Skip to main content
Top
Published in: BMC Psychiatry 1/2021

Open Access 01-12-2021 | COVID-19 | Research

Exploring COVID-19 patients’ experiences of psychological distress during the disease course: a qualitative study

Authors: Tahereh Toulabi, Fatemeh Jafari Pour, Atefeh Veiskramian, Heshmatolah Heydari

Published in: BMC Psychiatry | Issue 1/2021

Login to get access

Abstract

Background

The Coronavirus Disease 2019 (COVID-19) is an emerging disease with many unknown clinical and therapeutic dimensions. Patients with COVID-19 experience a variety of psychological problems during the disease. Understanding patients’ mental condition and their distress during the disease is the first step to help these patients. So, the aim of this study was to explain COVID-19 patients’ experiences of psychological distress during the disease course.

Methods

The present qualitative research was conducted in Iran from April 2020 to April 2021 using the conventional content analysis method. The participants included patients with COVID-19, selected by the purposeful sampling method. Data was collected through 34 telephone and in-person interviews and analyzed based on the method proposed by Lundman and Graneheim.

Results

Qualitative data analysis led to the emergence of sources of psychological distress as the main theme as well as seven categories and seven sub-categories. The categories were the disease’s nature (the subcategories of disease’s unknown dimensions, and disease severity), the anxiety caused by preventive behaviors (the subcategories of quarantine, worry about transmitting the infection to others and obsessive thoughts related to disinfection measures), the inefficient management by the health system (the subcategories of poor health care condition and lack of spiritual care), death anxiety, stigma, anxiety after recovery, and sleep pattern disturbance.

Conclusion

Patients with COVID-19 experience great psychological distress during the acute phase of the disease or even long after recovery. It is suggested that psychological and spiritual counseling, as a key element of treatment and support for these patients, is provided to patients in the acute phase of the disease, as well as after recovery. National and local media should boost awareness about the disease as a dangerous yet preventable and curable infectious disease. People should follow health instructions and leave their seeing the disease as a taboo.

