization in Shohada hospital in Sarpole Zahab, Kermanshah province. 198 elderly people were randomly selected from the list of hospitalized patients and were examined by completing the Salkovskis et al. short health anxiety inventory and demographic characteristics questionnaire. Data were analyzed by SPSS 21 software and using Chi-square test, Kruskal-Wallis H test, Mann-Whitney U test and Cramer’s V, Kendall’s Tau C correlation coefficients.

The results showed that 31.31% of the elderly suffered from high health anxiety and more than half of the elderly population (58.07%) experienced moderate to high health anxiety. There was a significant relationship between the demographic variables of sex (P=0.001), age (P<0.001), marital status (P<0.001), history of chronic disease (P=0.015) and the level of physical activity (P<0.001) with the level of health anxiety (p≤0.05).

Health anxiety is prevalent among recovered hospitalized elderly patients with COVID-19. Providing the mental health of this group of the elderly, along with their physical health, should be considered during the current epidemic. Adequate physical activity can play a protective role in this regard.