Psychological Impact and Associated Factors Among COVID-19 Patients Hospitalized During the First Wave: A Cross-Sectional Study from a Tertiary Hospital in Thailand

When a person is hospitalized with a serious illness, the physical battle to recover is only half the story. The mind faces its own set of challenges, often triggered by the fear of the unknown, the isolation of a hospital room, and the sudden disruption of a normal life. During the first wave of the global pandemic, doctors and researchers began to ask a critical question: how did the experience of being sick with the virus affect the mental health of those in the hospital? Specifically, they wanted to know how many patients were struggling with feelings of deep worry, sadness, or thoughts of ending their lives. While it was known that the virus could cause physical harm, the invisible toll on the psyche was less understood, especially in Southeast Asia, where cultural attitudes toward mental health and community support might shape the experience differently than in Western countries. Understanding this psychological landscape is vital because if a patient is suffering silently, they may not get the help they need to heal fully.

In Thailand, a team of researchers at Rajavithi Hospital in Bangkok set out to map this hidden landscape. Between May and December 2020, they invited 93 adult patients who had been admitted for COVID-19 to participate in a study. These were not the most critically ill patients; the researchers could only ask those who were well enough to sit up and answer questions. The team used two simple, validated tools to measure the patients' mental state. One tool asked about feelings of nervousness and low mood, while the other asked directly about thoughts of death or suicide. The goal was not to predict the future or to prove exactly what caused these feelings, but simply to take a snapshot of the mental health of this specific group during a unique moment in history.

The results they found were surprising when compared to reports from other parts of the world. In many Western studies and reports from other countries, a large portion of hospitalized patients were found to be suffering from significant anxiety or depression. In this Thai group, however, the numbers were much lower. Only a tiny fraction of the patients, about two out of every hundred, showed signs of severe anxiety, and about five out of every hundred showed signs of severe depression. These figures suggest that for this specific group of patients in Thailand, the immediate psychological crisis was less intense than what had been observed elsewhere. The researchers noted that the average scores for anxiety and sadness were low, falling well within the range of what is considered normal for people who are not clinically depressed.

However, the story was not entirely one of low distress. While severe depression was rare, a different and more urgent finding emerged. When the researchers asked about suicidal thoughts, they found that nearly thirteen out of every hundred patients reported having such thoughts. This is a striking number because it was more than double the rate of those who met the criteria for clinical depression. This suggests that for many of these patients, the urge to end their lives was not necessarily tied to a deep, lingering sadness or a diagnosed mood disorder. Instead, it appeared to be a reaction to the immediate, terrifying reality of being sick, the fear of dying, or the shame and isolation they felt while separated from their families. The data indicates that a patient could be thinking about suicide even if they did not appear clinically depressed.

The study also looked at which patients were more likely to struggle. The researchers found that older patients, specifically those aged sixty and above, were significantly more likely to report feelings of depression than younger patients. Similarly, those who required oxygen therapy to help them breathe were much more likely to feel depressed than those who did not need extra oxygen. These connections make intuitive sense: older adults often face higher risks of severe outcomes from the virus, and needing oxygen is a clear sign that the illness is serious. The fear and physical discomfort associated with these conditions likely weighed heavily on their minds. The researchers tried to use complex statistical methods to see if these factors were the sole cause, but the number of patients with these specific feelings was too small to draw a firm, mathematical conclusion. They could only say that these patterns existed in their group and needed to be confirmed by larger studies.

One of the most important takeaways from this work is the disconnect between depression and suicidal thoughts. In many medical settings, doctors might check for depression first, assuming that if a patient is not depressed, they are safe from suicidal ideation. This study suggests that approach could be dangerous. Because so many patients in this group thought about suicide without meeting the criteria for depression, the researchers argue that hospitals must ask everyone directly about suicidal thoughts, regardless of whether they seem sad or anxious. Relying only on depression screening would have missed more than half of the patients in this study who were at risk.

The researchers were careful to explain why their numbers might be lower than those seen in other countries. They noted that their study excluded the sickest patients, those in intensive care who were too ill to answer questions, which means the group they studied was generally healthier than the full population of hospitalized patients. They also pointed out that Thai culture, with its strong emphasis on community and Buddhist values of acceptance, might help people cope with adversity in ways that differ from Western cultures. It is possible that these cultural factors, combined with a healthcare system that was not overwhelmed during that specific time, provided a buffer against the worst psychological effects. However, the researchers could not prove this definitively, as they did not compare their group directly with patients from other nations.

Ultimately, this study serves as a clear, early warning and a guide for the future. It shows that while the rate of severe anxiety and depression among hospitalized COVID-19 patients in Thailand was lower than expected, the risk of suicidal thoughts was real and significant. It highlights that older patients and those with more severe breathing difficulties need extra attention. Most importantly, it demonstrates that mental health screening in hospitals cannot be a one-size-fits-all approach. Doctors must look beyond just depression and ask directly about the darkest thoughts, because the mind can be in crisis even when the mood seems stable. As the pandemic moves forward, these findings remind us that healing the body is essential, but healing the mind requires a different, more direct kind of care.