Trial registration number

Not applicable.
Literature
1.
go back to reference Hui DS, Azhar EI, Madani TA, Ntoumi F, Kock R, Dar O, et al. The continuing 2019-nCoV epidemic threat of novel coronaviruses to global health—the latest 2019 novel coronavirus outbreak in Wuhan, China. Int J Infect Dis. 2020;91:264–6.CrossRef Hui DS, Azhar EI, Madani TA, Ntoumi F, Kock R, Dar O, et al. The continuing 2019-nCoV epidemic threat of novel coronaviruses to global health—the latest 2019 novel coronavirus outbreak in Wuhan, China. Int J Infect Dis. 2020;91:264–6.CrossRef
3.
go back to reference Mahase E. China coronavirus: WHO declares international emergency as death toll exceeds 200. BMJ. 2020;368:m408.CrossRef Mahase E. China coronavirus: WHO declares international emergency as death toll exceeds 200. BMJ. 2020;368:m408.CrossRef
4.
go back to reference Guo Y-R, Cao Q-D, Hong Z-S, Tan Y-Y, Chen S-D, Jin H-J, et al. The origin, transmission and clinical therapies on coronavirus disease 2019 (COVID-19) outbreak–an update on the status. Mil Med Res. 2020;7(1):1–10. Guo Y-R, Cao Q-D, Hong Z-S, Tan Y-Y, Chen S-D, Jin H-J, et al. The origin, transmission and clinical therapies on coronavirus disease 2019 (COVID-19) outbreak–an update on the status. Mil Med Res. 2020;7(1):1–10.
6.
go back to reference Wu Z, McGoogan JM. Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: summary of a report of 72 314 cases from the Chinese Center for Disease Control and Prevention. JAMA. 2020;323(13):1239–42. https://doi.org/10.1001/jama.2020.2648. Wu Z, McGoogan JM. Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: summary of a report of 72 314 cases from the Chinese Center for Disease Control and Prevention. JAMA. 2020;323(13):1239–42. https://​doi.​org/​10.​1001/​jama.​2020.​2648.
7.
go back to reference Hu Y, Chen Y, Zheng Y, You C, Tan J, Hu L, et al. Factors related to mental health of inpatients with COVID-19 in Wuhan, China. Brain Behav Immun. 2020;89:587–93.CrossRef Hu Y, Chen Y, Zheng Y, You C, Tan J, Hu L, et al. Factors related to mental health of inpatients with COVID-19 in Wuhan, China. Brain Behav Immun. 2020;89:587–93.CrossRef
8.
go back to reference Ambelu A, Birhanu Z, Yitayih Y, Kebede Y, Mecha M, Abafita J, et al. Psychological distress during the COVID-19 pandemic in Ethiopia: an online cross-sectional study to identify the need for equal attention of intervention. Ann General Psychiatry. 2021;20(1):22.CrossRef Ambelu A, Birhanu Z, Yitayih Y, Kebede Y, Mecha M, Abafita J, et al. Psychological distress during the COVID-19 pandemic in Ethiopia: an online cross-sectional study to identify the need for equal attention of intervention. Ann General Psychiatry. 2021;20(1):22.CrossRef
9.
go back to reference Davis D, Searle SD, Tsui A. The Scottish intercollegiate guidelines network: risk reduction and management of delirium. Age Ageing. 2019;48(4):485–8.CrossRef Davis D, Searle SD, Tsui A. The Scottish intercollegiate guidelines network: risk reduction and management of delirium. Age Ageing. 2019;48(4):485–8.CrossRef
10.
go back to reference Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395(10223):497–506.CrossRef Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395(10223):497–506.CrossRef
11.
go back to reference Maunder R, Hunter J, Vincent L, Bennett J, Peladeau N, Leszcz M, et al. The immediate psychological and occupational impact of the 2003 SARS outbreak in a teaching hospital. Can Med Assoc J. 2003;168(10):1245–51. Maunder R, Hunter J, Vincent L, Bennett J, Peladeau N, Leszcz M, et al. The immediate psychological and occupational impact of the 2003 SARS outbreak in a teaching hospital. Can Med Assoc J. 2003;168(10):1245–51.
12.
