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Psychological experience of COVID-19 patients: A systematic review and qualitative meta-synthesis

Published:February 01, 2022DOI:https://doi.org/10.1016/j.ajic.2022.01.023

      Highlights

      • Qualitative research synthesis of COVID-19 patients’ experiences.
      • Analyze the experience of patients with COVID-19 to provide reference for the formulation of psychological interventions for patients.
      • Stigma and being labeled surround survivors.
      • Support, medical staff, and spiritual beliefs maintained mental health of participants.
      • Provide continuity of care for patients, and help them return to their families and society.

      Abstract

      Background

      Coronavirus disease 2019 (COVID-19) has not only placed an unprecedented strain on healthcare systems worldwide, but has also caused irreparable physical and psychological damage to those infected. It is essential to understand the disease process and psychological experience of patients with COVID-19, to provide them with efficacious psychological guidance and interventions. This qualitative systematic review sought to explore the experience of COVID-19 patients.

      Methods

      The meta-analysis methodology developed by the Joanna Briggs Institute guided this systematic review and qualitative meta-analysis. Seven databases were searched, with no language restrictions. This study was registered with PROSPERO under accession number CRD42021279266.

      Results

      A total of 3107 potentially eligible articles were identified through database and reference list searches, among which 23 studies (from 10 countries) were ultimately included in our analysis. Five interrelated themes emerged: the complex psychological course of COVID-19 patients; the impact of the disease on the body; the expectation of support and guidance from multiple sources; coping strategies; and post-traumatic growth.

      Conclusions

      Psychological distress among patients with COVID-19 was found to be widespread. Healthcare providers should pay attention to the psychological changes in patients, ensure continuity of care and provide professional support from hospital to home, and build patients’ confidence so that they can return to their families and society. Long-term follow-up studies may provide deeper insight into the psychological needs of survivors.

      Key Words

      Background

      Coronavirus disease 2019 (COVID-19) is a highly contagious virus. On January 30, 2020, the World Health Organization (WHO) announced that the global outbreak of COVID-19 was an international public health emergency and subsequently classified it as a worldwide pandemic on March 11, 2020.

      WHO. WHO announces COVID-19 outbreak of a pandemic.

      COVID-19 has not only placed healthcare system worldwide under tremendous pressure, but has also caused unpredictable losses in the domains of the economy, politics, and culture. Thus, countries all over the world are facing unprecedented pressures.
      • Lorusso D
      • Ray-Coquard I
      • Oaknin A
      • Banerjee S.
      Clinical research disruption in the post-COVID-19 era: will the pandemic lead to change?.
      Most studies have focused on the physical symptoms of COVID-19, such as fever, cough, and difficulty breathing.
      • Jin YH
      • Cai L
      • Cheng ZS
      • et al.
      A rapid advice guideline for the diagnosis and treatment of 2019 novel coronavirus (2019-nCoV) infected pneumonia (standard version).
      However, the potential psychological and mental health effects of COVID-19 survivors should also be taken seriously.

      WHO. Mental health and psychosocial considerations during the COVID-19 outbreak.

      Unlike the modest spread of viruses such as Ebola and Middle East Respiratory Syndrome, COVID-19 is a novel disease characterized by a sudden, global-scale outbreak, where infected people experience fear and worry due to uncertainty and the physical symptoms of the disease. Even in the absence of somatic symptoms, or when the symptoms are only mild, patients may experience negative emotions such as loneliness, guilt and pain as a result of isolation, and the effects of such negative emotions can be long-lasting.
      • Rubin GJ
      • Wessely S.
      The psychological effects of quarantining a city.
      Some survivors have reported experiencing varying degrees of anxiety and depression, even 6-12 months after discharge from the hospital.
      • Huang L
      • Yao Q
      • Gu X
      • et al.
      1-year outcomes in hospital survivors with COVID-19: a longitudinal cohort study.
      For patients, psychological distress can reach dangerous levels if not managed properly, affecting functional and mental health, undermining functioning and quality of life, and possibly even causing death. The psychological impacts and burden of major disasters on survivors are much more persistent and widespread than the physical damage.
      • Luo M
      • Guo L
      • Yu M
      • Jiang W
      • Wang H.
      The psychological and mental impact of coronavirus disease 2019 (COVID-19) on medical staff and general public - A systematic review and meta-analysis.
      The number of confirmed COVID-19 cases in countries around the world is still increasing, and the psychological effects of the outbreak are being felt by millions of people. Many studies have reported the experience of patients with COVID-19. However, medical systems and culture differ among countries, as do the disease experience and emotional changes of infected persons. Thus, a single qualitative study cannot fully reflect the authentic disease experience of heterogenous populations. Therefore, it is necessary to comprehensively investigate changes in the inner world of COVID-19 patients.
      In this study, the published quantitative literature on COVID-19 patients was evaluated and integrated, to elucidate the psychological experiences and needs of COVID-19 patients. We aimed to obtain deep insight into the psychological and spiritual changes of confirmed COVID-19 patients, provide a reference point for the formulation of psychological interventions for patients, promote physical and mental recovery, and help patients return to society and family life.

      Methods

      Design

      The meta-analysis methodology developed by the Joanna Briggs Institute (JBI) guided this systematic review and qualitative meta-analysis.
      • Lockwood C
      • Munn Z
      • Porritt K.
      Qualitative research synthesis: methodological guidance for systematic reviewers utilizing meta-aggregation.
      This approach is based on pragmatism and phenomenology, and was designed to aid the synthesis of qualitative research. We prospectively submitted the systematic review protocol for registration on PROSPERO (CRD42021279266).

      Inclusion criteria

      The Population, Indicators, Context and Study (PICoS) criteria were used as a framework when evaluating the literature, as shown in Table 1.
      Table 1Inclusion criteria for the literature studies
      PICoS criteriaEligibility criteria
      Population / ParticipantsAdult patients diagnosed with COVID-19 by clinicians
      Indicators/ phenomenon of interestPatients’ experiences of illness, mental state
      ContextAny country, hospital, or place
      Study designQualitative research, including phenomenological research, grounded theory, focus groups and other qualitative methods, as well as mixed methods with qualitative components
      Exclusion criteriaDuplicate publication and incomplete information; full text no available; poor-quality methodology; topic of the article cannot be extracted

      Search strategy

      The CNKI, Wanfang, SinoMed, Pubmed, Web of Science, Cochrane Library, and Embase databases were searched systematically, mainly for qualitative studies on the experience of COVID-19 patients. The retrieval period was January 2020-July 17, 2021. The search was carried out by combining subject words and free words. The whole search strategy is provided in Appendix S1.

      Quality assessment

      The quality of the literature studies was evaluated using the Quality Research Evaluation Criteria of the Centre for Evidence-based Health Care, JBI, Australia.
      • Lockwood C
      • Munn Z
      • Porritt K.
      Qualitative research synthesis: methodological guidance for systematic reviewers utilizing meta-aggregation.
      Grade A indicates that the quality standard is fully met, such that the possibility of bias is remote. Grade B indicates that the quality standard is partially met, such that the possibility of bias is moderate. Grade C indicates that the quality standard is not met at all, such that the possibility of bias is high. Grade C studies was excluded from this study. Two reviewers trained in qualitative research methods independently evaluated the studies, and a third reviewer arbitrated in the case of dissenting opinions. Literature quality assessment results in Appendix S2.

      Data extraction and synthesis

      The following data were extracted from the studies: author, location, qualitative research method, interesting phenomena, and qualitative analysis results (See Appendix S3). Using the standardized data extraction tool of JBI-QAR, the literature results were summarized and integrated using pooled integration method. The 2 reviewers extracted the theme of each study from the full text, reclassified the theme to derive a new category after discussion with the third reviewers, and then integrated the new theme.

      Results

      Study screening

      The research selection and inclusion processes are shown in Figure 1.
      Fig 1
      Fig 1PRISMA flow diagram of the study selection and inclusion processes.
      A total of 23 studies were included (8 in China, 3 in the United States, 5 in Iran, and 7 countries including South Korea, India, Belgium, Turkey, Nigeria, Australia, and Denmark). Qualitative studies (n = 22) and mixed-method studies (n = 1) with qualitative data were included in the meta-synthesis.

