One-year follow-up of depression, anxiety, and quality of life of Peruvian patients who survived COVID-19.

PURPOSE: To assess health-related quality of life (HRQoL) and its associated factors in patients who survived COVID-19 and to assess a prospective evaluation of the prevalence and severity of their depression and anxiety symptoms. METHODS: We followed up a sample of hospitalized patients who survived COVID-19 at 3 and 12 months after discharge. We assessed HRQoL (Euroqol-5D-5L) through telephone interviews. Any problem in any dimension of Euroqol-5D-5L was considered as low HRQoL. The depression and anxiety symptoms were measured using the Patient Health Questionnaire-9 and Generalized Anxiety Disorder-7 tools, respectively. We estimated the adjusted prevalence ratios (aPR) to low HRQoL using Poisson regression and the changes on their depression and anxiety symptoms during the follow-up. RESULTS: We included 119 patients with a mean follow-up time of 363.6 days. 74% of the participants had low HRQoL at one year after hospital discharge and were associated with being ≥ 41 years old (aPR: 1.95), having a previous history of psychiatric diagnoses before COVID-19 infection (aPR: 1.47), having any COVID-19 symptom during the follow-up at one year (aPR: 1.84), and having a family member who had died from COVID-19 during the first wave (aPR: 1.24). In addition, the clinically relevant depression symptoms were frequent, and they increased from 3 (14.3%) to 12 months (18.5%). CONCLUSION: One year after COVID-19 hospitalization discharge, patients had low HRQoL, and their depression symptoms increased. These findings acknowledge the need to provide services that adequately address mental health sequels and HRQoL to reduce the burden of the COVID-19.

Characteristics of undergraduate and second speciality mental health programmes in Peru: a cross-sectional study.

BACKGROUND: This study aims to describe the training offered and the availability of professionals required by the Ministry of Health for mental health problems management in the community. METHODS: A cross-sectional study was carried out on the training offered in mental health in Peruvian universities. A search for programs was conducted using the University Information System database and universities' websites, as well as using the Ministry of Health's database on health personnel and data on the number of enrolled and current students provided by the University Information System database and the Transparency section of the universities. RESULTS: There were 214 undergraduate, 55 specialty and 7 subspecialty programmes, of which 39%, 47% and 100%, respectively, were offered in the capital city. The duration ranged from 5 to 7 years for undergraduate programs and from 1 to 3 years for subspecialty and second specialty programs. The cost of undergraduate programs ranged from free of charge up to USD 6863.75 for the first semester of study. Second specialty programs ranged from 720 up to 11 986 USD and subspecialty programs ranged from 2267 up to 9138 USD, with medicine being the most expensive. On the other hand, there are a greater number of psychology students (n = 78 781) pursuing undergraduate studies than working professionals (n = 5368), while in the second specialty of psychiatry there are far fewer students pursuing the specialty (n = 67) than working professionals (n = 454). CONCLUSIONS: The problem of professional training in mental health requires that the institutions involved in health and education develop policies to decentralize programs, communicate the demand for professionals in certain areas, make them accessible to the low-income population, respond to mental health problems and guarantee their quality. On the other hand, regarding the low number of mental health personnel working, it is suggested to increase the mental health budget to generate more mental health services and employment.

Factors associated with suicidal ideation among medical students during the initial phase of the COVID-19 pandemic in Peru: A multicenter study.

We aimed to describe the prevalence and factors associated with suicidal ideation in a sample of 1238 medical students from different medical schools in Peru based on question 9 of the Patient Health Questionnaire (PHQ-9). Our results revealed that 17.9% of the participants had suicidal ideation. Furthermore, using logistic regression, we found that not practicing any religion, the presence of clinically significant depression, and the presence of clinically significant anxiety were statistically related to the presence of suicidal ideation. Our results indicate that suicidal ideation was highly prevalent in the sample of medical students studied.

An explanatory model of depressive symptoms from anxiety, post-traumatic stress, somatic symptoms, and symptom perception: the potential role of inflammatory markers in hospitalized COVID-19 patients.