go back to reference Wu J, Chen X, Yao S, Liu R. Anxiety persists after recovery from acquired COVID-19 in anaesthesiologists. J Clin Anesth. 2020;67:109984.CrossRef Wu J, Chen X, Yao S, Liu R. Anxiety persists after recovery from acquired COVID-19 in anaesthesiologists. J Clin Anesth. 2020;67:109984.CrossRef
13.
go back to reference Janiri D, Kotzalidis GD, Giuseppin G, Molinaro M, Modica M, Montanari S, et al. Psychological Distress After Covid-19 Recovery: Reciprocal Effects With Temperament and Emotional Dysregulation. An Exploratory Study of Patients Over 60 Years of Age Assessed in a Post-acute Care Service. Front Psychiatry. 2020;11:590135. https://doi.org/10.3389/fpsyt.2020.590135. Janiri D, Kotzalidis GD, Giuseppin G, Molinaro M, Modica M, Montanari S, et al. Psychological Distress After Covid-19 Recovery: Reciprocal Effects With Temperament and Emotional Dysregulation. An Exploratory Study of Patients Over 60 Years of Age Assessed in a Post-acute Care Service. Front Psychiatry. 2020;11:590135. https://​doi.​org/​10.​3389/​fpsyt.​2020.​590135.
14.
go back to reference Liu S, Yang L, Zhang C, Xiang Y-T, Liu Z, Hu S, et al. Online mental health services in China during the COVID-19 outbreak. Lancet Psychiatry. 2020;7(4):e17–e8.CrossRef Liu S, Yang L, Zhang C, Xiang Y-T, Liu Z, Hu S, et al. Online mental health services in China during the COVID-19 outbreak. Lancet Psychiatry. 2020;7(4):e17–e8.CrossRef
16.
go back to reference Cohen S, Janicki-Deverts D, Doyle WJ, Miller GE, Frank E, Rabin BS, et al. Chronic stress, glucocorticoid receptor resistance, inflammation, and disease risk. Proc Natl Acad Sci. 2012;109(16):5995–9.CrossRef Cohen S, Janicki-Deverts D, Doyle WJ, Miller GE, Frank E, Rabin BS, et al. Chronic stress, glucocorticoid receptor resistance, inflammation, and disease risk. Proc Natl Acad Sci. 2012;109(16):5995–9.CrossRef
17.
go back to reference Shi Y, Wang Y, Shao C, Huang J, Gan J, Huang X, et al. COVID-19 infection: the perspectives on immune responses: Nature Publishing Group; 2020. Shi Y, Wang Y, Shao C, Huang J, Gan J, Huang X, et al. COVID-19 infection: the perspectives on immune responses: Nature Publishing Group; 2020.
18.
go back to reference Galehdar N, Toulabi T, Kamran A, Heydari H. Exploring nurses’ perception about the care needs of patients with COVID-19: a qualitative study. BMC Nurs. 2020;19(1):1–8.CrossRef Galehdar N, Toulabi T, Kamran A, Heydari H. Exploring nurses’ perception about the care needs of patients with COVID-19: a qualitative study. BMC Nurs. 2020;19(1):1–8.CrossRef
19.
go back to reference Graneheim UH, Lundman B. Qualitative content analysis in nursing research: concepts, procedures and measures to achieve trustworthiness. Nurse Educ Today. 2004;24(2):105–12.CrossRef Graneheim UH, Lundman B. Qualitative content analysis in nursing research: concepts, procedures and measures to achieve trustworthiness. Nurse Educ Today. 2004;24(2):105–12.CrossRef
20.
go back to reference Ys L, Guba EG. Naturalistic inquiry. Beverly Hills: Sage Publications, Inc.; 1985. Ys L, Guba EG. Naturalistic inquiry. Beverly Hills: Sage Publications, Inc.; 1985.
21.
go back to reference Tanoue Y, Nomura S, Yoneoka D, Kawashima T, Eguchi A, Shi S, et al. Mental health of family, friends, and co-workers of COVID-19 patients in Japan. Psychiatry Res. 2020;291:113067.CrossRef Tanoue Y, Nomura S, Yoneoka D, Kawashima T, Eguchi A, Shi S, et al. Mental health of family, friends, and co-workers of COVID-19 patients in Japan. Psychiatry Res. 2020;291:113067.CrossRef
22.
go back to reference Mohammadi SM, Ashtari S, Khosh FM. The psychological impact of COVID-19 pandemic on mental health of Iranian population. Int J Travel Med Global Health. 2020;9(1):19–24.CrossRef Mohammadi SM, Ashtari S, Khosh FM. The psychological impact of COVID-19 pandemic on mental health of Iranian population. Int J Travel Med Global Health. 2020;9(1):19–24.CrossRef
