Indian Journal of Critical Care Medicine

Register      Login



Volume / Issue

Online First

Related articles

VOLUME 26 , ISSUE 12 ( December, 2022 ) > List of Articles

Original Article

Depression and Anxiety among COVID-19 Indian Intensive Care Unit Survivors: A Prospective Observational Study

Mallikarjun Gunjiganvi, Siddharth Rai, Rupali Bhalchandra Awale, Mohan Gurjar, Devendra Gupta

Keywords : Anxiety, Coronavirus disease-2019, Depression, Intensive care unit survivors, Mental health, Well-being

Citation Information : Gunjiganvi M, Rai S, Awale RB, Gurjar M, Gupta D. Depression and Anxiety among COVID-19 Indian Intensive Care Unit Survivors: A Prospective Observational Study. Indian J Crit Care Med 2022; 26 (12):1267-1274.

DOI: 10.5005/jp-journals-10071-24370

License: CC BY-NC 4.0

Published Online: 08-12-2022

Copyright Statement:  Copyright © 2022; The Author(s).


Background: Long-lasting physical, cognitive, and mental health sequelae including depression and anxiety are common in intensive care unit (ICU) survivors. Aim: This study was aimed to assess the immediate and medium-term mental health sequelae – depression and anxiety among coronavirus disease-2019 (COVID-19) ICU survivors. Methods: The COVID-19 ICU Survivors of a tertiary level ICU were recruited into this study from 1 July 2020 to 31 October 2020. Willing participants were circulated with an electronic questionnaire. It consisted of demographics and questionnaires related to COVID-19 disease, comorbidities, and a patient health questionnaire (PHQ-9) scale for depression, and generalized anxiety disorder (GAD-7) scale for anxiety. Responses were collected at the time of discharge. Follow-up was done at 2 weeks and 6 months. Results: Among the 133 COVID-19 ICU survivors contacted, 91 survivors submitted the baseline data at the time of discharge. Fourteen and another 11 survivors were lost to follow-up at 2 weeks and at 6 months. The median age was 52.75 and 68.1% (n = 62/91) were male. The median PHQ-9 and GAD-7 scores showed a statistically significant decrease at 2 weeks and a non-significant decrease at 6 months compared to baseline scores. The GAD-7 score was the same or worse between baselines to 2 weeks, but it reduced between baseline to 6 months for all variables and their subgroups. Conclusion: This study revealed a high prevalence of anxiety and depression in the immediate post-discharge period. These findings suggest the need for better mental rehabilitation strategies to deal with the well-being of critically ill survivors in future pandemics.

