Psychological features and emotional well-being in COVID-19 patients with gastrointestinal symptoms

Abstract

The prevalence of gastrointestinal (GI) symptoms in COVID-19 patients is more than 20%. Research has revealed that the incidence of GI symptoms, including anorexia, nausea, vomiting, and abdominal pain, can be as high as 79.1%, and that diarrhea, as the main symptom, can be present in 49.5% of the cases. Among these patients, the psychological impact of various GI symptoms poses an essential consideration in the quality of life after hospital discharge and recovery. In this study, 102 patients hospitalized for COVID-19, with GI symptoms, were divided into two groups: The GI group (n = 54), with the predominant GI symptoms of anorexia, nausea, vomiting, and abdominal pain, and the D group (n = 48), with the predominant symptom of diarrhea. Questionnaires assessing positive and negative moods, anxiety, and depression were administered to all patients, and psychological evaluation took place 3 months after the first positive polymerase chain reaction test for COVID-19. The results demonstrate that patients in the GI group exhibited lower scores in the negative mood, anxiety, and depression tests, and higher scores in the positive mood test, compared to the patients in the D group. In conclusion, emotions play an important role in the outcome of COVID-19 patients with different GI symptoms. Notably, diarrhea is an important symptom associated with negative mood, anxiety, and depression. Understanding the emotional impact of specific GI symptoms on COVID-19 patients is essential for developing a comprehensive approach to the care and well-being of COVID-19 patients.

Keywords

Psychological features / COVID-19 patients / Digestive system / Gastrointestinal effects / Diarrhea / Anxiety

Acknowledgments

The authors would like to thank their families, their patients, physicians, and nurses of the COVID-19 clinics.

Funding

None.

Conflict of interest

Kalliopi Megari is the Youth Editorial Board Member of this journal, but was not in any way involved in the editorial and peer-review process conducted for this paper, directly or indirectly. Separately, other authors declared that they have no known competing financial interests or personal relationships that could have influenced the work reported in this paper.

Author contributions

Conceptualization: Kalliopi Megari

Formal analysis: Kalliopi Megari, Efthymia Efthymiou, Alexandros Argyriadis

Investigation: Evanthia Thomaidou, Dimitra V. Katsarou, Eugenia I. Toki

Methodology: Kalliopi Megari, Evangelos Mantsos, Soultana Papadopoulou

Writing - original draft: Kalliopi Megari, Evanthia Thomaidou

Writing - review & editing: Kalliopi Megari, Evanthia Thomaidou

Ethics approval and consent to participate

All procedures involving human subjects/patients were approved by the Bioethics and Ethics Committee of AHEPA University Hospital, School of Medicine, Aristotle University of Thessaloniki, Greece, under the approval number 34191. Human subjects were involved, and written permission was obtained from each of the subjects to participate in the study.

Consent for publication

Human subjects were involved, and written permission was obtained from each of the subjects to publish their data and/or images.

Availability of data

Data cannot be shared publicly due to the sensitive nature of the research.

References

[1] Jin S, Lu X, Xu C. COVID-19 induces gastrointestinal symptoms and affects patients’ prognosis. J Int Med Res. 2022; 50(10):1-11. doi: 10.1177/03000605221129543

[2] Wang C, Horby PW, Hayden FG, et al. A novel coronavirus outbreak of global health concern. Lancet. 2020; 395(10223):470-473. doi: 10.1016/S0140-6736(20)30185-9

[3] Whitworth J. COVID-19: A fast evolving pandemic. Trans R Soc Trop Med Hyg. 2020;114:241-248. doi: 10.1093/trstmh/traa025

[4] Oshima T, Miwa H. Epidemiology of functional gastrointestinal disorders in Japan and in the world. J Neurogastroenterol Motil. 2015;21:320-329. doi: 10.5056/jnm14165

[5] Zaim S, Chong JH, Sankaranarayanan V, Harky A. COVID-19 and multiorgan response. Curr Probl Cardiol. 2020;45:100618. doi: 10.1016/j.cpcardiol.2020.100618

[6] Drossman DA, Hasler WL. Rome IV‐functional GI disorders: Disorders of gut-brain interaction. Gastroenterology. 2016; 150:1257-1261. doi: 10.1053/j.gastro.2016.03.035

[7] Oshima T, Siah KT, Yoshimoto T, et al. Impacts of the COVID‐19 pandemic on functional dyspepsia and irritable bowel syndrome: A population‐based survey. J Gastroenterol Hepatol. 2021; 36(7):1820-1827. doi: 10.1111/jgh.15346