BACKGROUND: The context of the COVID-19 pandemic has harmed the mental health of the population, increasing the incidence of mental health problems such as depression, especially in those who have had COVID-19. Our study puts forward an explanatory model of depressive symptoms based on subjective psychological factors in those hospitalized for COVID-19 with and without biological markers (i.e., inflammatory markers). Therefore, we aim to evaluate the hypotheses proposed in the model to predict the presence of depressive symptoms. METHOD: We conducted a cross-sectional study, using a simple random sampling. Data from 277 hospitalized patients with COVID-19 in Lima-Peru, were collected to assess mental health variables (i.e., depressive, anxiety, post-traumatic stress, and somatic symptoms), self-perception of COVID-19 related symptoms, and neutrophil/lymphocyte ratio (NLR) such as inflammatory marker. We performed a structural equation modeling analysis to evaluate a predictive model of depressive symptoms. RESULTS: The results showed a prevalence of depressive symptoms (11.2%), anxiety symptoms (7.9%), somatic symptoms (2.2%), and symptoms of post-traumatic stress (6.1%) in the overall sample. No association was found between the prevalence of these mental health problems among individuals with and without severe inflammatory response. The mental health indicators with the highest prevalence were sleep problems (48%), low energy (47.7%), nervousness (48.77%), worry (47.7%), irritability (43.7%) and back pain (52%) in the overall sample. The model proposed to explain depressive symptoms was able to explain more than 83.7% of the variance and presented good goodness-of-fit indices. Also, a different performance between the proposed model was found between those with and without severe inflammatory response. This difference was mainly found in the relationship between anxiety and post-traumatic stress symptoms, and between the perception of COVID-19 related symptoms and somatic symptoms. CONCLUSIONS: Results demonstrated that our model of mental health variables may explain depressive symptoms in hospitalized patients of COVID-19 from a third-level hospital in Peru. In the model, perception of symptoms influences somatic symptoms, which impact both anxiety symptoms and symptoms of post-traumatic stress. Thus, anxiety symptoms could directly influence depressive symptoms or through symptoms of post-traumatic stress. Our findings could be useful to decision-makers for the prevention of depression, used to inform the creation of screening tools (i.e., perception of symptoms, somatic and anxiety symptoms) to identify vulnerable patients to depression.

Psychometric properties of the Spanish version of the fear of COVID-19 scale in Peruvian medical students.

The Coronavirus Disease 2019 (COVID-19) pandemic continues to produce significant emotional consequences at the individual, community, societal, and global levels. This study describes the psychometric properties of the Spanish version of the Fear of COVID-19 Scale (FCV-19S) in Peruvian medical students. Data were collected by a convenience sampling method, resulting in a total of 1238 medical students from different medical schools in Peru. Our analyses suggest that a two-factor model explains the underlying two-dimensional structure of the FCV-19S. The results indicated that the Spanish version of the FCV-19S scale was found to have adequate psychometric properties.

Depression, post-traumatic stress, anxiety, and fear of COVID-19 in the general population and health-care workers: prevalence, relationship, and explicative model in Peru.

BACKGROUND: This study has two aims. First, determine the fit of the fear model to COVID-19, anxiety, and post-traumatic stress in the general population and health-care workers. Second, determine which model best explains the relationship between depression and the triad of fear, anxiety, and post-traumatic stress in both groups. METHOD: A cross-sectional study was conducted using self-reported questionnaires for anxiety, fear of COVID-19, depression, and post-traumatic stress. Information was collected from adults living in Lima, the capital and the most populous city in Peru. The explanatory models were evaluated using a structural equation model. RESULTS: A total of 830 participants were included, including general population (n = 640) and health-care workers (n = 190). A high overall prevalence of depressive symptoms (16%), anxiety (11.7%), and post-traumatic stress (14.9%) were identified. A higher prevalence of depressive, anxious, or stress symptoms was identified in the general population (28.6%) compared to health-care workers (17.9%). The triad model of fear of COVID-19, anxiety, and stress presented adequate goodness-of-fit indices for both groups. A model was identified that manages to explain depressive symptoms in more than 70% of the general population and health-care workers, based on the variables of the triad (CFI = 0.94; TLI = 0.94; RMSEA = 0.06; SRMR = 0.06). In the general population post-traumatic stress mediated the relationship between anxiety and depression (ß = 0.12; 95%CI = 0.06 to 0.18) which was significant, but the indirect effect of post-traumatic stress was not significant in health care workers (ß = 0.03; 95%CI = - 0.11 to 0.19). LIMITATIONS: The prevalence estimates relied on self-reported information. Other variables of interest, such as intolerance to uncertainty or income level, could not be evaluated. CONCLUSIONS: Our study proposes and tests one model that explains more than 70% of depressive symptoms. This explanatory model can be used in health contexts and populations to determine how emotional factors can affect depressive symptoms.