  1. World Health Organization. WHO Director-General's opening remarks at the media briefing on COVID-19—11 March 2020. Available at:—11-march-2020 Accessed on: 5 May 2020.
  2. Fu L, Wang B, Yuan T, Chen X, Ao Y, Fitzpatrick T, et al. Clinical characteristics of coronavirus disease 2019 (COVID-19) in China: A systematic review and meta-analysis. J Infect 2020;80:656–665. DOI: 10.1016/j.jinf.2020.03.041.
  3. Taylor WD, Blackford JU. Mental health treatment for front-line clinicians during and after the coronavirus disease 2019 (COVID-19) Pandemic: A plea to the medical community. Ann Intern Med 2020;173(7):574–575. DOI: 10.7326/M20-2440.
  4. 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(3):e203976. DOI: 10.1001/jamanetworkopen.2020.3976.
  5. Brooks SK, Webster RK, Smith LE, et al. The psychological impact of quarantine and how to reduce it: rapid review of the evidence. Lancet 2020;395(10227):912–920. DOI: 10.1016/S0140-6736(20)30460-8.
  6. Cheng SK, Wong CW, Tsang J, Wong KC. Psychological distress and negative appraisals in survivors of severe acute respiratory syndrome (SARS). Psychol Med 2004;34(7):1187–1195. DOI: 10.1017/s0033291704002272.
  7. Lam MH, Wing YK, Yu MW, Leung CM, Ma RC, Kong AP, et al. Mental morbidities and chronic fatigue in severe acute respiratory syndrome survivors: Long-term follow-up. Arch Intern Med 2009;169:2142–2147. DOI: 10.1001/archinternmed.2009.384.
  8. Mak IW, Chu CM, Pan PC, Yiu MG, Chan VL. Long-term psychiatric morbidities among SARS survivors. Gen Hosp Psychiatry 2009;31: 318–326. DOI: 10.1016/j.genhosppsych.2009.03.001.
  9. Pfizer, Inc. Patient health Questionnaire – PHQ9. Available at: Accessed on: 15 April 2020.
  10. Spitzer RL, Kroenke K, Williams JBW, Löwe B. A brief measure for assessing generalized anxiety disorder: The GAD-7. Arch Intern Med 2006;166(10):1092–1097.
  11. Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. B. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020;395(10223):497–506. DOI: 10.1016/S0140-6736(20) 30183-5.
  12. Ferguson N, Laydon D, Nedjati G, Imai N, Ainslie K, Ba-guelin, et al. Impact of non-pharmaceutical interventions (NPIs) to reduce COVID-19 mortality and healthcare demand. Imperial College COVID-19 Response Team, London UK. Available at: Accessed on: 5 October 2022.
  13. CDC COVID-19 Response Team. Severe outcomes among patients with coronavirus disease 2019 (COVID-19) United States, February 12–March 16, 2020. MMWR Morb Mortal Wkly Rep 2020;69(12):343–346. DOI: 10.15585/mmwr.mm6912e2.
  14. Wang C, Pan R, Wan X, Tan Y, Xu L, Ho CS, et al. Immediate psychological responses and associated factors during the initial stage of the 2019 coronavirus disease (COVID-19) epidemic among the general population in China. Int J Environ Res Public Health 2020;17(5):E1729. DOI: 10.3390/ijerph17051729.
  15. Xiao H, Zhang Y, Kong D, Li S, Yang N. Social capital and sleep quality in individuals who self-isolated for 14 days during the coronavirus disease 2019 (COVID-19) outbreak in January 2020 in China. Med Sci Monit 2020;26: e923921-1–e923921-8. DOI: 10.12659/MSM.923921.
  16. Yadav R, Yadav P, Kumar SS, Kumar R. Assessment of depression, anxiety, and sleep disturbance in COVID-19 patients at tertiary care center of North India. J Neurosci Rural Pract 2021;12(2):316–322. doi: 10.1055/s-0040-1722811.
  17. Imran J, Nasa P, Alexander L, Upadhyay S, Alanduru V. Psychological distress among survivors of moderate-to-critical COVID-19 illness: A multicentric prospective cross-sectional study. Indian J Psychiatry 2021;63(3):285–289. DOI: 10.4103/psychiatry.IndianJPsychiatry_1074_20.
  18. Devlin JW, Weinhouse GL. Earplugs, sleep improvement, and delirium: A noisy relationship. Crit Care Med 44:1022–1023. DOI: 10.1097/CCM.0000000000001734.
  19. Bienvenu OJ, Friedman LA, Colantuoni E, Dinglas VD, Sepulveda KA, Mendez–Tellez P, et al. Psychiatric symptoms after acute respiratory distress syndrome: A 5-year longitudinal study. Intensive Care Medicine, 2018;44:38–47. DOI: 10.1007/s00134-017-5009-4.
  20. Nikayin S, Rabiee A, Hashem MD, Huang M, Bienvenu OJ, Turnbull AE, et al. Anxiety symptoms in survivors of critical illness: A systematic review and meta-analysis. Gen Hosp Psychiatry 2016;43:23–29. DOI: 10.1016/j.genhosppsych.2016.08.005.
  21. Jackson JC, Jutte JE, Hunter CH, Ciccolella N, Warrington H, Sevin C, et al. Posttraumatic stress disorder (PTSD) after critical illness: A conceptual review of distinct clinical issues and their implications. Rehabil Psychol 2016;61:132–140. DOI: 10.1037/rep0000085.
  22. Xiao X, Yang X, Zheng W, Wang B, Fu L, Luo D, et al. Depression, anxiety and post-traumatic growth among COVID-19 survivors six-month after discharge. Eur J Psychotraumatol 2022;13:2055294. DOI: 10.1080/20008198.2022.2055294.
  23. Danquah J, Mante PK. Post-illness anxiety, depression and PTSD symptoms in COVID-19 survivors. Int J Ment Health 2022;51:2,131–141. DOI: 10.1080/00207411.2022.2028057.
  24. Korupolu R, Francisco GE, Levin H, Needham DM. Rehabilitation of critically ill COVID-19 survivors. J Int Soc Phys Rehab Med 2020;3(2):45–52. DOI: 10.4103/jisprm.jisprm_8_20.
  25. Dong L, Bouey J. Public mental health crisis during COVID-19 pandemic, China. Emerg Infect Dis 2020;23:26.
  26. Parker AM, Sricharoenchai T, Raparla S, Schneck KW, Bienvenu OJ, Needham DM. Posttraumatic stress disorder in critical illness survivors: A meta-analysis. Critical Care Med 2015;43(5):1121–1129. DOI: 10.1097/CCM.0000000000000882.
  27. Tucker P, Czapla CS, et al. Post-COVID stress disorder: Another emerging consequence of the global pandemic. Psychiatr Times 2021;38(1). Available at: Acceessed on: 29 September 2022.
  28. Todt BC, Szlejf C, Duim E, Linhares AOM, Kogiso D, Varela G, et al. Clinical outcomes and quality of life of COVID-19 survivors: A follow-up of 3 months post hospital discharge. Respir Med 2021;184:106453. DOI: 10.1016/j.rmed.2021.
  29. Mazza MG, Palladini M, De Lorenzo R, Bravi B, Poletti S, Roberto F, et al. One-year mental health outcomes in a cohort of COVID-19 survivors. J Psychiatr Res 2021;145:118–124. DOI: 10.1016/j.jpsychires.2021.11.031.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.