      Meta-synthesis of qualitative data

      Eighty-seven topics were extracted from the 23 studies. The topics were then reclassified, summarized, and integrated into 20 categories and 5 themes Table 2. lists the main themes and subthemes.
      Table 2Main themes and associated subthemes
      ThemeAssociated subtheme
      Theme1: Complex psychological course of COVID-19 patients1. COVID-19 perceived as a distant threat
      2. Panic caused by COVID-19 diagnosis
      3. Feelings of loneliness and helplessness
      4. Stigma and being labeled
      5. Uncertainty and desire for respect
      Theme 2: Impact of disease on the body6. Painful physical manifestations
      7. Powerlessness over the after-effects of the disease
      Theme 3: Expectation of support and guidance from multiple sources8. Inadequate information about the disease
      9. Desire for communication and emotional support
      10. Heavy financial burden
      11. Desire for continuous medical support
      12. Expectation of support from family, society and the state
      Theme 4: Coping strategies13. Active personal response
      14. Support from family and friends
      15. Reassurance from medical staff
      16. Spiritual beliefs provide comfort
      Theme 5: Post-traumatic growth17. Rethinking the meaning of life
      18. Enhancement of health literacy
      19. Increased stress resistance
      20. Gratitude to the country and healthcare providers

      Theme 1: Complex psychological course of COVID-19 patients

      COVID-19 perceived as a distant threat

      Four studies showed that some people pay no attention to COVID-19 and have insufficient awareness of the disease; this can be referred to as “blind confidence.”
      • Shaban RZ
      • Nahidi S
      • Sotomayor-Castillo C
      • et al.
      SARS-CoV-2 infection and COVID-19: the lived experience and perceptions of patients in isolation and care in an Australian healthcare setting.
      • Cervantes L
      • Martin M
      • Frank MG
      • et al.
      Experiences of latinx individuals hospitalized for COVID-19: A qualitative study.
      • Santiago-Rodriguez EI
      • Maiorana A
      • Peluso MJ
      • et al.
      Characterizing the COVID-19 illness experience to inform the study of post-acute sequelae and recovery: a qualitative study.
      • Kürtüncü M
      • Kurt A
      • Arslan N.
      The experiences of COVID-19 patients in intensive care units: a qualitative study.
      They believe that the threat of the virus is remote and only infects people with low immunity, such as the elderly and children, while those who regularly exercise and are in good health will not be infected. Thus, they have low self-awareness of prevention measures like wearing masks and social distancing. When patients show early stage COVID-19 symptoms, they often believe that they are suffering from other conditions (such as the common cold, allergies, or digestive tract diseases). However, while waiting for the results of the COVID-19 tests, patients are often nervous and anxious, and hope that they will not test positive.
      • Sun N
      • Wei L
      • Wang H
      • et al.
      Qualitative study of the psychological experience of COVID-19 patients during hospitalization.
      ,
      • Aliyu S
      • Travers JL
      • Norful AA
      • Clarke M
      • Schroeder K.
      The lived experience of being diagnosed with COVID-19 among black patients: a qualitative study.

      Panic caused to COVID-19 diagnosis

      After receiving the news of a COVID-19 diagnosis, the psychological course of the patient is time-dependent. Three studies reported that the first thing the patients showed was shock, perceiving the result as a surreal event.
      • Shaban RZ
      • Nahidi S
      • Sotomayor-Castillo C
      • et al.
      SARS-CoV-2 infection and COVID-19: the lived experience and perceptions of patients in isolation and care in an Australian healthcare setting.
      ,
      • Aliyu S
      • Travers JL
      • Norful AA
      • Clarke M
      • Schroeder K.
      The lived experience of being diagnosed with COVID-19 among black patients: a qualitative study.
      ,
      • Guo Q
      • Zheng Y
      • Shi J
      • et al.
      Immediate psychological distress in quarantined patients with COVID-19 and its association with peripheral inflammation: A mixed-method study.
      Four other studies mentioned that patients first expressed denial.
      • Kürtüncü M
      • Kurt A
      • Arslan N.
      The experiences of COVID-19 patients in intensive care units: a qualitative study.
      ,
      • Sun N
      • Wei L
      • Wang H
      • et al.
      Qualitative study of the psychological experience of COVID-19 patients during hospitalization.
      ,
      • Missel M
      • Bernild C
      • Christensen SW
      • Dagyaran I
      • Berg SK.
      It's not just a virus! lived experiences of people diagnosed with COVID-19 infection in Denmark.
      ,
      • Jamili S
      • Ebrahimipour H
      • Adel A
      • et al.
      Experience of patients hospitalized with COVID-19: A qualitative study of a pandemic disease in Iran.
      Infected individuals believing that their disease experience is inconsistent with the clinical symptoms reported in the media may question the test results. Once infection is confirmed, fear may arise; this emotion was expressed by all participants. Fear comes from 2 primary sources: uncertainty about the disease (concern regarding prognosis and the possibility of death), and the requirement to isolate. The unfamiliarity of the isolation ward, constant beeping of instruments, and proximity of medical staff in strange clothing create a sense of oppression. Also, negative events such as resuscitation and death of other patients can occur in the ward.
      Twenty-three studies reported the presence of worry in patients, for various reasons. Some people expressed concern about their illness, fearing that they would not receive timely medical assistance, and that the disease would worsen resulting into complications or even death.
      • Santiago-Rodriguez EI
      • Maiorana A
      • Peluso MJ
      • et al.
      Characterizing the COVID-19 illness experience to inform the study of post-acute sequelae and recovery: a qualitative study.
      ,
      • Aliyu S
      • Travers JL
      • Norful AA
      • Clarke M
      • Schroeder K.
      The lived experience of being diagnosed with COVID-19 among black patients: a qualitative study.
      ,
      • Jesmi AA
      • Mohammadzade-Tabrizi Z
      • Rad M
      • Hosseinzadeh-Younesi E
      • Pourhabib A
      Lived experiences of patients with COVID-19 infection: a phenomenology study.
      Some people are afraid that they will infect their family and friends, and damage their health.
      • Shaban RZ
      • Nahidi S
      • Sotomayor-Castillo C
      • et al.
      SARS-CoV-2 infection and COVID-19: the lived experience and perceptions of patients in isolation and care in an Australian healthcare setting.
      ,
      • Kürtüncü M
      • Kurt A
      • Arslan N.
      The experiences of COVID-19 patients in intensive care units: a qualitative study.
      ,
      • Sun N
      • Wei L
      • Wang H
      • et al.
      Qualitative study of the psychological experience of COVID-19 patients during hospitalization.
      ,
      • JingYuan Wang LWGW
      A qualitative study of the experience of illness in 15 patients with COVID-19.
      • Fang Li LL
      A qualitative study of psychological experiences during illness in patients with COVID-19.
      • Kong Shunzhen YHQL.
      Qualitative study on the experience of severe patients with COVID-19.
      • Moradi Y
      • Mollazadeh F
      • Karimi P
      • Hosseingholipour K
      • Baghaei R.
      Psychological disturbances of survivors throughout COVID-19 crisis: a qualitative study.
      • Sahoo S
      • Mehra A
      • Suri V
      • et al.
      Lived experiences of the corona survivors (patients admitted in COVID wards): A narrative real-life documented summaries of internalized guilt, shame, stigma, anger.
      • Wu C
      • Cheng J
      • Zou J
      • Duan L
      • Campbell JE.
      Health-related quality of life of hospitalized COVID-19 survivors: An initial exploration in Nanning city.
      • Akbarbegloo M
      • Sanaeefar M
      • Majid P
      • Mohammadzadeh M.
      Psychosocial care experiences of patients with COVID-19 at home in Iran: a qualitative study.
      • Norouzadeh R
      • Abbasinia M
      • Tayebi Z
      • et al.
      Experiences of patients With COVID-19 admitted to the intensive care units: a qualitative study.
      Some patients play multiple roles, such as the family breadwinner and a leader at work. Infection forces them to play the patient role, possibly leading to role conflict and feelings of guilt due to failure to fulfill family responsibilities and work in a timely manner.
      • Jamili S
      • Ebrahimipour H
      • Adel A
      • et al.
      Experience of patients hospitalized with COVID-19: A qualitative study of a pandemic disease in Iran.
      ,
      • JingYuan Wang LWGW
      A qualitative study of the experience of illness in 15 patients with COVID-19.
      ,
      • Sahoo S
      • Mehra A
      • Suri V
      • et al.
      Lived experiences of the corona survivors (patients admitted in COVID wards): A narrative real-life documented summaries of internalized guilt, shame, stigma, anger.
      ,
      • Yu Feng DHLS
      Qualitative study on factors contributing anxiety and depression in COVID-19 patients.
      ,
      • Son HM
      • Choi WH
      • Hwang YH
      • HR Yang
      The lived experiences of COVID-19 patients in South Korea: a qualitative study.
      Patients with children may think that being sent to the hospital by ambulance will cause psychological distress for their children.