In-Person and Teleconsultation Services at a National Hospital in Peru: Time Series Analysis of General and Psychiatric Care Amid the COVID-19 Pandemic.

BACKGROUND: The COVID-19 pandemic led to a global reduction in health care accessibility for both infected and noninfected patients, posing a particular burden on those with chronic conditions, including mental health issues. Peru experienced significant devastation from the pandemic, resulting in a collapsed health care system and leading to the world's highest per capita mortality rate as a result of COVID-19. Understanding the trends in health care utilization, particularly in mental health care, is crucial for informing pandemic response efforts and guiding future recovery strategies. OBJECTIVE: This study aims to analyze the trends of outpatient medical and psychiatric consultations during the COVID-19 pandemic in a national hospital in Peru. METHODS: This observational study was conducted at a national hospital in Lima, Peru. We analyzed data on user care across all services, including psychiatric services, from May 2019 to December 2022. The data were calculated for users served per month, including the number of users seen monthly in mental health services. Sociodemographic variables such as sex (female or male), age (≥0 years), type of medical appointment (regular or additional), and modality of care (in-person or teleconsultations) were taken into account. An interrupted time series regression model was conducted to assess the number of outpatient medical and psychiatric consultations. Subgroup analyses were performed based on service modality, including overall consultations, telemonitoring/teleconsultations only, or face-to-face only, for all service users and for mental health service users. RESULTS: A total of 1,515,439 participants were included, with females comprising 275,444/484,994 (56.80%) of the samples. Only 345,605/1,515,439 (22.81%) visits involved telemedicine. The total monthly outpatient visits were significantly reduced compared with the expected projection (P<.001) at the beginning of the pandemic, followed by a later monthly increment of 298.7 users. Face-to-face interventions experienced a significant reduction at the beginning of the pandemic (P<.001), gradually recovering in the following months. By contrast, telemedicine use initially increased but subsequently declined toward the end of the pandemic. A similar trend was observed in mental health units. CONCLUSIONS: During the pandemic years, health care utilization in both general and psychiatric services experienced a significant decrease, particularly at the beginning of the pandemic (March 2020). However, no significant trends were observed in either case throughout the pandemic period. Telemedicine consultations witnessed a significant increase overall during this period, particularly among mental health users.

Psychometric properties of the GAD-7 (General Anxiety Disorder-7): a cross-sectional study of the Peruvian general population.

BACKGROUND: Anxiety disorders are among the main mental health problems worldwide and are considered one of the most disabling conditions. Therefore, it is essential to have measurement tools that can be used to screen for anxiety symptoms in the general population and thus identify potential cases of people with anxiety symptoms and provide them with timely care. Our aim was to evaluate the psychometric properties of the General Anxiety Disorder-7 scale (GAD-7) in the Peruvian population. METHOD: Our study was a cross-sectional study. The sample included people aged 12 to 65 years in Peru. Confirmatory factor analysis, analysis of measurement invariance, convergent validity with the Patient Health Questionnaire-9 (PHQ-9) and internal consistency analysis were performed. RESULTS: In total, 4431 participants were included. The one-factor model showed the best fit (CFI = 0.994; TLI = 0.991; RMSEA = 0.068; WRMR = 1.567). The GAD-7 score showed measurement invariance between men and women and between age groups (adults vs. adolescents) (ΔCFI < 0.01). The internal consistency of the one-factor model was satisfactory (ω = 0.90, α = 0.93). The relationship between depressive symptoms (PHQ-9) and anxiety symptoms (GAD-7) presented a moderate correlation (r = 0.77). CONCLUSIONS: Our study concluded that the GAD-7 score shows evidence of validity and reliability for the one-factor model. Furthermore, because the GAD-7 score is invariant, comparisons can be made between groups (i.e., by sex and age group). Finally, we recommend the use of the GAD-7 for the general population in the Peruvian context.

