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Revista del Hospital Psiquiátrico de
La Habana
Volumen 22 | Año 2025 | Publicación continua
ISSN: 0138-7103 | RNPS: 2030
___________________________________________
Original
Association between Post-COVID-19 Disabling Sequelae
and Mental Health Symptoms in Adult Patients
Asociación entre las secuelas discapacitantes pos-
COVID-19 y los síntomas de salud mental en pacientes
adultos
Rolando Rodríguez Puga1*
Yoánderson Pérez Díaz1
Daysi López Moré2
1University of Medical Sciences “Dr. Carlos J. Finlay.” Provincial Pediatric Teaching Hospital “Dr. “Eduardo Agramonte
Piña”. Department of Hospital Epidemiology. Camaguey, Cuba
2University of Medical Sciences “Dr. Carlos J. Finlay.” Technological Faculty. Nursing Department. Camaguey, Cuba
Recibido: 12/12/2024
Aceptado: 20/02/2025
Association between Post-COVID-19 Disabling Sequelae and Mental Health Symptoms in Adult Patients
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Abstract
Introduction: COVID-19 has left deep marks on the physical and mental health of adults.
Disabling consequences, such as fatigue and respiratory problems, are often associated with
an increase in symptoms such as anxiety and depression, complicating the patient's
comprehensive recovery.
Objective: To analyze the association between post-COVID-19 disabling sequelae and
mental health symptoms in adult patients.
Methods: An analytical, case-control study was carried out on patients treated at the
municipal post-COVID-19 consultation, located at the “José Martí” Polyclinic in the city of
Camagüey, between the months of January to December 2021. From a universe of 265
patients, we worked with a sample of 200, divided into two groups of 100, one of cases and
the other of controls. Sociodemographic variables, comorbidities, clinical manifestations,
mental health symptoms and psychosocial factors were analyzed.
Results: In the age group of 20-39 years, there is a significant association between patients
with a history of COVID-19 who developed sequelae and those who did not. High blood
pressure, loss of taste and smell, as well as depression were significantly more prevalent in
patients with post-COVID-19 disabling sequelae. The study suggests that family support can
be beneficial.
Conclusions: Post-COVID-19 disabling sequelae significantly affect the mental health of
adult patients. The research reveals a correlation between the presentation of sequelae and
an increase in symptoms such as anxiety and depression, highlighting the need for a
comprehensive approach to treatment.
Keywords: post-COVID-19 disabling sequelae; symptoms; mental health symptoms;
anxiety; depression.
Resumen
Introducción: La COVID-19 ha dejado profundas huellas en la salud física y mental de los
adultos. Las secuelas discapacitantes, como la fatiga y los problemas respiratorios, a menudo
se asocian con un aumento de síntomas como la ansiedad y la depresión, complicando la
recuperación integral del paciente.
Objetivo: Analizar la asociación entre las secuelas discapacitantes pos-COVID-19 y los
síntomas de salud mental en pacientes adultos.
Métodos: Se realizó un estudio analítico, de casos y controles, en pacientes atendidos en la
consulta municipal de pos-COVID-19, ubicada en el Policlínico “José Martí” de la ciudad
de Camagüey, entre los meses de enero a diciembre de 2021. De un universo de 265 pacientes
se trabajó con una muestra de 200, divididos en dos grupos de 100, uno de casos y otro de
controles. Se analizaron las variables sociodemográficas, comorbilidades, manifestaciones
clínicas, síntomas de salud mental y factores psicosociales.
Association between Post-COVID-19 Disabling Sequelae and Mental Health Symptoms in Adult Patients
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Resultados: En el grupo de edad de 20-39 años, existe una asociación significativa entre los
pacientes con antecedentes de COVID-19 que desarrollaron secuelas y los que no. La
hipertensión arterial, la pérdida del gusto y del olfato, así como la depresión resultaron
significativamente más prevalente en pacientes con secuelas discapacitantes pos-COVID-19.
El estudio sugiere que el apoyo familiar puede resultar beneficioso.
Conclusiones: Las secuelas discapacitantes pos-COVID-19 afectan significativamente la
salud mental de los pacientes adultos. La investigación revela una correlación entre la
presentación de las secuelas y el aumento de síntomas como ansiedad y depresión, resaltando
la necesidad de un enfoque integral en el tratamiento.
Palabras clave: secuelas discapacitantes pos-COVID-19; síntomas; síntomas de salud
mental; ansiedad; depresión.