      Feelings of loneliness and helplessness

      Eventually, patients tend to gradually accept their diagnosis and cooperate with the treatment. Because COVID-19 can be transmitted through droplets and aerosols, patients must be isolated. During the treatment period, patients are not allowed visitors, cannot communicate with others face to face, lack social contact and are thus socially disconnected. Patients may feel abandoned, such that their mental health is impaired. Patients are deprived of their freedoms and cut off from the outside world, with phones being the only means of communication therewith. Eleven studies reported that patients felt lonely and missed their families.
      • Cervantes L
      • Martin M
      • Frank MG
      • et al.
      Experiences of latinx individuals hospitalized for COVID-19: A qualitative study.
      ,
      • Kürtüncü M
      • Kurt A
      • Arslan N.
      The experiences of COVID-19 patients in intensive care units: a qualitative study.
      • Sun N
      • Wei L
      • Wang H
      • et al.
      Qualitative study of the psychological experience of COVID-19 patients during hospitalization.
      • Aliyu S
      • Travers JL
      • Norful AA
      • Clarke M
      • Schroeder K.
      The lived experience of being diagnosed with COVID-19 among black patients: a qualitative study.
      • Guo Q
      • Zheng Y
      • Shi J
      • et al.
      Immediate psychological distress in quarantined patients with COVID-19 and its association with peripheral inflammation: A mixed-method study.
      ,
      • Jamili S
      • Ebrahimipour H
      • Adel A
      • et al.
      Experience of patients hospitalized with COVID-19: A qualitative study of a pandemic disease in Iran.
      ,
      • Jesmi AA
      • Mohammadzade-Tabrizi Z
      • Rad M
      • Hosseinzadeh-Younesi E
      • Pourhabib A
      Lived experiences of patients with COVID-19 infection: a phenomenology study.
      ,
      • Kong Shunzhen YHQL.
      Qualitative study on the experience of severe patients with COVID-19.
      ,
      • Moradi Y
      • Mollazadeh F
      • Karimi P
      • Hosseingholipour K
      • Baghaei R.
      Psychological disturbances of survivors throughout COVID-19 crisis: a qualitative study.
      ,
      • Wu C
      • Cheng J
      • Zou J
      • Duan L
      • Campbell JE.
      Health-related quality of life of hospitalized COVID-19 survivors: An initial exploration in Nanning city.
      ,
      • Yu Feng DHLS
      Qualitative study on factors contributing anxiety and depression in COVID-19 patients.
      During isolation patients need to take care of themselves, due to their diminished health status, and cannot do many things by themselves.
      • Son HM
      • Choi WH
      • Hwang YH
      • HR Yang
      The lived experiences of COVID-19 patients in South Korea: a qualitative study.
      One patient reported that it was difficult for him to drink a glass of water. The monotonous and tedious isolation days mean that patients eagerly look forward to the end of that period.
      • Shaban RZ
      • Nahidi S
      • Sotomayor-Castillo C
      • et al.
      SARS-CoV-2 infection and COVID-19: the lived experience and perceptions of patients in isolation and care in an Australian healthcare setting.

      Stigma and being labeled

      Seven studies reported that patients felt ashamed; they thought that their failure to protect themselves caused more people to become infected, and their lack of opportunity to apologize to them, led to feelings of guilt.
      • Shaban RZ
      • Nahidi S
      • Sotomayor-Castillo C
      • et al.
      SARS-CoV-2 infection and COVID-19: the lived experience and perceptions of patients in isolation and care in an Australian healthcare setting.
      ,
      • Cervantes L
      • Martin M
      • Frank MG
      • et al.
      Experiences of latinx individuals hospitalized for COVID-19: A qualitative study.
      ,
      • Aliyu S
      • Travers JL
      • Norful AA
      • Clarke M
      • Schroeder K.
      The lived experience of being diagnosed with COVID-19 among black patients: a qualitative study.
      ,
      • Moradi Y
      • Mollazadeh F
      • Karimi P
      • Hosseingholipour K
      • Baghaei R.
      Psychological disturbances of survivors throughout COVID-19 crisis: a qualitative study.
      ,
      • Sahoo S
      • Mehra A
      • Suri V
      • et al.
      Lived experiences of the corona survivors (patients admitted in COVID wards): A narrative real-life documented summaries of internalized guilt, shame, stigma, anger.
      ,
      • Akbarbegloo M
      • Sanaeefar M
      • Majid P
      • Mohammadzadeh M.
      Psychosocial care experiences of patients with COVID-19 at home in Iran: a qualitative study.
      ,
      • Norouzadeh R
      • Abbasinia M
      • Tayebi Z
      • et al.
      Experiences of patients With COVID-19 admitted to the intensive care units: a qualitative study.
      • Yu Feng DHLS
      Qualitative study on factors contributing anxiety and depression in COVID-19 patients.
      • Son HM
      • Choi WH
      • Hwang YH
      • HR Yang
      The lived experiences of COVID-19 patients in South Korea: a qualitative study.
      ,
      • Sun W
      • Zhou Y
      • Chen WT
      • et al.
      Disclosure experience among COVID-19-confirmed patients in China: A qualitative study.
      The feelings of shame were so persistent that some patients continued to feel it even after discharged from the hospital.
      • Aliyu S
      • Travers JL
      • Norful AA
      • Clarke M
      • Schroeder K.
      The lived experience of being diagnosed with COVID-19 among black patients: a qualitative study.
      Fear of being contagious was reported, along with feeling under pressure when hearing people talk about COVID-19, due to fear that the conversation will be about them.
      With the spread of rumors, the public's attitude towards infected persons has deteriorated. Patients with COVID-19 reported being discriminated against and labeled by others. Epidemiological traceability is a component of disease investigations, and infected individuals are required to disclose their travel plans for outbreak prevention and control. However, some respondents stated that the survey process made them uncomfortable, as if they were being interrogated like criminals.
      • Son HM
      • Choi WH
      • Hwang YH
      • HR Yang
      The lived experiences of COVID-19 patients in South Korea: a qualitative study.
      Some patients’ privacy is compromised, and they became subjects of gossip, sometimes even suffering personal attacks and cyberbullying. Patients thus may feel angry and aggrieved, given that they are also victims of the virus.
      • Sun N
      • Wei L
      • Wang H
      • et al.
      Qualitative study of the psychological experience of COVID-19 patients during hospitalization.
      ,
      • Guo Q
      • Zheng Y
      • Shi J
      • et al.
      Immediate psychological distress in quarantined patients with COVID-19 and its association with peripheral inflammation: A mixed-method study.
      ,
      • JingYuan Wang LWGW
      A qualitative study of the experience of illness in 15 patients with COVID-19.
      ,
      • Sahoo S
      • Mehra A
      • Suri V
      • et al.
      Lived experiences of the corona survivors (patients admitted in COVID wards): A narrative real-life documented summaries of internalized guilt, shame, stigma, anger.
      ,
      • Son HM
      • Choi WH
      • Hwang YH
      • HR Yang
      The lived experiences of COVID-19 patients in South Korea: a qualitative study.