Perception of personal protective equipment availability and mental health outcomes in workers from two national hospitals during the COVID-19 pandemic.

Background: During the first wave of the pandemic, a constant concern of healthcare workers, who are more vulnerable to contagion, is their personal safety. This is directly related to the availability of adequate PPE, which led to a perception of dissatisfaction and inequality with government responses. We aim t o determines whether perception of adequate PPE availability is associated with depressive, anxiety, and stress symptoms in different types of healthcare workers. Methods: Analytical cross-sectional study surveyed clinical and non-clinical healthcare workers in two third-level hospitals in Lima, Peru. An online self-survey assessed the perception of adequate PPE availability, using a Likert scale question, which was then dichotomized for the analysis. In addition, we assessed the depressive, anxiety, and stress symptoms using validated questionnaires. Results: 563 participants were included. In general, there is no association between perception of PPE availability and three mental health outcomes. However, in the subgroup analysis, physicians with better perception of PPE availability had less moderate-severe outcomes in mental health; in contrast, nurses had higher moderate-severe outcomes. The type of profession in healthcare workers may modify the effect of this association. Conclusion: The association between perception of PPE availability and mental health outcomes is complex in healthcare workers from two third-level hospitals. This association can vary according to the type of work.

Evolution and differences of suicide rates in Peru by gender and department, 2017-2019.

INTRODUCTION: Annual suicide rates are increasingly notably worldwide due to various accompanying risk factors. The objective of this study is to know the suicide mortality rates and their distribution between the years 2017 and 2019. METHODS: The national death registries of the Ministry of Health of Peru were analysed, calculating the regional death rates from suicides adjusted for age and gender using the standardisation recommended by the World Health Organization. RESULTS: A total of 1666 cases of suicide were identified (69.3% males); the age group with the highest frequency was that of 20-29 years (27.8%); the mean age at suicide was higher in males (37.49±18.96 vs. 27.86±15.42; P<.001). Hanging was the most common suicide method among both males (58.87%) and females (48.14%). For males, hanging was followed by poisoning (22.6%) and firearms (4.59%); for females, by poisoning (38.75%) and firearms (0.59%). The suicide rate increased from 2017 (1.44/100,000 inhabitants) to 2019 (1.95). The highest rates were identified in the departments of Arequipa, Moquegua and Tacna. CONCLUSIONS: In recent years, there has been an increase in the number of suicide cases and the rates by department, with the highest number of cases reported in males. Males tend to use more violent suicide methods. The risk factors in the vulnerable populations that were identified in this study need to be known.

Sensitivity and specificity of the Patient Health Questionnaire (PHQ-9, PHQ-8, PHQ-2) and General Anxiety Disorder scale (GAD-7, GAD-2) for depression and anxiety diagnosis: a cross-sectional study in a Peruvian hospital population.

OBJECTIVES: The Patient Health Questionnaire (PHQ) and Generalised Anxiety Disorder Scale (GAD) are widely used screening tools, but their sensitivity and specificity in low-income and middle-income countries are lower than in high-income countries. We conducted a study to determine the sensitivity and specificity of different versions of these scales in a Peruvian hospital population. DESIGN: Our study has a cross-sectional design. SETTING: Our participants are hospitalised patients in a Peruvian hospital. The gold standard was a clinical psychiatric interview following ICD-10 criteria for depression (F32.0, F32.1, F32.2 and F32.3) and anxiety (F41.0 and F41.1). PARTICIPANTS: The sample included 1347 participants. A total of 334 participants (24.8%) were diagnosed with depression, and 28 participants (2.1%) were diagnosed with anxiety. RESULTS: The PHQ-9's≥7 cut-off point showed the highest simultaneous sensitivity and specificity when contrasted against a psychiatric diagnosis of depression. For a similar contrast against the gold standard, the other optimal cut-off points were: ≥7 for the PHQ-8 and ≥2 for the PHQ-2. In particular, the cut-off point ≥8 had good performance for GAD-7 with sensitivity and specificity, and cut-off point ≥10 had lower levels of sensitivity, but higher levels of specificity, compared with the cut-off point of ≥8. Also, we present the sensitivity and specificity values of each cut-off point in PHQ-9, PHQ-8, PHQ-2, GAD-7 and GAD-2. We confirmed the adequacy of a one-dimensional model for the PHQ-9, PHQ-8 and GAD-7, while all PHQ and GAD scales showed good reliability. CONCLUSIONS: The PHQ and GAD have adequate measurement properties in their different versions. We present specific cut-offs for each version.

