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Association between mental health symptoms and autoimmunity in patients with long COVID
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Guillen-Burgos, Hernan F.
Sarmiento, Mauricio
Gálvez-Flórez, Juan F.
Rojas, Catalina
Lora, Yaneth Beatriz
Lozada-Martinez, Ivan David
Diazgranados-Garcia, María C.
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Rojas, Manuel
Salazar-Uribe, Juan Carlos
Fecha
2024-04-02
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Resumen
Los síntomas neuropsiquiátricos son manifestaciones frecuentes tanto en la COVID-19 aguda como en la COVID prolongada, aunque los mecanismos fisiopatológicos subyacentes aún no se comprenden completamente. Este estudio tuvo como objetivo evaluar la presencia de síntomas depresivos, de ansiedad e insomnio en sobrevivientes de COVID-19 con COVID prolongada, así como explorar su posible asociación con actividad autoinmune. Se realizó un estudio observacional y transversal en 228 adultos reclutados de un programa de atención a COVID prolongada en Cartagena, Colombia. Los participantes fueron evaluados mediante entrevistas clínicas y escalas psicométricas validadas (PHQ-9, GAD-7 e ISI), además de la recolección de datos sociodemográficos, clínicos y biológicos. Se analizó un panel de autoanticuerpos, incluyendo anticuerpos antinucleares (ANA), anti-SSA/Ro, anti-SSB/La, anti-RNP, anti-Smith, factor reumatoide, anti-tiroglobulina y anti-peroxidasa tiroidea, utilizando técnicas de ELISA e inmunofluorescencia. Los resultados mostraron que el 57 % de los participantes presentó COVID prolongada, con altas prevalencias de síntomas depresivos (21,2 %), ansiedad (31,2 %) e insomnio (28,7 %). Asimismo, se observó una asociación significativa entre la positividad de autoanticuerpos —especialmente ANA aislados o en combinación con anti-TPO— y la presencia de síntomas neuropsiquiátricos en individuos con COVID prolongada. Estos hallazgos sugieren una posible relación entre alteraciones psicopatológicas, actividad autoinmune y perfiles clínicos específicos de la COVID prolongada, lo que resalta la necesidad de estudios longitudinales adicionales.
Abstract
Background Neuropsychiatric symptoms are common features in long COVID. The pathogenesis of neuropsychiatric manifestations in both acute COVID-19 and long COVID remains unclear. This study aimed to examine mental health symptoms—depressive, anxiety, and insomnia symptoms—in COVID-19 survivors with long COVID, and to explore their potential association with autoimmune activity. Methods We conducted an observational, cross-sectional study of 228 adults recruited from a long COVID program in Cartagena, Colombia. Participants underwent clinician-administered interviews and completed validated psychometric scales to assess depressive (PHQ-9), anxiety (GAD-7), and insomnia (ISI) symptoms. Sociodemographic, clinical, and biological data were collected. The autoantibody panel included antinuclear antibodies (ANA), anti-SSA/ Ro, anti-SSB/La, anti-RNP, anti-Smith (Sm), rheumatoid factor (RF), anti-thyroglobulin (Tg), and anti-thyroid peroxidase (TPO), measured via ELISA and immunofluorescence. Robust logistic regression models were used to evaluate associations between long COVID, autoantibody positivity, and mental health symptoms, adjusting for age, sex, and relevant covariates. Results 57% of participants with a history of COVID-19 acute infection reported long COVID. In participants with long COVID, we reported high proportions of depressive (21.2%), anxiety (31.2%), and insomnia (28.7%) symptoms. Moreover, an association of all three mental health symptoms with autoantibody positivity (particularly antinuclear antibodies [ANA] isolated or co-occurring with anti-TPO antibodies) was observed in individuals with long COVID. Our f indings suggest a potential association between psychopathological symptoms, autoantibody positivity, and distinct clinical profiles of long COVID, warranting further longitudinal investigation. Conclusions Mental health symptoms (MHS) should be considered one of the main targets involved in translational research in long COVID. There is an urgent need for consultation-liaison physicians to work closely with immunologists, rheumatologists, and pain medicine physicians in clinical settings as well as in research. This will contribute to a better understanding of the impact of MHS during illness in long COVID variants.
Palabras clave
COVID prolongada , Síntomas neuropsiquiátricos , Depresión , Ansiedad , Insomnio , Autoinmunidad , Anticuerpos antinucleares , Salud mental , SARS-CoV-2 , Estudios observacionales
Keywords
Long COVID , Depressive , Anxiety , Insomnia , Autoantibody positivity , Neuroinflammation , Antinuclear - antibodies