      Uncertainty and the desire for respected

      In the late stages of treatment, patients may feel happy and excited on learning that a viral nucleic acid test is negative. After receiving the discharge notification, many patients show concern regarding the uncertainty of the disease course. Five studies reported that patients did not know if the virus was still present in their bodies, fearing that the illness would return, they felt like “ticking time bombs” and cut themselves off from other people.
      • Shaban RZ
      • Nahidi S
      • Sotomayor-Castillo C
      • et al.
      SARS-CoV-2 infection and COVID-19: the lived experience and perceptions of patients in isolation and care in an Australian healthcare setting.
      ,
      • Cervantes L
      • Martin M
      • Frank MG
      • et al.
      Experiences of latinx individuals hospitalized for COVID-19: A qualitative study.
      ,
      • Sun N
      • Wei L
      • Wang H
      • et al.
      Qualitative study of the psychological experience of COVID-19 patients during hospitalization.
      ,
      • Kong Shunzhen YHQL.
      Qualitative study on the experience of severe patients with COVID-19.
      ,
      • Son HM
      • Choi WH
      • Hwang YH
      • HR Yang
      The lived experiences of COVID-19 patients in South Korea: a qualitative study.
      This persistent alienation had an impact on the participants’ social and emotional functioning. The participants also feared being re-infected by others, and never wanted to go through that painful time again.
      Ten studies showed that the public's alienation of COVID-19 patients can affect the relationships of the cured at home and work, where they are sometimes asked to work in separate offices or homeschool their children.
      • Shaban RZ
      • Nahidi S
      • Sotomayor-Castillo C
      • et al.
      SARS-CoV-2 infection and COVID-19: the lived experience and perceptions of patients in isolation and care in an Australian healthcare setting.
      ,
      • Cervantes L
      • Martin M
      • Frank MG
      • et al.
      Experiences of latinx individuals hospitalized for COVID-19: A qualitative study.
      ,
      • Sun N
      • Wei L
      • Wang H
      • et al.
      Qualitative study of the psychological experience of COVID-19 patients during hospitalization.
      ,
      • Aliyu S
      • Travers JL
      • Norful AA
      • Clarke M
      • Schroeder K.
      The lived experience of being diagnosed with COVID-19 among black patients: a qualitative study.
      ,
      • Missel M
      • Bernild C
      • Christensen SW
      • Dagyaran I
      • Berg SK.
      It's not just a virus! lived experiences of people diagnosed with COVID-19 infection in Denmark.
      ,
      • Jamili S
      • Ebrahimipour H
      • Adel A
      • et al.
      Experience of patients hospitalized with COVID-19: A qualitative study of a pandemic disease in Iran.
      ,
      • Akbarbegloo M
      • Sanaeefar M
      • Majid P
      • Mohammadzadeh M.
      Psychosocial care experiences of patients with COVID-19 at home in Iran: a qualitative study.
      ,
      • Son HM
      • Choi WH
      • Hwang YH
      • HR Yang
      The lived experiences of COVID-19 patients in South Korea: a qualitative study.
      ,
      • Mukhtar NB
      • Abdullahi A
      • Abba MA
      • Mohammed J.
      Views and experiences of discharged COVID-19 patients in Kano, Nigeria: a qualitative study.
      ,
      • Sun W
      • Zhou Y
      • Chen WT
      • et al.
      Disclosure experience among COVID-19-confirmed patients in China: A qualitative study.
      Others associate survivors with the virus. Recovered persons may always feel that others are talking about them behind their back, that people “avoid them like the plague”, and that they are seen as a “walking virus” that brings misfortune to others.
      • Sun N
      • Wei L
      • Wang H
      • et al.
      Qualitative study of the psychological experience of COVID-19 patients during hospitalization.
      Avoidance, rejection, and blaming of the healed person are more difficult to deal with than physical pain. Patients have an innate desire to be respected and understood. To address this situation, some people in recovery try to conceal their medical history from others.
      • Jamili S
      • Ebrahimipour H
      • Adel A
      • et al.
      Experience of patients hospitalized with COVID-19: A qualitative study of a pandemic disease in Iran.

      Theme 2: Impact of disease on the body

      Painful physical manifestations

      In ten studies, patients reported feeling miserable, and that the illness was an awful experience.
      • Shaban RZ
      • Nahidi S
      • Sotomayor-Castillo C
      • et al.
      SARS-CoV-2 infection and COVID-19: the lived experience and perceptions of patients in isolation and care in an Australian healthcare setting.
      ,
      • Santiago-Rodriguez EI
      • Maiorana A
      • Peluso MJ
      • et al.
      Characterizing the COVID-19 illness experience to inform the study of post-acute sequelae and recovery: a qualitative study.
      • Kürtüncü M
      • Kurt A
      • Arslan N.
      The experiences of COVID-19 patients in intensive care units: a qualitative study.
      • Sun N
      • Wei L
      • Wang H
      • et al.
      Qualitative study of the psychological experience of COVID-19 patients during hospitalization.
      • Aliyu S
      • Travers JL
      • Norful AA
      • Clarke M
      • Schroeder K.
      The lived experience of being diagnosed with COVID-19 among black patients: a qualitative study.
      ,
      • Jesmi AA
      • Mohammadzade-Tabrizi Z
      • Rad M
      • Hosseinzadeh-Younesi E
      • Pourhabib A
      Lived experiences of patients with COVID-19 infection: a phenomenology study.
      ,
      • Kong Shunzhen YHQL.
      Qualitative study on the experience of severe patients with COVID-19.
      ,
      • Norouzadeh R
      • Abbasinia M
      • Tayebi Z
      • et al.
      Experiences of patients With COVID-19 admitted to the intensive care units: a qualitative study.
      ,
      • Son HM
      • Choi WH
      • Hwang YH
      • HR Yang
      The lived experiences of COVID-19 patients in South Korea: a qualitative study.
      ,
      • Mukhtar NB
      • Abdullahi A
      • Abba MA
      • Mohammed J.
      Views and experiences of discharged COVID-19 patients in Kano, Nigeria: a qualitative study.
      Unlike ordinary pneumonia infections, COVID-19 is associated with an intense attack on bodily systems by a highly functioning immune system, in addition to compromised lung function. Patients may exhibit non-specific symptoms such as labored breathing, high fever, headache, loss of taste, diarrhea, and weakness, as well as inexplicable crying, emotional disorders, hallucinations, and recurrent nightmares. In some patients, underlying illnesses are also aggravated by COVID-19, which can be a very severe mental test.
      • Wu C
      • Cheng J
      • Zou J
      • Duan L
      • Campbell JE.
      Health-related quality of life of hospitalized COVID-19 survivors: An initial exploration in Nanning city.
      Every person who has recovered from the virus experiences pain that may be difficult for others to imagine.

      Powerlessness over the after-effects of the disease

      Although patients are discharged from hospital when cured, the devastating effect on the body of the illness remain. Recovered patients may think they are entirely free of the virus, and thus do not expect the sequelae thereof to be unbearable.
      • Missel M
      • Bernild C
      • Christensen SW
      • Dagyaran I
      • Berg SK.
      It's not just a virus! lived experiences of people diagnosed with COVID-19 infection in Denmark.
      ,
      • Son HM
      • Choi WH
      • Hwang YH
      • HR Yang
      The lived experiences of COVID-19 patients in South Korea: a qualitative study.
      Typical sequelae of SARS and COVID-19 in severely ill patients 1-3 years after discharge from the hospital include pulmonary fibrosis. Stroke and tinnitus may also be experienced while in recovery, and even simple movements (such as going up and down stairs or turning over in bed) can be a struggle. Thus, their battle with the virus is not over, they may in fact experience more torment after being cured. COVID-19 not only affects the body, but also weakens the will; the recovered person suffers the double blow of physical and psychological damage. The life of the recovered patient thus changes markedly.

      Theme 3: Expectation of support and guidance from multiple sources

      Inadequate information about the disease

      As a novel infectious virus, the COVID-19 pandemic has also constituted an information crisis. There is a lack of public knowledge about the characteristics of COVID-19, as well as prevention and control measures in the early stages of the disease. Mass media (TV, radio), social media platforms (WeChat, Facebook), and online resources (web search) are essential channels through which the public can obtain information about diseases, but mixed messages from various sources makes it difficult for patients to distinguish the true from the false, leading to confusion and distrust of information.
      • Cervantes L
      • Martin M
      • Frank MG
      • et al.
      Experiences of latinx individuals hospitalized for COVID-19: A qualitative study.
      ,
      • Guo Q
      • Zheng Y
      • Shi J
      • et al.
      Immediate psychological distress in quarantined patients with COVID-19 and its association with peripheral inflammation: A mixed-method study.
      ,
      • Moradi Y
      • Mollazadeh F
      • Karimi P
      • Hosseingholipour K
      • Baghaei R.
      Psychological disturbances of survivors throughout COVID-19 crisis: a qualitative study.
      As a consequence, some people try to prevent the virus with obscure remedies, such as eating and performing nasal washes with salt water.
      • Shaban RZ
      • Nahidi S
      • Sotomayor-Castillo C
      • et al.
      SARS-CoV-2 infection and COVID-19: the lived experience and perceptions of patients in isolation and care in an Australian healthcare setting.
      ,
      • Son HM
      • Choi WH
      • Hwang YH
      • HR Yang
      The lived experiences of COVID-19 patients in South Korea: a qualitative study.
      With the rising number of confirmed diagnoses and deaths reported in the media, patients may experience a substantial psychological burden. Some intentionally avoid exposure to news about COVID-19.
      • Mukhtar NB
      • Abdullahi A
      • Abba MA
      • Mohammed J.
      Views and experiences of discharged COVID-19 patients in Kano, Nigeria: a qualitative study.
      The confusion, vague predictions, and sense of impending doom associated with COVID-19 messaging has created uncertainty and confusion among patients. Some participants described the experience as like being caught between life and death.
      • Santiago-Rodriguez EI
      • Maiorana A
      • Peluso MJ
      • et al.
      Characterizing the COVID-19 illness experience to inform the study of post-acute sequelae and recovery: a qualitative study.
      ,
      • Yu Feng DHLS
      Qualitative study on factors contributing anxiety and depression in COVID-19 patients.