Mental Health in COVID-2019 Survivors from a General Hospital in Peru: Sociodemographic, Clinical, and Inflammatory Variable Associations.

The current coronavirus disease-2019 (COVID-19) pandemic constitutes a significant public health problem worldwide, as well as mental health problems. This study aimed to evaluate the mental health of COVID-19 survivors, considering their sociodemographic, clinical, and immune variables. A cross-sectional and correlational study was conducted on 318 COVID-19 survivors from one hospital in Peru. Through telephone interviews, evaluation of the presence of depressive symptoms using the Patient Health Questionnaire-9, anxiety symptoms through the Generalized Anxiety Disorder-7, somatic symptoms through Patient Health Questionnaire-15, and posttraumatic stress disorder (PTSD) symptoms through Impact of Event Scale-Revised was carried out. Poisson regression analyses were performed with their adjusted variances to calculate the prevalence ratio (PR) with their 95% confidence interval. All regression models were adjusted (PRa) for follow-up time. A significant proportion of patients have depressive (30.9%), anxious (31.1%), somatic (35.2%), and PTSD (29.5%) symptoms. The variables associated with a higher frequency of clinically relevant mental symptoms were female sex, self-perception of greater COVID-19 severity, presence of persistent COVID-19 symptoms, loss of a family member due to COVID-19, and prior psychiatric diagnosis or treatment. In addition, the neutrophil-to-lymphocyte ratio was significantly higher in patients with clinically relevant symptoms of depression. COVID-19 survivors showed a high prevalence of negative mental symptoms. Our findings help to identify patients who are vulnerable and require psychiatric care.

Factors associated with mental health in Peruvian medical students during the COVID-19 pandemic: a multicentre quantitative study.

OBJECTIVE: To assess the mental health status and associated factors of Peruvian medical students during the COVID-19 pandemic. METHODS: Descriptive, multicentre, correlational study that used the "Patient Health Questionnaire-9 (PHQ-9)", the "Generalized Anxiety Disorder-7 (GAD-7)" and the "Impact of Event Scale-Revised (IES-R)" questionnaires to evaluate mental health problems. RESULTS: A total of 1,238 students from 8 Peruvian medical schools participated in the study. Of these, 68.5% were women, and the mean age was 21.4 years. Depressive symptoms were found in 74% of the participants, anxiety symptoms in 57% and distress symptoms in 65%. The variables associated with the development of symptoms of moderate-severe depression, anxiety and distress were: not having family economic stability, being in the first years of medical training, being female, and fearing that their medical training would be delayed and impaired. CONCLUSIONS: In a sample of medical students surveyed during the COVID-19 pandemic, mental health problems were common. The factors associated with mental health reported in this study could be useful in identifying vulnerable medical students who require timely psychosocial support and/or psychiatric care.

Factors Associated with Distress Among Medical Staff During the Initial Phase of the COVID-19 Pandemic in Peru.

The current COVID-19 pandemic affects the mental health of medical staff. Our objective was to evaluate the factors that are associated with the distress of physicians in two general hospitals in Lima, Peru. A cross-sectional correlational survey study was carried out. Physicians completed The Impact of Event Scale-Revised-22 (IES-R), Patient Health Questionnaire-9 (PHQ-9), and Generalized Anxiety Disorder-7 (GAD-7). A total of 310 physicians completed the survey, 36.5% of whom reported distress symptoms. Higher levels of distress were reached by women, by those with a prior psychiatric diagnosis, by those who considered that the hospital does not provide adequate personal protective equipment, and by those who perceived stigma from family members. Multiple regression analysis showed that there is a correlation between distress symptoms and anxiety symptoms, (B = 0.509), depressive symptoms (B = 0.305), the total hours/week worked in the Emergency Department (B=-0.142), and the stigma perception (B = 0.096). Early intervention programs must be developed to support medical staff members exposed to severe distress situations such as the current viral pandemic.

Analysis of the care provided over a six-month period by the liaison psychiatry unit at a general hospital in Lima, Peru.

