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OBJECTIVE: We aimed to assess the interplay between functional impairment and anxiety, depression, and problematic Internet use levels in front-line healthcare workers who work in inpatient clinics of coronavirus disease-2019 (COVID-19) during the COVID-19 pandemic. METHODS: Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), Internet Addiction Test (IAT), and Sheehan Disability Scale (SDS) were administered to assess the depression, anxiety, problematic Internet use, and functional impairment levels of the participants. RESULTS: Two hundred thirteen participants were enrolled in the present study. Medical doctors showed significantly higher scores of IAT than the nurses and other medical staff (Kruskal-Wallis=6.519, p=0.038). Levels of SDS total are significantly correlated with scores of IAT (r=0.257, p<0.001), BDI (r=0.383, p<0.001), and BAI (r=0.308, p<0.001). All subdomain scores of SDS (social, family, work) and total scores of SDS were significantly and positively correlated with BAI, BDI, and IAT scores (p<0.05). In the separation mediation analysis, problematic Internet use partially mediated the relationship between anxiety-depression and global functional impairment. CONCLUSION: Health politicians should produce policies to develop strategies for coping with consequences of anxiety and depression in healthcare professionals during any health crisis. In addition, we should raise healthcare professionals' awareness that problematic Internet use is not suitable for dealing with anxiety and depression and may even lead to increase of functional loss.
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ABSTRACT Background: Coronavirus disease-2019 (COVID-19) results in acute lung injury. This study examined the usefulness of serum transforming growth factor-beta 1 (TGF-β1) and connective tissue growth factor (CTGF) levels in predicting disease severity in COVID-19 patients with pulmonary involvement. Methods: Fifty patients with confirmed COVID-19 and pulmonary involvement between September 2020, and February 2021 (Group 1) and 45 healthy controls (Group 2) were classified into three subgroups based on clinical severity: moderate, severe, and critical pneumonia. Serum TGF-β1 and CTGF concentrations were measured on days 1 and 7 of admission in Group 1 using an enzyme-linked immunosorbent assay. These concentrations were also measured in control cases. The mean serum TGF-β1 and CTGF levels were then compared among COVID-19 patients, based on clinical severity. Results: Significantly higher mean serum TGF-β1 and CTGF levels were observed on both days in Group 1 than in the control group. The mean serum TGF-β1 and CTGF levels on day 7 were also significantly higher than those on day 1 in Group 1. The critical patient group had the highest serum TGF-β1 and CTGF levels on both days, and the difference between this group and the moderate and severe pneumonia groups was significant. Cutoff values of 5.36 ng/mL for TGF-β1 and 626.2 pg/mL for CTGF emerged as predictors of COVID-19 with pulmonary involvement in receiver-operating characteristic curve analysis. Conclusions: TGF-β1 and CTGF are potential markers that can distinguish COVID-19 patients with pulmonary involvement and indicate disease severity. These findings may be useful for initiating treatment for early-stage COVID-19.