      The desire for communication and emotional support

      In ten studies, patients reported desire for emotional support from family and medical care, especially during isolation.
      • Shaban RZ
      • Nahidi S
      • Sotomayor-Castillo C
      • et al.
      SARS-CoV-2 infection and COVID-19: the lived experience and perceptions of patients in isolation and care in an Australian healthcare setting.
      ,
      • Cervantes L
      • Martin M
      • Frank MG
      • et al.
      Experiences of latinx individuals hospitalized for COVID-19: A qualitative study.
      ,
      • Sun N
      • Wei L
      • Wang H
      • et al.
      Qualitative study of the psychological experience of COVID-19 patients during hospitalization.
      ,
      • Aliyu S
      • Travers JL
      • Norful AA
      • Clarke M
      • Schroeder K.
      The lived experience of being diagnosed with COVID-19 among black patients: a qualitative study.
      ,
      • Missel M
      • Bernild C
      • Christensen SW
      • Dagyaran I
      • Berg SK.
      It's not just a virus! lived experiences of people diagnosed with COVID-19 infection in Denmark.
      ,
      • Moradi Y
      • Mollazadeh F
      • Karimi P
      • Hosseingholipour K
      • Baghaei R.
      Psychological disturbances of survivors throughout COVID-19 crisis: a qualitative study.
      ,
      • Akbarbegloo M
      • Sanaeefar M
      • Majid P
      • Mohammadzadeh M.
      Psychosocial care experiences of patients with COVID-19 at home in Iran: a qualitative study.
      • Norouzadeh R
      • Abbasinia M
      • Tayebi Z
      • et al.
      Experiences of patients With COVID-19 admitted to the intensive care units: a qualitative study.
      • Yu Feng DHLS
      Qualitative study on factors contributing anxiety and depression in COVID-19 patients.
      • Son HM
      • Choi WH
      • Hwang YH
      • HR Yang
      The lived experiences of COVID-19 patients in South Korea: a qualitative study.
      However, precautions to prevent viral transmission make it difficult for patients to interact and communicate with others. Some patients reported being unable to communicate with healthcare providers because of language barriers (eg, limited English proficiency, poor ability to communication in local languages), and their needs were not accurately communicated to healthcare providers.
      • Shaban RZ
      • Nahidi S
      • Sotomayor-Castillo C
      • et al.
      SARS-CoV-2 infection and COVID-19: the lived experience and perceptions of patients in isolation and care in an Australian healthcare setting.
      ,
      • Yu Feng DHLS
      Qualitative study on factors contributing anxiety and depression in COVID-19 patients.
      Isolating patients can only relieve their distress through phone screens and videos calls their families.

      Heavy financial burden

      Seven studies reported on the stress that financial burdens placed on patients.
      • Cervantes L
      • Martin M
      • Frank MG
      • et al.
      Experiences of latinx individuals hospitalized for COVID-19: A qualitative study.
      ,
      • Aliyu S
      • Travers JL
      • Norful AA
      • Clarke M
      • Schroeder K.
      The lived experience of being diagnosed with COVID-19 among black patients: a qualitative study.
      ,
      • Jamili S
      • Ebrahimipour H
      • Adel A
      • et al.
      Experience of patients hospitalized with COVID-19: A qualitative study of a pandemic disease in Iran.
      ,
      • Fang Li LL
      A qualitative study of psychological experiences during illness in patients with COVID-19.
      ,
      • Wu C
      • Cheng J
      • Zou J
      • Duan L
      • Campbell JE.
      Health-related quality of life of hospitalized COVID-19 survivors: An initial exploration in Nanning city.
      ,
      • Akbarbegloo M
      • Sanaeefar M
      • Majid P
      • Mohammadzadeh M.
      Psychosocial care experiences of patients with COVID-19 at home in Iran: a qualitative study.
      ,
      • Son HM
      • Choi WH
      • Hwang YH
      • HR Yang
      The lived experiences of COVID-19 patients in South Korea: a qualitative study.
      In particular, the sudden change of circumstances disrupted the financial plans of married people staying at home due to their illness. Many young and middle-aged patients stated that it was difficult to meet their regular financial commitments. Hospitalization disrupted the family's primary financial source in some cases, leading to the inability to repay loans and the need for home care even after discharge from the hospital, all of which put families under tremendous financial pressure.
      • Aliyu S
      • Travers JL
      • Norful AA
      • Clarke M
      • Schroeder K.
      The lived experience of being diagnosed with COVID-19 among black patients: a qualitative study.
      ,
      • Fang Li LL
      A qualitative study of psychological experiences during illness in patients with COVID-19.
      ,
      • Akbarbegloo M
      • Sanaeefar M
      • Majid P
      • Mohammadzadeh M.
      Psychosocial care experiences of patients with COVID-19 at home in Iran: a qualitative study.
      Moreover, the uncertainty associated with the disease meant that some patients were unable to return to work in a timely manner, and some feared being fired by their bosses or replaced by others. For various reasons, it can be difficult for recovered patients to find jobs again even after they are discharged from the hospital.
      • Cervantes L
      • Martin M
      • Frank MG
      • et al.
      Experiences of latinx individuals hospitalized for COVID-19: A qualitative study.
      ,
      • Jamili S
      • Ebrahimipour H
      • Adel A
      • et al.
      Experience of patients hospitalized with COVID-19: A qualitative study of a pandemic disease in Iran.
      ,
      • Wu C
      • Cheng J
      • Zou J
      • Duan L
      • Campbell JE.
      Health-related quality of life of hospitalized COVID-19 survivors: An initial exploration in Nanning city.
      ,
      • Son HM
      • Choi WH
      • Hwang YH
      • HR Yang
      The lived experiences of COVID-19 patients in South Korea: a qualitative study.

      Desire for continuous medical support

      In the early stages of the pandemic, overcrowded hospitals and a large number of new patients prevented timely treatment. As they moved from hospital to hospital, patients became tired, experienced feelings of helplessness, and even became distrustful of hospitals and the government.
      • Aliyu S
      • Travers JL
      • Norful AA
      • Clarke M
      • Schroeder K.
      The lived experience of being diagnosed with COVID-19 among black patients: a qualitative study.
      ,
      • JingYuan Wang LWGW
      A qualitative study of the experience of illness in 15 patients with COVID-19.
      ,
      • Norouzadeh R
      • Abbasinia M
      • Tayebi Z
      • et al.
      Experiences of patients With COVID-19 admitted to the intensive care units: a qualitative study.
      ,
      • Mukhtar NB
      • Abdullahi A
      • Abba MA
      • Mohammed J.
      Views and experiences of discharged COVID-19 patients in Kano, Nigeria: a qualitative study.
      Recovered patients returning to their families after discharge are not trained by medial staff. Hospitals may fail to provide continuous medical care, such that the families do not knowing anything about the physical and psychological problems of recovered patients; this causing considerable stress and tension within families.
      • Cervantes L
      • Martin M
      • Frank MG
      • et al.
      Experiences of latinx individuals hospitalized for COVID-19: A qualitative study.
      ,
      • Akbarbegloo M
      • Sanaeefar M
      • Majid P
      • Mohammadzadeh M.
      Psychosocial care experiences of patients with COVID-19 at home in Iran: a qualitative study.

      Expectation of support from family, society, and the state

      The power of individuals to overcome the disease or combat rumors is weak, and patients desire support from the family, society, and government.
      • Cervantes L
      • Martin M
      • Frank MG
      • et al.
      Experiences of latinx individuals hospitalized for COVID-19: A qualitative study.
      ,
      • Kong Shunzhen YHQL.
      Qualitative study on the experience of severe patients with COVID-19.
      The government may implore the public to change their perceptions of COVID-19 survivors, help survivors resume work and productive activities, improve the tenuous economic status of patients, and enact relevant laws and regulations to protect the privacy and rights of patients and the interests of their families.