Introduction
The coronavirus pandemic has had a significant impact on public health globally for a long
time. Beyond lung problems and the large number of cases of illness, another point of focus
has emerged: the growing number of patients who, after recovering, face serious
consequences.(1)
These consequences, known as long COVID or post-COVID syndrome, include both
physical and psychological problems that can considerably affect people's well-being.
Mental health symptoms are a crucial aspect that deserves thorough exploration, as they
compound the complex challenges faced by those dealing with physical and mental
disabilities.(2)
The clinical landscape of COVID-19 has expanded to include not only the usual symptoms
of the disease, such as fever, cough and shortness of breath, but also a wide variety of
neurological and mental health problems. These symptoms can manifest as anxiety,
depression, post-traumatic stress disorder (PTSD), sleep problems, cognitive difficulties, and
emotional changes, which are common in individuals after the contagious period.(3)
The relationship between having had COVID-19, whether mild or severe, and mental health
problems is complex and interconnected, leading many people to face the challenge of
recovering their physical condition while protecting their mental stability. Research has
shown an increase in mental health conditions among COVID-19 survivors, indicating that
about a third may suffer psychological distress after recovery.(4)
This issue is of great concern, especially considering that a multitude of people belonged to
groups that were already struggling with psychological well-being before the onset of the
global health crisis. Pre-existing health problems, the distress of being told you have an
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illness, and the limitations imposed by the pandemic, along with social restrictions, have
created an environment where emotional and mental health can deteriorate.(5)
A worrying factor in this context is the challenges faced by both those seeking medical help
and healthcare providers in identifying and treating these psychological manifestations.
Physical conditions usually receive more attention when treating a person, but we cannot
forget that mental health requires specialized care. The lack of trained professionals and
inadequate treatment create disparities that lead many patients to endure symptoms in an
isolated and persistent way.(6)
It is important to realize that the impact of COVID-19 does not affect everyone equally. This
depends on several personal factors, such as age, sex, socioeconomic level, and the culture
of the human environment. Therefore, addressing psychiatric symptoms in this population
requires a comprehensive strategy that considers not only the clinical aspects, but also the
emotional, social, and economic factors that impact an individual's overall health.(7)
This situation encourages increased awareness about the conditions faced by COVID-19
survivors. Emerging research findings suggest that adopting preventive and restorative
initiatives focused on mental health may be important in improving overall outcomes. The
education and training of health professionals in this population category, as well as the
creation of a safe environment for dialogue and dissemination of these topics, are key actions
for more comprehensive and effective health care.(8)
Managing patients' mental health symptoms can have long-term consequences. The
aftermath of COVID-19 is a serious challenge that requires urgent measures. The interaction
of physical and psychological symptoms requires a holistic approach that takes into account
the complexities of post-coronavirus syndrome. As understanding of the disease and its
consequences continues to grow, it is essential to research, participate and create tools that
promote comprehensive recovery for patients.(9)
In relation to the above, collaborative action is needed to reduce the long-term impact of the
pandemic and ensure that COVID-19 survivors receive the help they need to safely
reintegrate into society and resume their lives. In this sense, it is proposed establish the
association between post-COVID-19 disabling sequelae and mental health symptoms in adult
patients.
Method
A retrospective analytical observational case-control study was carried out in a series of cases
treated in the post-COVID-19 municipal consultation, located at the “Jose Marti” Polyclinic
Association between Post-COVID-19 Disabling Sequelae and Mental Health Symptoms in Adult Patients
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in the city of Camagüey. The research was carried out between January and December 2021
and included patients from the nine health areas of the municipality of Camagüey.
From a universe of 265 patients, we worked with a sample of 200, selected through non-
probabilistic convenience sampling. Each group included a total of 100 patients, while the
cases corresponded to those diagnosed with post-COVID-19 disabling sequelae and the
controls corresponded to those who recovered completely, without sequelae.
The following eligibility criteria were taken into account:
Inclusion criteria
Patients between the ages of 20 and 59 diagnosed with COVID-19.
Patients willing to participate in the study with prior informed consent.
Exclusion criteria
Patients with pre-existing psychiatric disorders diagnosed before becoming ill with
COVID-19.
Patients with serious medical conditions that preclude evaluation of mental health
symptoms.
Sociodemographic variables, comorbidities, clinical manifestations, mental health symptoms
and psychosocial factors were analyzed. In each case the following aspects were considered:
- Sociodemographic variables: age group (20-39), sex (male), socioeconomic level
(adequate), educational, level (pre-university and university), employment status
(stable) and housing conditions (adequate).
- Comorbidities: diabetes mellitus, high blood pressure, bronchial asthma, ischemic
heart disease, chronic obstructive pulmonary disease and obesity.