[8] Ye Q, Wang B, Zhang T, Xu J, Shang S.The mechanism and treatment of gastrointestinal symptoms in patients with COVID-19. Am J Physiol Gastroint Liver Physiol. 2020; 319(2):G245-G252. doi: 10.1152/ajpgi.00148.2020

[9] Han CQ, Duan CH, Zhang SY, et al. Digestive symptoms inCOVID-19 patients with mild disease severity: Clinical presentation, stoolviral RNA Testing, and outcomes. Am J Gastroenterol. 2020; 115:916-923. doi: 10.14309/ajg.0000000000000664.28

[10] Ma C, Cong Y, Zhang H. COVID-19 and the digestive system. Am J Gastroenterol. 2020; 115:1003-1006. doi: 10.14309/ajg.0000000000000691

[11] Delgado-Gonzalez P, Gonzalez-Villarreal CA, Roacho- Perez JA, et al.Inflammatory effect on the gastrointestinal system associated with COVID-19. World J Gastroenterol. 2021; 27(26):4160-4171. doi: 10.3748/wjg.v27.i26.4160

[12] Bold J, Harris M, Fellows L, Chouchane M. Nutrition, the digestive system and immunity in COVID-19 infection. Gastroenterol Hepatol Bed Bench. 2020; 13(4):331-340.

[13] Manchia M, Gathier AW, Yapici-Eser H, et al. The impact of the prolonged COVID-19 pandemic on stress resilience and mental health: A critical review across waves. Eur Neuropsychopharmacol. 2022; 55:22-83. doi: 10.1016/j.euroneuro.2021.10.864

[14] Taquet M, Luciano S, Geddes JR, Harrison PJ.Bidirectional associations between COVID-19 and psychiatric disorder: Retrospective cohort studies of 62354 COVID-19 cases in the USA. Lancet Psychiatry. 2021;8:130-140. doi: 10.1016/S2215-0366(20)30462-4

[15] Nakov R, Dimitrova-Yurukova D, Snegarova V, Nakov V, Fox M, Heinrich H. Increased prevalence of gastrointestinal symptoms and disorders of gut-brain interaction during the COVID-19 pandemic: An internet-based survey. Neurogastroenterol Motil. 2021;34:e14197. doi: 10.1111/nmo.14197

[16] Watson D, Clark LA, Tellegen A. Development and validation of brief measures of positive and negative affect: The PANAS Scales. J Pers Soc Psychol. 1988;47:1063-1070. doi: 10.1037//0022-3514.54.6.1063

[17] Spielberger CD. Manual for the State-Trait Anxiety Inventory (Self-Evaluation Questionnaire). Palo Alto: CA, Consulting Psychologists Press; 1970.

[18] Zung WWK. Zung self-rating depression scale and depression status inventory. In: Sartorius N, Ban TA, editors. Assessment of Depression. Berlin, Heidelberg: Springer; 1986. doi: 10.1007/978-3-642-70486-4_21

[19] Almazan AN, Chun AS, Perez-Urbano I.The medical student response to the mental health consequences of COVID-19. Acad Psychiatry. 2020;44:689-690.

[20] Abenavoli L, Cinaglia P, Lombardo G, et al. Anxiety and gastrointestinal symptoms related to COVID-19 during Italian Lockdown. J Clin Med. 202116; 10(6):1221. doi: 10.3390/jcm10061221

[21] Miguel AQC, Tempski P, Kobayasi R, Mayer FB, Martins MA. Predictive factors of quality of life among medical students: Results from a multicentric study. BMC Psychol. 2021;9:36. doi: 10.1186/s40359-021-00534-5

[22] Megyeri K, Dernovics Á, Al-Luhaibi ZII, Rosztóczy A. COVID-19-associated diarrhea. World J Gastroenterol. 2021; 27(23):3208-3222. doi: 10.3748/wjg.v27.i23.3208

[23] Lee SY, Ryu HS, Choi SC, Jang SH. A study of psychological factors associated with functional gastrointestinal disorders and use of health care. Clin Psychopharmacol Neurosci. 2020; 18(4):580-586. doi: 10.9758/cpn.2020.18.4.580

[24] Nie XD, Wang Q, Wang MN, et al.Anxiety and depression and its correlates in patients with coronavirus disease 2019 in Wuhan. Int J Psychiatry Clin Pract. 2021;25:109-114. doi: 10.1080/13651501.2020.1791345