23.
go back to reference Zandifar A, Badrfam R, Yazdani S, Arzaghi SM, Rahimi F, Ghasemi S, et al. Prevalence and severity of depression, anxiety, stress and perceived stress in hospitalized patients with COVID-19. J Diabetes Metab Disorders. 2020;19(2):1431–8.CrossRef Zandifar A, Badrfam R, Yazdani S, Arzaghi SM, Rahimi F, Ghasemi S, et al. Prevalence and severity of depression, anxiety, stress and perceived stress in hospitalized patients with COVID-19. J Diabetes Metab Disorders. 2020;19(2):1431–8.CrossRef
24.
go back to reference Usher K, Bhullar N, Durkin J, Gyamfi N, Jackson D. Family violence and COVID-19: increased vulnerability and reduced options for support. Int J Ment Health Nurs. 2020;29(4):549–52.CrossRef Usher K, Bhullar N, Durkin J, Gyamfi N, Jackson D. Family violence and COVID-19: increased vulnerability and reduced options for support. Int J Ment Health Nurs. 2020;29(4):549–52.CrossRef
27.
go back to reference Abhijit C, Soumen K. Impact of COVID-19 on Obsessive Compulsive Disorder (OCD). Iran J Psychiatry. 2020;15(3):256–9. Abhijit C, Soumen K. Impact of COVID-19 on Obsessive Compulsive Disorder (OCD). Iran J Psychiatry. 2020;15(3):256–9.
28.
go back to reference Rogers JP, Chesney E, Oliver D, Pollak TA, McGuire P, Fusar-Poli P, 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(7):611–27.CrossRef Rogers JP, Chesney E, Oliver D, Pollak TA, McGuire P, Fusar-Poli P, 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(7):611–27.CrossRef
29.
go back to reference Fineberg NA, Van Ameringen M, Drummond L, Hollander E, Stein DJ, Geller D, et al. How to manage obsessive-compulsive disorder (OCD) under COVID-19: A clinician's guide from the International College of Obsessive Compulsive Spectrum Disorders (ICOCS) and the Obsessive-Compulsive and Related Disorders Research Network (OCRN) of the European College of Neuropsychopharmacology. Compr Psychiatry. 2020;100:152174.CrossRef Fineberg NA, Van Ameringen M, Drummond L, Hollander E, Stein DJ, Geller D, et al. How to manage obsessive-compulsive disorder (OCD) under COVID-19: A clinician's guide from the International College of Obsessive Compulsive Spectrum Disorders (ICOCS) and the Obsessive-Compulsive and Related Disorders Research Network (OCRN) of the European College of Neuropsychopharmacology. Compr Psychiatry. 2020;100:152174.CrossRef
30.
go back to reference Imran N, Afzal H, Aamer I, Hashmi A, Shabbir B, Asif A, et al. Scarlett letter: a study based on experience of stigma by COVID-19 patients in quarantine. Pakistan J Med Sci. 2020;36(7):1471–7. Imran N, Afzal H, Aamer I, Hashmi A, Shabbir B, Asif A, et al. Scarlett letter: a study based on experience of stigma by COVID-19 patients in quarantine. Pakistan J Med Sci. 2020;36(7):1471–7.
31.
go back to reference Khalil A, Gondal F, Imran N, Azeem MW. Self-stigmatization in children receiving mental health treatment in Lahore, Pakistan. Asian J Psychiatr. 2020;47:101839.CrossRef Khalil A, Gondal F, Imran N, Azeem MW. Self-stigmatization in children receiving mental health treatment in Lahore, Pakistan. Asian J Psychiatr. 2020;47:101839.CrossRef
32.
go back to reference Strang P, Bergström J, Martinsson L, Lundström S. Dying from COVID-19: loneliness, end-of-life discussions, and support for patients and their families in nursing homes and hospitals. A National Register Study. J Pain Symptom Manag. 2020;60(4):e2–e13.CrossRef Strang P, Bergström J, Martinsson L, Lundström S. Dying from COVID-19: loneliness, end-of-life discussions, and support for patients and their families in nursing homes and hospitals. A National Register Study. J Pain Symptom Manag. 2020;60(4):e2–e13.CrossRef
33.