- Clinical manifestations: chronic fatigue, respiratory difficulty, muscle and joint
pain, tachycardia, loss of taste and smell and reduced functional capacity
- Mental health symptoms: anxiety, depression, post-traumatic stress, insomnia,
irritability and concentration problems.
- Psychosocial factors: social isolation, adaptability, family support, social support,
access to health resources and social stigmatization.
The information obtained through a demographic questionnaire made it possible to create a
database in Microsoft Excel as the primary record of the research. The patients' medical
records were also consulted in order to obtain data that were not included in the surveys.
Validated scales such as the Beck Depression Inventory (BDI) and the Hamilton Anxiety
Scale (HAM-A) were used to evaluate mental health symptoms. Likewise, structured
interviews were conducted to delve deeper into the clinical history and reported symptoms.
Data processing was carried out using the Statistical Package for the Social Sciences (SPSS),
version 27.0, so that descriptive and inferential statistics were applied. The results were
expressed in numbers and percentages and the Odds ratio (OR) was calculated as a measure
of effect in this type of studies, in addition to the confidence interval (CI) and statistical
significance (p). The results are displayed in the form of texts and tables.
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The research was approved by the Scientific Council and the Ethics Committee of the
Pediatric Hospital of Camagüey. It maintained the confidentiality of the information by
coding the variables, accessible only to the researchers. The data collected were not used for
purposes other than the research, and the provisions contained in the Declaration of Helsinki
were taken into consideration.
Results
Table 1 shows the sociodemographic variables, so that the interpretation of the study suggests
that, in the age group of 20-39 years, there is a significant association between patients with
a history of COVID-19 who developed post-disabling sequelae. COVID-19 and those who
don't. The odds ratio indicates that the probability of presenting these symptoms is almost
double.
Regarding the association between educational level and post-COVID-19 disabling
consequences, there is no significance. The confidence interval includes the value 1, and
statistical significance indicates that the results are inconclusive.
Table 1. Distribution of patients with (cases) and without (controls) post-COVID-19 disabling sequelae
according to sociodemographic variables
Source: own elaboration
Sociodemographic variables
Study group
95 % CI
OR
p
Cases
Controls
L.I
L.S
%
%
Age group (20-39)
Yes
56,0
39,0
1,1333
3,4968
1,9907
0,0166
No
44,0
61,0
Sex (male)
Yes
42,0
52,0
0,3825
1,1681
0,6684
0,1573
No
58,0
48,0
Socioeconomic level (adequate)
Yes
62,0
60,0
0,6161
1,9204
1,0877
0,7719
No
38,0
40,0
Educational level (pre-university and university)
Yes
73,0
69,0
0,6587
2,2400
1,2147
0,5333
No
27,0
31,0
Employment status (stable)
Yes
36,0
47,0
0,3600
1,1177
0,6343
0,1153
No
64,0
53,0
Housing conditions (adequate)
Yes
65,0
62,0
0,6398
2,0251
1,1382
0,6595
No
35,0
38,0
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Comorbidities, such as high blood pressure, are seen in table 2, where this significantly
increases the risk of disabling post-COVID-19 sequelae. The confidence interval and odds
ratio indicate a strong and statistically significant relationship between these conditions and
long-term consequences. Similarly, diabetes mellitus increases the risk of presenting
disabling sequelae post-COVID-19. The results, with a confidence interval between 1.9519
and 6.5328 and an odds ratio of 3.5709, are statistically significant.
Table 2 - Distribution of patients with (cases) and without (controls) post-COVID-19 disabling sequelae
according to comorbidities
Source: own elaboration
The analysis indicates a strong association between post-COVID-19 disabling sequelae and
chronic fatigue, evidenced by a wide confidence interval and a high odds ratio, supporting
statistical significance. The study reveals a strong association between the loss of taste and
smell in cases of post-COVID-19 disabling sequelae, with an odds ratio of 16.1163 and
statistical significance (p: 0.0078), indicating that these clinical manifestations are relevant
in this population (table 3).