      Theme 4: Coping strategies

      Active personal response

      After a bout of depression, patients tend to adjust their mindset to face treatment in a positive manner and comply with the requirements of healthcare provider. Six studies reported that patients improved their self-confidence by constantly encouraging themselves to overcome the disease through enhanced resilience.
      • Shaban RZ
      • Nahidi S
      • Sotomayor-Castillo C
      • et al.
      SARS-CoV-2 infection and COVID-19: the lived experience and perceptions of patients in isolation and care in an Australian healthcare setting.
      ,
      • Sun N
      • Wei L
      • Wang H
      • et al.
      Qualitative study of the psychological experience of COVID-19 patients during hospitalization.
      ,
      • JingYuan Wang LWGW
      A qualitative study of the experience of illness in 15 patients with COVID-19.
      ,
      • Sahoo S
      • Mehra A
      • Suri V
      • et al.
      Lived experiences of the corona survivors (patients admitted in COVID wards): A narrative real-life documented summaries of internalized guilt, shame, stigma, anger.
      ,
      • Akbarbegloo M
      • Sanaeefar M
      • Majid P
      • Mohammadzadeh M.
      Psychosocial care experiences of patients with COVID-19 at home in Iran: a qualitative study.
      ,
      • Son HM
      • Choi WH
      • Hwang YH
      • HR Yang
      The lived experiences of COVID-19 patients in South Korea: a qualitative study.
      Most patients reduced their anxiety via cognitive adjustment and distraction. During isolation, many patients distracted themselves from their monotonous surroundings by reading, listening to music, and participating in religious activities.

      Support from family and friends

      During isolation, 11 studies reported that patients mentioned family support as the best source of motivation to overcome the disease.
      • Shaban RZ
      • Nahidi S
      • Sotomayor-Castillo C
      • et al.
      SARS-CoV-2 infection and COVID-19: the lived experience and perceptions of patients in isolation and care in an Australian healthcare setting.
      ,
      • Sun N
      • Wei L
      • Wang H
      • et al.
      Qualitative study of the psychological experience of COVID-19 patients during hospitalization.
      ,
      • Missel M
      • Bernild C
      • Christensen SW
      • Dagyaran I
      • Berg SK.
      It's not just a virus! lived experiences of people diagnosed with COVID-19 infection in Denmark.
      • Jamili S
      • Ebrahimipour H
      • Adel A
      • et al.
      Experience of patients hospitalized with COVID-19: A qualitative study of a pandemic disease in Iran.
      • Jesmi AA
      • Mohammadzade-Tabrizi Z
      • Rad M
      • Hosseinzadeh-Younesi E
      • Pourhabib A
      Lived experiences of patients with COVID-19 infection: a phenomenology study.
      • JingYuan Wang LWGW
      A qualitative study of the experience of illness in 15 patients with COVID-19.
      ,
      • Wu C
      • Cheng J
      • Zou J
      • Duan L
      • Campbell JE.
      Health-related quality of life of hospitalized COVID-19 survivors: An initial exploration in Nanning city.
      ,
      • Akbarbegloo M
      • Sanaeefar M
      • Majid P
      • Mohammadzadeh M.
      Psychosocial care experiences of patients with COVID-19 at home in Iran: a qualitative study.
      ,
      • Son HM
      • Choi WH
      • Hwang YH
      • HR Yang
      The lived experiences of COVID-19 patients in South Korea: a qualitative study.
      • Mukhtar NB
      • Abdullahi A
      • Abba MA
      • Mohammed J.
      Views and experiences of discharged COVID-19 patients in Kano, Nigeria: a qualitative study.
      • Berends K
      • Claus L
      • De Waele E
      • Crunelle CL
      • Matthys F
      • Vanderbruggen N
      [Experiences of COVID-ICU-survivors: mixed-methods study of psychological consequences by written survey].
      Patients experienced love from, and recognized the value of their families. Three studies reported the importance of the comfort and support from friends during treatment, who helped patients through difficult times by providing money and food.
      • Shaban RZ
      • Nahidi S
      • Sotomayor-Castillo C
      • et al.
      SARS-CoV-2 infection and COVID-19: the lived experience and perceptions of patients in isolation and care in an Australian healthcare setting.
      ,
      • Son HM
      • Choi WH
      • Hwang YH
      • HR Yang
      The lived experiences of COVID-19 patients in South Korea: a qualitative study.
      ,
      • Mukhtar NB
      • Abdullahi A
      • Abba MA
      • Mohammed J.
      Views and experiences of discharged COVID-19 patients in Kano, Nigeria: a qualitative study.
      A special kind of friendship is also established among friends who have overcome the virus together. In such a shared environment, patients develop empathy for each other, and build deep friendships by sharing information, and listening to and encouraging each other.

      Reassurance from medical staff

      Doctors and nurses had the most contact with patients during isolation, and provided a sense of security during hospitalization. Patients in 7 studies reported that the healthcare providers not only saved their lives but also boosted their morale and helped to manage negative emotions.
      • Cervantes L
      • Martin M
      • Frank MG
      • et al.
      Experiences of latinx individuals hospitalized for COVID-19: A qualitative study.
      ,
      • Kürtüncü M
      • Kurt A
      • Arslan N.
      The experiences of COVID-19 patients in intensive care units: a qualitative study.
      • Sun N
      • Wei L
      • Wang H
      • et al.
      Qualitative study of the psychological experience of COVID-19 patients during hospitalization.
      • Aliyu S
      • Travers JL
      • Norful AA
      • Clarke M
      • Schroeder K.
      The lived experience of being diagnosed with COVID-19 among black patients: a qualitative study.
      ,
      • Jamili S
      • Ebrahimipour H
      • Adel A
      • et al.
      Experience of patients hospitalized with COVID-19: A qualitative study of a pandemic disease in Iran.
      ,
      • Mukhtar NB
      • Abdullahi A
      • Abba MA
      • Mohammed J.
      Views and experiences of discharged COVID-19 patients in Kano, Nigeria: a qualitative study.
      ,
      • Sun W
      • Zhou Y
      • Chen WT
      • et al.
      Disclosure experience among COVID-19-confirmed patients in China: A qualitative study.
      Equal respect and love were felt by everyone; discrimination against patients who had the virus was not experienced. According to 1 study, the medical team also gave small gifts and sang songs for patients who had birthdays during hospitalization, and this humanistic care brought patients psychological comfort.
      • Sun W
      • Zhou Y
      • Chen WT
      • et al.
      Disclosure experience among COVID-19-confirmed patients in China: A qualitative study.

      Spiritual beliefs provide comfort

      Although countries vary in terms of culture and ethnicity, spiritual beliefs have helped patients in many nations deal with the difficulties caused by the pandemic. Some patients believe in and rely on God, and that faith will help them through difficult times. During illness, some religious people try to find spiritual comfort. Charitable acts and oaths can bring inner peace and strengthen their faith. Such people believe in divine destiny and are satisfied with the future planned for them by God. Many participants reported that their relationship with God improved after experiencing difficult and exhausting situations associated with the pandemic.
      • Shaban RZ
      • Nahidi S
      • Sotomayor-Castillo C
      • et al.
      SARS-CoV-2 infection and COVID-19: the lived experience and perceptions of patients in isolation and care in an Australian healthcare setting.
      ,
      • Cervantes L
      • Martin M
      • Frank MG
      • et al.
      Experiences of latinx individuals hospitalized for COVID-19: A qualitative study.
      ,
      • Aliyu S
      • Travers JL
      • Norful AA
      • Clarke M
      • Schroeder K.
      The lived experience of being diagnosed with COVID-19 among black patients: a qualitative study.
      ,
      • Jesmi AA
      • Mohammadzade-Tabrizi Z
      • Rad M
      • Hosseinzadeh-Younesi E
      • Pourhabib A
      Lived experiences of patients with COVID-19 infection: a phenomenology study.
      ,
      • Sahoo S
      • Mehra A
      • Suri V
      • et al.
      Lived experiences of the corona survivors (patients admitted in COVID wards): A narrative real-life documented summaries of internalized guilt, shame, stigma, anger.
      ,
      • Akbarbegloo M
      • Sanaeefar M
      • Majid P
      • Mohammadzadeh M.
      Psychosocial care experiences of patients with COVID-19 at home in Iran: a qualitative study.

