Tesis

Gambaran gangguan jiwa pada pasien dengan berbagai derajat keparahan COVID-19 dan faktor-faktor yang memengaruhi di RSUP Persahabatan Jakarta = Psychiatric disorders in patients with various degrees of COVID- 19 severity and influencing factors at Persahabatan Hospital Jakarta.

Latar Belakang: Wabah Coronavirus disease 2019 (COVID-19) yang dideklarasikan sebagai pandemi oleh WHO sejak Maret 2020 telah menimbulkan masalah kesehatan jiwa baik pada pasien, publik, maupun tenaga kesehatan. Pandemi COVID-19 dan adaptasi terhadap kebiasaan baru seperti karantina, pembatasan sosial dan perubahan pada pola hidup berdampak terhadap kesehatan mental dan berpotensi memicu terjadinya gangguan jiwa. Pada pasien COVID-19 dapat terjadi inflamasi dan keterlibatan sistem neuropsikiatri, yang dipengaruhi isolasi dan stres psikososial, sehingga berpengaruh terhadap kejadian gangguan jiwa, antara lain depresi, gangguan cemas, gangguan panik, dan sebagainya. Penelitian ini bertujuan untuk mengetahui gambaran gangguan jiwa pada pasien COVID-19 dan hubungan antara derajat keparahan COVID-19 yang diderita pasien dengan faktor-faktor yang memengaruhi di RSUP Persahabatan. Metode: Desain penelitian ini adalah studi analitik potong lintang dengan metode wawancara langsung kepada pasien COVID-19 dengan berbagai derajat keparahan (ringan dan sedang-berat) yang dirawat di RSUP Persahabatan dan memenuhi kriteria inklusi dengan menggunakan Instrumen Penilaian Gangguan Jiwa MINI ICD-10 dan Skala Penilaian Penyesuaian Sosial Holmes-Rahe. Penelitian dilakukan di RSUP Persahabatan dalam periode November 2020 – Oktober 2021 dengan teknik simple random sampling. Data penelitian diolah dengan analisis bivariat dan multivariat dengan luaran kategorik. Hasil: Didapatkan 89 subjek penelitian dengan dengan proporsi gangguan jiwa sebanyak 40,4%. Terdapat hubungan bermakna antara derajat keparahan COVID-19 dengan gangguan jiwa (OR 3,85 (IK 95% 1,55 – 9,53), p=0,003). Pada analisis subgrup didapatkan hubungan yang bermakna antara derajat keparahan COVID-19 dengan episode depresi (OR 3,43 (IK 95% 1,22 – 9,62), p=0,016) dan agorafobia (OR 7,68 (IK 95% 1,93 – 30,53), p=0,003). Pada analisis multivariat untuk faktor-faktor yang memengaruhi gangguan jiwa didapatkan hubungan yang bermakna secara statistik antara derajat keparahan COVID-19 (adjusted OR 8,12 (IK 95% 1,65 – 40,04), p=0,010) dan kematian anggota keluarga dekat (adjusted OR 13,21 (IK 95% 2,57 – 67,89, p=0,002) dengan kejadian gangguan jiwa dengan nilai r2 45,1%. Kesimpulan: Terdapat hubungan yang bermakna antara derajat keparahan COVID-19 dengan kejadian gangguan jiwa yang dipengaruhi kematian anggota keluarga dekat pada penelitian ini. Jenis gangguan jiwa yang memiliki hubungan bermakna dengan derajat keparahan COVID-19 adalah episode depresi dan agorafobia.
Kata Kunci: agorafobia, COVID-19, episode depresi, gangguan jiwa



Background: The outbreak of Coronavirus disease 2019 (COVID-19) which was declared a pandemic by WHO since March 2020 with number of cases reaching 618 million cases and 6.5 million deaths worldwide has caused mental health problems for patients, public, and health workers. The COVID-19 pandemic and adaptation to new habits such as quarantine, social restrictions and changes in lifestyle have an impact on mental health and have the potential to trigger psychiatric disorders. In COVID-19 patients, inflammation and involvement of the neuropsychiatric system could develop, along with isolation and psychosocial stress that they could affect the incidence of psychiatric disorders, including depression, anxiety disorders, panic disorders, et cetera. This study aims to describe psychiatric disorders in COVID-19 patients and determine the association between the severity of COVID-19 with the associating factors in Persahabatan Hospital. Methods: The design of this study was analytic, cross-sectional with direct interview method to COVID-19 patients with various degrees of severity (mild and moderate to severe) who were treated at Persahabatan Hospital and met the inclusion criteria using the MINI ICD-10 Mental Disorder Assessment Instrument and the Social Readjustment Rating Scale Holmes-Rahe. The research was conducted at Persahabatan Hospital in the period of November 2020 – October 2021 with simple random sampling technique. The data were processed by bivariate and multivariate analysis with categorical outcomes. Results: Eighty-nine subjects were obtained with the proportion of psychiatric disorders 40.4%. There was a significant association between the severity of COVID-19 and psychiatric disorders (OR 3.85 (95% CI 1.55 – 9.53), p=0.003). In the subgroup analysis, there was a significant association between the severity of COVID-19 and episodes of depression (OR 3.43 (95% CI 1.22 – 9.62), p = 0.016) and agoraphobia (OR 7.68 (95% CI 1 .93 – 30.53), p=0.003). In a multivariate analysis of factors influencing psychiatric disorders, a statistically significant association was found between the severity of COVID-19 (adjusted OR 8.12 (95% CI 1.65 – 40.04), p=0.010) and the death of close family members (adjusted OR 13.21 (95% CI 2.57 – 67.89, p=0.002) with the incidence of psychiatric disorders with r2 value of 45.1%. Conclusion: There is a significant association between the severity of COVID-19 and psychiatric disorders that are influenced by the death of close family members in this study. The types of psychiatric disorders found to have a significant association with the severity of COVID-19 were episodes of depression and agoraphobia.
Keywords: agoraphobia, COVID-19, episodes of depression, psychiatric disorders