Comorbidities
Study group
95 % CI
OR
p
Cases
Controls
L.I
L.S
n
%
n
%
Diabetes mellitus
Yes
53
53,0
24
24,0
1,9519
6,5328
3,5709
<0,0001
No
47
47,0
76
76,0
High blood pressure
Yes
55
55,0
25
25,0
2,0121
6,6817
3,6667
<0,0001
No
45
45,0
75
75,0
Bronchial asthma
Yes
15
15,0
8
8,0
0,8191
5,0283
2,0294
0,1263
No
85
85,0
92
92,0
Ischemic heart disease
Yes
11
11,0
4
4,0
0,9113
9,6551
2,9663
0,0710
No
89
89,0
96
96,0
Chronic obstructive pulmonary disease
Yes
13
13,0
4
4,0
1,1269
11,4125
3,5862
0,0306
No
87
87,0
96
96,0
Obesity
Yes
26
26,0
17
17,0
0,8630
3,4097
1,7154
0,1236
No
74
74,0
83
83,0
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Table 3. Distribution of patients with (cases) and without (controls) post-COVID-19 disabling sequelae
according to clinical manifestations
Source: own elaboration
Table 4 shows depression as a mental health symptom in patients with and without post-
COVID-19 disabling sequelae, such that it was significantly more prevalent in patients with
post-COVID-19 disabling sequelae, with an odds ratio of 2.3146, indicating double the
probability compared to controls, and a confidence interval that supports this association.
Irritability also presented a statistically significant relationship and an odds ratio of 2.6781
indicates that people with these sequelae are more likely to experience the mental health
symptom in question.
Clinical
manifestation
s
Study group
95 % CI
OR
p
Cases
Controls
L.I
L.S
N
%
n
%
Chronic fatigue
Yes
17
17,0
2
2,0
2,2527
44,7132
10,0361
0,0025
No
83
83,0
98
98,0
Respiratory difficulty
Yes
15
15,0
7
7,0
0,9121
6,0269
2,3445
0,0769
No
85
85,0
93
93,0
Muscle and joint pain
Yes
19
19,0
9
9,0
1,0160
5,5366
2,3717
0,0459
No
81
81,0
91
91,0
Tachycardia
Yes
8
8,0
3
3,0
0,7236
10,9243
2,8116
0,1355
No
92
92,0
97
97,0
Loss of taste and smell
Yes
14
14,0
1
1,0
2,0763
125,0973
16,1163
0,0078
No
86
86,0
99
99,0
Reduced functional capacity
Yes
6
6,0
1
1,0
0,7466
53,4828
6,3191
0,0907
No
94
94,0
99
99,0
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Table 4. Distribution of patients with (cases) and without (controls) post-COVID-19 disabling sequelae
according to mental health symptoms
Source: own elaboration
The study suggests that family support can reduce post-COVID-19 disabling consequences.
The confidence interval and the odds ratio indicate a significant relationship between family
support and improvement in the patients' condition, being statistically relevant. Adaptability
influences the presentation of post-COVID-19 disabling sequelae, so the confidence interval
indicates a potential association, although the statistical significance suggests that the results
are not conclusive (table 5).
Mental health
symptoms
Study group
95 % CI
OR
p
Cases
Controls
L.I
L.S
n
%
n
%
Anxiety
Yes
21
21,0
12
12,0
0,9011
4,2169
1,9494
0,0900
No
79
79,0
88
88,0
Depression
Yes
29
29,0
15
15,0
1,1511
4,6539
2,3146
0,0185
No
71
71,0
85
85,0
Post-traumatic stress
Yes
10
10,0
6
6,0
0,6076
4,9874
1,7407
0,3020
No
90
90,0
94
94,0
Insomnia
Yes
23
23,0
17
17,0
0,7246
2,9351
1,4584
0,2903
No
77
77,0
83
83,0
Irritability
Yes
17
17,0
8
8,0
1,0946
6,5525
2,6781
0,0309
No
73
73,0
92
92,0
Concentration problems
Yes
15
15,0
6
6,0
1,0261
7,4493
2,7647
0,0443
No
85
85,0
94
94,0
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Table 5. Distribution of patients with (cases) and without (controls) post-COVID-19 disabling sequelae
according to psychosocial factors
Source: own elaboration
Discussion
The emergence of COVID-19 has caused considerable effects, which not only affect the
physical well-being, but also the mental well-being of people. Recent research targeting a
matched-pair scheme attempts to understand markers of psychological distress in people
suffering from post-COVID sequelae. This analysis is enriched by comparison with that of
other scholars in the field, allowing for a deeper and more complex understanding of the
topic at hand.(10,11)
The research brought together two cohorts of subjects: individuals affected by COVID-19
and persistent sequelae (case group), versus uninfected individuals (control group).