      Theme 5: Post-traumatic growth

      Rethinking the meaning of life

      Patients in 8 studies viewed their illness as a significant turning point in their lives.
      • Kürtüncü M
      • Kurt A
      • Arslan N.
      The experiences of COVID-19 patients in intensive care units: a qualitative study.
      ,
      • Sun N
      • Wei L
      • Wang H
      • et al.
      Qualitative study of the psychological experience of COVID-19 patients during hospitalization.
      ,
      • JingYuan Wang LWGW
      A qualitative study of the experience of illness in 15 patients with COVID-19.
      • Fang Li LL
      A qualitative study of psychological experiences during illness in patients with COVID-19.
      • Kong Shunzhen YHQL.
      Qualitative study on the experience of severe patients with COVID-19.
      ,
      • Wu C
      • Cheng J
      • Zou J
      • Duan L
      • Campbell JE.
      Health-related quality of life of hospitalized COVID-19 survivors: An initial exploration in Nanning city.
      ,
      • Norouzadeh R
      • Abbasinia M
      • Tayebi Z
      • et al.
      Experiences of patients With COVID-19 admitted to the intensive care units: a qualitative study.
      ,
      • Berends K
      • Claus L
      • De Waele E
      • Crunelle CL
      • Matthys F
      • Vanderbruggen N
      [Experiences of COVID-ICU-survivors: mixed-methods study of psychological consequences by written survey].
      Some participants reported experiencing a physical and spiritual cleansing, and feelings of rejuvenation. The pandemic slowed down their fast-paced lives, and patients had time to reflect on and re-prioritize their lives. Some patients states that they would be more respectful of life and appreciate how hard health is to come by. They also said that they intended to cherish every day, spend more time with their families, exercise more, and approach life with an optimistic attitude.
      • Sun N
      • Wei L
      • Wang H
      • et al.
      Qualitative study of the psychological experience of COVID-19 patients during hospitalization.

      Enhancement of health literacy

      Cured patients in 3 studies stated that COVID-19 improved their health literacy.
      • Shaban RZ
      • Nahidi S
      • Sotomayor-Castillo C
      • et al.
      SARS-CoV-2 infection and COVID-19: the lived experience and perceptions of patients in isolation and care in an Australian healthcare setting.
      ,
      • Kürtüncü M
      • Kurt A
      • Arslan N.
      The experiences of COVID-19 patients in intensive care units: a qualitative study.
      ,
      • Norouzadeh R
      • Abbasinia M
      • Tayebi Z
      • et al.
      Experiences of patients With COVID-19 admitted to the intensive care units: a qualitative study.
      These patients reflected on their previously unhealthy lifestyles and reported that they would improve their personal hygiene and pay more attention to diet, nutrition, and protection measured; they intended to wash their hands more frequently, wear masks, and maintain social distancing. However, some patients reported extreme, compulsive behaviors such as washing their hands all the time and completely shutting themselves off from others.

      Increased stress resistance

      The pandemic has caused not only negative emotions and effects, but also many positive ones, such as courage, personal growth, and increased mental toughness. In particular, some survivors of COVID-19 thanked the virus for giving them the courage to face life,
      • Kong Shunzhen YHQL.
      Qualitative study on the experience of severe patients with COVID-19.
      ,
      • Norouzadeh R
      • Abbasinia M
      • Tayebi Z
      • et al.
      Experiences of patients With COVID-19 admitted to the intensive care units: a qualitative study.
      and other described the experience as “touching the devil's nose and coming back.”
      • Sun N
      • Wei L
      • Wang H
      • et al.
      Qualitative study of the psychological experience of COVID-19 patients during hospitalization.
      Some of those who recovered from the disease stated that they are not afraid to face difficulties in the future.

      Gratitude to the country and healthcare providers

      Medical staff had to wear heavy protective clothing, risked infection, and worked tirelessly to provide medical support to patients, resulting in a significant change in patients’ attitudes toward medical staff and increased awareness of their importance for disease recovery. During the pandemic, the citizens of many countries experienced a sense of social responsibility, solidarity and warmth toward society.
      • Kürtüncü M
      • Kurt A
      • Arslan N.
      The experiences of COVID-19 patients in intensive care units: a qualitative study.
      • Sun N
      • Wei L
      • Wang H
      • et al.
      Qualitative study of the psychological experience of COVID-19 patients during hospitalization.
      • Aliyu S
      • Travers JL
      • Norful AA
      • Clarke M
      • Schroeder K.
      The lived experience of being diagnosed with COVID-19 among black patients: a qualitative study.
      ,
      • Norouzadeh R
      • Abbasinia M
      • Tayebi Z
      • et al.
      Experiences of patients With COVID-19 admitted to the intensive care units: a qualitative study.
      ,
      • Son HM
      • Choi WH
      • Hwang YH
      • HR Yang
      The lived experiences of COVID-19 patients in South Korea: a qualitative study.
      The Chinese government covered the treatment costs of diagnosed patients, deployed human and material resources at the national level, and implemented various measures to protect people's livelihoods. Patients felt the strength and vigor of their motherland, and a sense of well-being.
      • JingYuan Wang LWGW
      A qualitative study of the experience of illness in 15 patients with COVID-19.
      • Fang Li LL
      A qualitative study of psychological experiences during illness in patients with COVID-19.
      • Kong Shunzhen YHQL.
      Qualitative study on the experience of severe patients with COVID-19.
      The selflessness of many community service workers, volunteers, and police officers deeply affected some patients. Many of them also developed a sense of purpose, and hope to give back to society after discharged and recovery. One respondent stated that “Others saved me, and now I want to give back to the community.”
      • Kong Shunzhen YHQL.
      Qualitative study on the experience of severe patients with COVID-19.