go back to reference Roder-DeWan S. Health system quality in the time of COVID-19. Lancet Glob Health. 2020;8(6):e738–e9.CrossRef Roder-DeWan S. Health system quality in the time of COVID-19. Lancet Glob Health. 2020;8(6):e738–e9.CrossRef
34.
go back to reference Zandifar A, Badrfam R. Fighting COVID-19 in Iran; Economic Challenges Ahead. Arch Iran Med. 2020;23(4):284.CrossRef Zandifar A, Badrfam R. Fighting COVID-19 in Iran; Economic Challenges Ahead. Arch Iran Med. 2020;23(4):284.CrossRef
35.
go back to reference Lee AM, Wong JG, McAlonan GM, Cheung V, Cheung C, Sham PC, et al. Stress and psychological distress among SARS survivors 1 year after the outbreak. Can J Psychiatr. 2007;52(4):233–40.CrossRef Lee AM, Wong JG, McAlonan GM, Cheung V, Cheung C, Sham PC, et al. Stress and psychological distress among SARS survivors 1 year after the outbreak. Can J Psychiatr. 2007;52(4):233–40.CrossRef
36.
go back to reference Mak IW, Chu CM, Pan PC, Yiu MG, Chan VL. Long-term psychiatric morbidities among SARS survivors. Gen Hosp Psychiatry. 2009;31(4):318–26.CrossRef Mak IW, Chu CM, Pan PC, Yiu MG, Chan VL. Long-term psychiatric morbidities among SARS survivors. Gen Hosp Psychiatry. 2009;31(4):318–26.CrossRef
37.
go back to reference Peeri NC, Shrestha N, Rahman MS, Zaki R, Tan Z, Bibi S, et al. The SARS, MERS and novel coronavirus (COVID-19) epidemics, the newest and biggest global health threats: what lessons have we learned? Int J Epidemiol. 2020;49(3):717–26.CrossRef Peeri NC, Shrestha N, Rahman MS, Zaki R, Tan Z, Bibi S, et al. The SARS, MERS and novel coronavirus (COVID-19) epidemics, the newest and biggest global health threats: what lessons have we learned? Int J Epidemiol. 2020;49(3):717–26.CrossRef
38.
go back to reference Tony AA, Tony EA, Ali SB, Ezzeldin AM, Mahmoud AA. COVID-19-associated sleep disorders: a case report. Neurobiol Sleep Circadian Rhythms. 2020;9:100057.CrossRef Tony AA, Tony EA, Ali SB, Ezzeldin AM, Mahmoud AA. COVID-19-associated sleep disorders: a case report. Neurobiol Sleep Circadian Rhythms. 2020;9:100057.CrossRef
39.
go back to reference Ibarra-Coronado EG, Pantaleón-Martínez AM, Velazquéz-Moctezuma J, Prospéro-García O, Méndez-Díaz M, Pérez-Tapia M, et al. The bidirectional relationship between sleep and immunity against infections. J Immunol Res. 2015;2015:678164. https://doi.org/10.1155/2015. Ibarra-Coronado EG, Pantaleón-Martínez AM, Velazquéz-Moctezuma J, Prospéro-García O, Méndez-Díaz M, Pérez-Tapia M, et al. The bidirectional relationship between sleep and immunity against infections. J Immunol Res. 2015;2015:678164. https://​doi.​org/​10.​1155/​2015.
40.
go back to reference Maas MB, Kim M, Malkani RG, Abbott SM, Zee PC. Obstructive sleep apnea and risk of COVID-19 infection, Hospital Respiratory Failure. Sleep Breath. 2020:1–3. Maas MB, Kim M, Malkani RG, Abbott SM, Zee PC. Obstructive sleep apnea and risk of COVID-19 infection, Hospital Respiratory Failure. Sleep Breath. 2020:1–3.
42.
go back to reference Pirzada A, Awadh AA, Aleissi SA, Almeneessier AS, BaHammam AS. Reopening sleep medicine Services in the Conundrum of an ongoing COVID-19 pandemic: a global view. Sleep Vigil. 2020:1–8. Pirzada A, Awadh AA, Aleissi SA, Almeneessier AS, BaHammam AS. Reopening sleep medicine Services in the Conundrum of an ongoing COVID-19 pandemic: a global view. Sleep Vigil. 2020:1–8.
Metadata
Title
Exploring COVID-19 patients’ experiences of psychological distress during the disease course: a qualitative study
Authors
Tahereh Toulabi
Fatemeh Jafari Pour
Atefeh Veiskramian
Heshmatolah Heydari
Publication date
01-12-2021
Publisher
BioMed Central
Keywords
COVID-19
Anxiety
Published in
BMC Psychiatry / Issue 1/2021
Electronic ISSN: 1471-244X
DOI
https://doi.org/10.1186/s12888-021-03626-z

Other articles of this Issue 1/2021

BMC Psychiatry 1/2021 Go to the issue