Psychological evaluations were performed to detect signs such as anxiety, depression and
post-traumatic stress disorder (PTSD). The scientists used approved tests like the Beck
Depression Checklist and anxiety questionnaires to make sure the results were accurate.(12,13)
Psychosocial
factors
Study group
95 % CI
OR
P
Cases
Controls
L.I
L.S
n
%
n
%
Social isolation
Yes
28
28,0
21
21,0
0,6742
2,4476
1,2846
0,4465
No
82
82,0
79
79,0
Adaptability
Yes
20
20,0
13
13,0
0,7813
3,5826
1,6731
0,1852
No
80
80,0
87
87,0
Family support
Yes
73
73,0
59
59,0
1,0366
3,4055
1,8788
0,0377
No
27
27,0
41
41,0
Social support
Yes
81
81,0
79
79,0
0,5663
2,2677
1,1332
0,7238
No
19
19,0
21
21,0
Access to health resources
Yes
98
98,0
99
99,0
0,0442
5,5478
0,4949
0,5684
No
2
2,0
1
1,0
Social stigmatization
Yes
3
3,0
1
1,0
0,3130
29,9488
3,0619
0,3362
No
97
97,0
99
99,0
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Research results revealed that a significant number of people recovering from COVID-19
had indicators of psychological distress that exceeded the incidence rates observed in the
comparison group. This suggests there could be a link between the physical effects of the
disease and worsening mental health. Additionally, a person's mental health problems
seemed to match the duration and severity of their physical problems.(14-16)
Existing literature shows similar patterns. According to research by Arriaga Castañeda et
al.(17) in 2023, up to 30 % of people recovering from COVID-19 were found to have some
mental health symptoms. A study conducted by Pincay Baque et al.(18) revealed that, months
after recovery, patients showed greater anxiety and depressive symptoms compared to the
norms of the general population.
These investigations support the results of the current study, underscoring the need to address
psychological well-being in post-pandemic recovery. However, it is important to note that
some research presents different opinions. Certain studies suggest that the emergence of
mental disorders among COVID-19 survivors does not differ significantly from community
levels, considering previous psychiatric conditions
Other scholars highlight the importance of taking social and cultural factors into account
when assessing the impact of the pandemic on mental well-being. In this sense, social and
health strategies must be designed and implemented to counteract the symptoms through
interdisciplinary actions.(19-21)
The findings underscore the urgent need for tailored mental health approaches for those
facing the lasting after-effects of COVID-19. However, if I had to simplify it, I would say:
"Take care of yourself in general, considering the physical and mental problems related to
the disease." It is essential to promote regular physical activity.
The study reviews provided valuable information about the prevalence of mental health
symptoms in people suffering from the long-term consequences of COVID-19. Compared to
similar research,(22-24) it is evident that there is a worrying pattern that needs attention.
However, more research is needed to better understand these connections and develop
effective strategies that adequately address physical and psychological well-being after the
pandemic. Integrating ideas from different areas will be key to solving the problem.(25)
The study offers a valuable approach to understanding the problem of mental health
symptoms and their association with post-COVID-19 disabling consequences. Its scope lies
in identifying patterns and correlations that can help develop specific interventions.
However, its limitations include the possibility of bias in participant selection and the
difficulty of establishing direct causality. Furthermore, external factors such as
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socioeconomic context and previous experiences with mental illness are not always possible
to control, which can influence the results and their generalization to broad populations.
Conclusions
Post-COVID-19 disabling sequelae significantly affect the mental health of adult patients.
The research reveals a correlation between the severity of the sequelae and the increase in
symptoms such as anxiety and depression, highlighting the need for a comprehensive
approach to treatment.
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citada la fuente primaria de publicación.
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Conflicts of interest
The authors declare that they have no conflicts of interest.
Authors' contribution
Conceptualization: Rolando Rodríguez Puga and Yoánderson Pérez Díaz.
Data curation: Rolando Rodríguez Puga and Yoánderson Pérez Díaz.
Formal analysis: Rolando Rodríguez Puga and Yoánderson Pérez Díaz.
Research: Rolando Rodríguez Puga and Yoánderson Pérez Díaz.
Methodology: Rolando Rodríguez Puga and Daysi López Moré.
Project administration: Rolando Rodríguez Puga and Yoánderson Pérez Díaz.
Resources: Rolando Rodríguez Puga and Yoánderson Pérez Díaz.
Software: Rolando Rodríguez Puga and Yoánderson Pérez Díaz.
Supervision: Rolando Rodríguez Puga and Yoánderson Pérez Díaz.
Validation-Verification: Rolando Rodríguez Puga and Yoánderson Pérez Díaz.
Visualization: Rolando Rodríguez Puga and Yoánderson Pérez Díaz.
Original draft: Rolando Rodríguez Puga and Yoánderson Pérez Díaz.
Writing-review and editing: Rolando Rodríguez Puga and Daysi López Moré.