[25] Speth MM, Singer-Cornelius T, Oberle M, Gengler I, Brockmeier SJ, Sedaghat AR. Mood, anxiety and olfactory dysfunction in COVID-19: Evidence of central nervous system involvement? Laryngoscope. 2020; 130:2520-2525. doi: 10.1002/lary.28964

[26] Mazza MG, De Lorenzo R, Conte C, et al. Anxiety and depression in COVID-19 survivors: Role of inflammatory and clinical predictors. Brain Behav Immun. 2020; 89:594-600. doi: 10.1016/j.bbi.2020.07.037

[27] Thye AY, Law JW, Tan LT, et al. Psychological symptoms in COVID-19 patients: Insights into pathophysiology and risk factors of long COVID-19. Biology (Basel). 2022; 11(1):61. doi: 10.3390/biology11010061

[28] Rogers JP, Chesney E, Oliver D, et al. Psychiatric and neuropsychiatric presentations associated with severe coronavirus infections: A systematic review and meta-analysis with comparison to the COVID-19 pandemic. Lancet Psychiatry. 2020;7:611-627. doi: 10.1016/S2215-0366(20)30203-0

[29] Heneka MT, Golenbock D, Latz E, Morgan D, Brown R. Immediate and long-term consequences of COVID-19 infections for the development of neurological disease. Alzheimers Res Ther. 2020;12:69. doi: 10.1186/s13195-020-00640-3

[30] Kępińska AP, Iyegbe CO, Vernon AC, Yolken R, Murray RM, Pollak TA.Schizophrenia and influenza at the centenary of the1918-1919 Spanish influenza pandemic: Mechanisms of psychosis risk. Front Psychiatry. 2020;11:72. doi: 10.3389/fpsyt.2020.00072

[31] Mendez R, Balanzá-Martínez V, Luperdi SC, et al. Short-term neuropsychiatric outcomes and quality of life in COVID-19 survivors. J Intern Med. 2021; 290:621-631. doi: 10.1111/joim.13262

[32] Tabacof L, Tosto-Mancuso J, Wood J, et al. Post-acute COVID-19 syndrome negatively impacts physical function, cognitive function, health-related quality of life and participation. Am J Phys Med Rehabil. 2021; 101:48-52. doi: 10.1097/PHM.0000000000001910

[33] Gouraud C, Bottemanne H, Lahlou-Laforêt K, et al. Association between psychological distress, cognitive complaints, and neuropsychological status after a severe COVID-19 episode: A cross-sectional study. Front Psychiatry. 2021;12:725861. doi: 10.3389/fpsyt.2021.725861

[34] Poletti S, Palladini M, Mazza MG, et al. Long-term consequences of COVID-19 on cognitive functioning up to 6 months after discharge: Role of depression and impact on quality of life. Eur Arch Psychiatry Clin Neurosci. 2021;272:773-782. doi: 10.1007/s00406-021-01346-9

[35] Boesl F, Audebert H, Endres M, Pruss H, Franke C. A neurological outpatient clinic for patients with post- COVID-19 syndrome-a report on the clinical presentations of the first 100 patients. Front Neurol. 2021;12:738405. doi: 10.3389/fneur.2021.738405

[36] Mahmoudi H, Saffari M, Movahedi M, et al.A mediating role for mental health in associations between COVID- 19-related self-stigma, PTSD, quality of life, and insomnia among patients recovered from COVID-19. Brain Behav. 2021;11:e02138. doi: 10.1002/brb3.2138

[37] Gohil K, Samson R, Dastager S, Dharne M.Probiotics in the prophylaxis of COVID-19: Something is better than nothing. 3 Biotech. 2021;11:1-10. doi: 10.1007/s13205-020-02554-1

[38] Megari K. Quality of life in chronic disease patients. Health Psychol Res. 2013; 1(3):e27. doi: 10.4081/hpr.2013.e27

[39] Megari K, Thomaidou E, Chatzidimitriou E. Highlighting the neuropsychological consequences of COVID-19: Evidence from a narrative review. Inquiry. 2024;61:1-10. doi: 10.1177/00469580241262442

[40] Megari K, Thomaidou E, Theodoratou M, et al. Do gastrointestinal symptoms influence neurocognitive functioning in COVID-19 patients? J Clin Neurosci. 2025;135:111147. doi: 10.1016/j.jocn.2025.111147