INTRODUCTION: Consultation-liaison psychiatry is a branch of clinical psychiatry that enables psychiatrists to carry out a series of activities within a general hospital. The number of liaison psychiatry units around the world has increased significantly, and Peru is no exception. However, this development is heterogeneous and unknown, so recent study reports are required to reveal the characteristics and details of the clinical care services provided by these units. AIM: To describe and report the socio-demographic and clinical characteristics of patients evaluated in the Liaison Psychiatry Unit of the Guillermo Almenara Irigoyen National Hospital in Lima, Peru, and to analyse the symptomatic and syndromic nature of the identified conditions. METHODS: Cross-sectional descriptive study. Referrals to the Liaison Psychiatry Unit of the Guillermo Almenara Irigoyen National Hospital between May and October 2019 were studied, and a factor analysis of the symptoms was conducted. RESULTS: In a total of 400 referrals evaluated, the average age was 58 ±â€¯17.09 years and 61.5% of the patients were women. The rate of psychiatric consultation was 2.73%. Internal medicine (13.9%) was the service that most frequently requested a psychiatric consultation. The disorder most frequently diagnosed was anxiety (44%), and the symptoms most frequently found were depression (45.3%), insomnia (44.5%), and anxiety (41.3%). The most used treatments were antidepressants (44.3%). The exploratory factor analysis of the symptoms showed three syndromic components: delirium, depression, and anxiety. CONCLUSIONS: The typical patient of this sample is a woman in her late 50s, suffering from a non-psychiatric medical illness, and with anxiety disorders as the main diagnosis resulting from the psychiatric consultation.

Psychometric Properties of a Spanish Version of the Fear of COVID-19 Scale in General Population of Lima, Peru.

The current pandemic of the novel coronavirus COVID-19 has increased the anxiety and fear experienced by many. The main objective of this study was to analyze the psychometric properties of the Spanish-translated version of the Fear of COVID-19 Scale (FCV-19S) using a sample of population in Peru. This is a cross-sectional instrumental study. Data were collected by a convenience sampling method, resulting in a total of 832 participants, and the collection took place over 1 week, April 17-23, 2020. The original version of the FCV-19S was translated from English into Spanish. The results support a bifactor model consisting of one general factor and two specific factors-one of emotional fear reactions and another of somatic expressions of fear of COVID-19 (CFI = 0.988, RMSEA = 0.075). Invariance between healthcare workers and age groups was reached (ΔCFI < 0.01), but the invariance between men and women was not met (ΔCFI = 0.02). Convergent validity was found with depressive, anxious, and posttraumatic stress symptoms. The general factor of the fear of COVID-19 and two specific factors had an optimal level of internal consistency (ω > 0.89 and α > 0.83). The study found the Spanish-translated version of the FCV-19S has good psychometric properties and presents evidence of validity and reliability.

Factors Associated with Mental Health Outcomes in Hospital Workers during the COVID-19 Pandemic: A Mixed-Methods Study.

BACKGROUND: We investigated some of the factors associated with depression, perceived stress, and anxiety in clinical and nonclinical healthcare workers of two hospitals. METHODS: A mixed-methods approach was used. The sample included clinical (physicians, nurses, and others) and nonclinical (security and cleaning staff) healthcare workers of two tertiary hospitals in Peru. Participants completed an online self-survey. In the qualitative analysis, data were subjected to thematic analysis. RESULTS: We analyzed data from 613 participants, of which 8.6%, 9.0%, and 78.2% had moderate-to-severe anxiety, depression, and perceived stress, respectively. Having a previous mental health problem, being concerned about losing one's job, having at least two COVID-19 symptoms in the preceding two weeks, and being afraid of infecting family members increased the prevalence of experiencing moderate-to-severe depression and anxiety. The qualitative analysis allowed us to identify five recurring factors that caused a negative impact on workers' lives during the pandemic: emotional distress linked to hospital experiences of suffering and death, modification of routines, fear of COVID-19, exacerbation of mental disorders, and physical problems associated with emotional distress. CONCLUSIONS: Clinical and nonclinical healthcare workers in Peru have experienced depression, anxiety, and stress during the COVID-19 pandemic. Future research and interventions are necessary to improve psychological support for hospital workers.