      Discussion

      This meta-synthesis included 23 qualitative studies pertaining to the inner world of confirmed COVID-19 patients. These studies covered more than 10 countries, including China, the USA, and Iran, allowing comprehensive analysis and interpretation of the experience, inner feelings and, psychological needs of infected persons. Five themes emerged: the complex psychological journey of patients with COVID-19, the physical impact of the disease, the expectation of multifaceted support and guidance, coping strategies, and post-traumatic growth. Our findings should help the public and healthcare professionals gain insight into the inner world of patients and could inform tailored care.
      COVID-19 is a novel disease, such that patients have gone through the process of diagnosis, treatment, and recovery with limited information about their condition. Their healthcare experiences and the psychological journeys have been complex and dynamic; most interviewees experienced unpleasant physical, psychological, and social effect of their illness, and many developed post-traumatic stress reactions. Infected patients feel threatened by the unpredictability of the disease and may have a constant fear of death, as an instinctive reaction to unknown circumstances. The Centers for Disease Control and Prevention showed that patients in the acute phase of disease fear death due to clinical deterioration. Patients who are quarantined may not be aware of the possible psychological challenges after crisis ends. A qualitative study by Brooks
      • Brooks SK
      • Webster RK
      • Smith LE
      • et al.
      The psychological impact of quarantine and how to reduce it: rapid review of the evidence.
      revealed that isolation leads to negative emotional states such as irritability, insomnia, decreased concentration, and even anxiety and depression, which may all worsen over time. Similar conclusions were reached with respect to survivors of SARS, Ebola, and H1N1.
      • Ahmed H
      • Patel K
      • Greenwood DC
      • et al.
      Long-term clinical outcomes in survivors of severe acute respiratory syndrome and Middle East respiratory syndrome coronavirus outbreaks after hospitalisation or ICU admission: A systematic review and meta-analysis.
      • Almutairi AF
      • Adlan AA
      • Balkhy HH
      • Abbas OA
      • Clark AM.
      "It feels like I'm the dirtiest person in the world.": Exploring the experiences of healthcare providers who survived MERS-CoV in Saudi Arabia.
      • Cheng SK
      • Wong CW
      • Tsang J
      • Wong KC.
      Psychological distress and negative appraisals in survivors of severe acute respiratory syndrome (SARS).
      Park found that 42.9% of survivors experienced post-traumatic stress disorder, and 27.0% reported depression 1 year after Middle East Respiratory Syndrome.
      • Park HY
      • Park WB
      • Lee SH
      • et al.
      Posttraumatic stress disorder and depression of survivors 12 months after the outbreak of Middle East respiratory syndrome in South Korea.
      If negative emotions are not alleviated promptly, patients may exhibit unpredictable behaviors, such as concealing their disease, avoiding screening, and resistance to routine vaccination. Therefore, it is necessary to provide timely psychological treatment and counseling for patients. There are differences in the emotional responses among patients with different characteristics. for example, older infected patients with chronic diseases tend to be more anxious and pessimistic about their condition, while younger people are more positive. Also, female patients are more likely to express their feelings and show anxiety, while men tend to suppress their emotions and show anger.
      • Vindegaard N
      • Benros ME.
      COVID-19 pandemic and mental health consequences: Systematic review of the current evidence.
      Therefore, psychological interventions should be individualized according to the patient's different characteristics.
      The emotional reactions of patients differ by disease stages. Therefore, stage-specific psychological interventions should be developed for patients. In the early stage, patients are guided and encouraged to use the Internet to actively communicate their inner thoughts to family, friends, and medical personnel.
      • Fan J
      • Zhou M
      • Wei L
      • Fu L
      • Zhang X
      • Shi Y.
      A qualitative study on the psychological needs of hospitalized newborns’ parents during covid-19 outbreak in China.
      In the middle stage, medical personnel impart disease knowledge to patients, and explain treatments and medications so that patients can understand their condition; they may also introduce patients to others who have been cured and discharged from hospital, to enhance patients’ confidence about overcoming the disease. Positive encouragement and guidance can promote inner resilience, which is important because the disease can put the individual under psychological pressure. Patients are subsequently informed about home care and self-examination and -testing, and are encouraged to reintegrate with society and family life.
      To alleviate negative emotions among the public and patients during the COVID-19 pandemic. China implemented a series of interventions, including the provision of mental health manuals and video education pertaining to disease prevention and control.
      • Li W
      • Yang Y
      • Liu ZH
      • et al.
      Progression of Mental Health Services during the COVID-19 Outbreak in China.
      Italy formed a multidisciplinary mental health team to provide services to inpatients and outpatients.
      • D'Agostino A
      • Demartini B
      • Cavallotti S
      • Gambini O.
      Mental health services in Italy during the COVID-19 outbreak.
      The Korean Neuropsychiatric Association issued targeted psychological guidance for various groups
      • Jung SJ
      • Jun JY.
      Mental health and psychological intervention amid COVID-19 outbreak: perspectives from South Korea.
      (eg, the general public, parents of young children, healthcare providers, etc.). Countries such as the USA
      • Goldman ML
      • Druss BG
      • Horvitz-Lennon M
      • et al.
      Mental health policy in the era of COVID-19.
      and UK
      • Holmes EA
      • O'Connor RC
      • Perry VH
      • et al.
      Multidisciplinary research priorities for the COVID-19 pandemic: a call for action for mental health science.
      have taken similar measures. Isolated patients should be provided with adequate spaces in which they can walk around freely, while isolation wards with windows allow patients to observe and maintain contact with the outside world. Finally, clocks on walls enable patients to keep track of time. Given the contagious nature of COVID-19, online therapy is recommended, via video conferencing with telephone follow-ups, to reduce the chance of viral transmission. It is recommended that hospitals establish psychological clinics so that survivors and their families can receive psychotherapy to reduce the adverse effects of the pandemic.
      Notably, the survivors mentioned social stigma many times. Social stigma has long been closely associated with disease, with some labeling the sick unfavorably, creating stereotypes, and stigmatizing and othering the sick.
      • Bhattacharya P
      • Banerjee D
      • The Rao TS.
      Untold" side of COVID-19: social stigma and its consequences in india.
      An example of this is the 18th century “Typhoid Mary” phenomenon in the UK.
      • Marineli F
      • Tsoucalas G
      • Karamanou M
      • Androutsos G.
      Mary Mallon (1869-1938) and the history of typhoid fever.
      Outbreaks of COVID-19 result in social stigmatization of the infected and discrimination by others. Social stigma spreads much faster than diseases themselves and can have long-lasting psychosocial consequences for cured patients. It is therefore vital to communicate with patients and the public about COVID-19, and to prevent the stigmatization of patients. Stigmatization is irresponsible. Everyone should be treated equally during a pandemic, and survivors should not be isolated and viewed with suspicion. Negative stereotypes and misconceptions deny patients, who have already experienced physical suffering, their human rights. Social stigma exists among people and races, as well as cities and countries (eg, the label of the “Chinese virus”).
      • Cabrini L
      • Landoni G
      • Zangrillo A.
      Minimise nosocomial spread of 2019-nCoV when treating acute respiratory failure.
      No country is innocent in an outbreak; the worldwide community should unite to overcome pandemics. In the case of COVID-19, final victory will only be achieved when the last patient with the disease is discharged from hospital.
      Some studies have reported factors promoting disease recovery, where the cultural milieu can significantly influence patient’ psychological adjustment and adaptation. Traditional Chinese culture is collectivist, emphasizing collective. After the COVID-19 outbreak, the Chinese government fought the pandemic while under tremendous pressure, isolating Wuhan and surrounding cities to contain the spread of the virus. The solidarity among family members during the crisis was profoundly inspiring for patients. Medical and nursing staff always adhere to their code of professional ethics. Their fearlessness while fighting the pandemic conveyed a strong sense of support and security to patients. Religiosity also played an essential role with belief in God, prayer, and meditation creating inner peace for patients by promoting a positive attitude.
      • Hamilton JB
      • Best NC
      • Barney TA
      • Worthy VC
      • Phillips NR.
      Using spirituality to Cope with COVID-19: the experiences of African American breast cancer survivors.
      In the current study, most survivors articulated multiple unmet needs, including a lack of employment, health literacy, and sanitation. According to the International Labor Organization report, the global unemployment rate is projected to rise from 4.936% to 5.644% pre-vs post-pandemic, equating to 24.7 million lost jobs.
      • Kawohl W
      • Nordt C.
      COVID-19, unemployment, and suicide.
      As the outbreak stabilizes, the state should actively encourage enterprises to resume work and production, and provide financial assistance to people with damaged livelihoods and economic difficulties, to foster economic development of cities and create more jobs. In addition, many patients expressed concerns about relapse after discharge, recovery of physical and mental status, and disease complications. High-risk (ie, psychologically impaired) groups should receive more psychological support. In the context of the current pandemic, survivors should be allowed to actively participate in prevention and control efforts, such as community-based disease awareness activities and anti-discrimination campaigns, and could also provide peer support for those having the same experience.
      • James PB
      • Wardle J
      • Steel A
      • Adams J.
      Post-Ebola psychosocial experiences and coping mechanisms among Ebola survivors: a systematic review.
      For patients with sequelae, healthcare providers need to provide professional guidance and education; ongoing follow-up is needed after discharge, and home planning and hands-on rehabilitation are needed for patients and caregivers.
      The initial phase of the COVID-19 outbreak exposed the inadequacy of public health event management, and individual countries should learn from their experience.
      • Liu Q
      • Luo D
      • Haase JE
      • et al.
      The experiences of health-care providers during the COVID-19 crisis in China: a qualitative study.
      A new system for epidemic prevention and control, and a new consultation process, should be implemented, along with public education pertaining to major public health emergencies. Also, healthcare departments should provide patients with relevant information on epidemic prevention and control, and address misconceptions. Governmental administrators should disseminate health and disease information through the Internet, media, and official channels. If necessary, celebrities could be employed to increase public confidence in a timely, open, and transparent manner.
      • Wang C
      • Pan R
      • Wan X
      • et al.
      A longitudinal study on the mental health of general population during the COVID-19 epidemic in China.
      Adequate medical resources, and up-to-date and accurate health information, can reduce panic among the public.
      Pandemic prevention and control measures can create medical ethical issues due to invasion of patient's privacy (eg, the disclosure of patients’ residential addresses, workplaces, and movements and disclosure of information about patients’ families). Patients may feel angry and powerless in this context, which promotes distrust of the government. Therefore, public health departments must safeguard patients’ privacy, while carrying out prevention and control work. Confidential and practical information must be disseminated rapidly and accurately.
      Countries around the world are implementing strictly measures to check for and control the spread of the virus. Overall, the COVID-19 global pandemic has been well controlled, and such that we are now in the so-called post-epidemic era that is an era in which the virus has not completely disappeared, fluctuates seasonally, and may break out on a small scale at any time. In the post-epidemic era, people are slowly adapting to the “new normal”, and how to coexist with the virus merits deeper investigation. Reconstructing the inner world of COVID-19 survivors is an important long-term goal. The improvement in the pandemic situation and optimistic data made many people less vigilant; some even expressed the opinion that “this disease is not difficult to cure and many people recover”, and “even if you get infected, it can be cured anyway.” However, everyone who has experienced infection will likely agree that it is painful, with many unknowns. Only when the pandemic is completely over will patients’ lives return to normal.
      Meta-synthesis involves reinterpretation of study findings others and has many strengths and limitations. The strict inclusion criteria of this study ensured the reliability of the included articles, and the lack of publication language restriction ensured an adequate number of papers and national data sources. However, this study did have some limitations; gray literature may have been missed, and the data were mainly from COVID-19 survivors rather than family members and healthcare providers. Also, we were concerned only with the recent psychological experience of survivors; the long-term effects of COVID-19 on patients need to be further explored in the future. Long-term follow-up studies are needed to gain a deeper understanding of how the psychological needs of survivors evolve over time.

      Conclusions

      This systematic qualitative review examined the experiences of COVID-19 infected individuals worldwide. Five themes emerged highlighting the commonalities and characteristics of patients. We conclude that all patients experience difficulty adjusting to the role change between healthy person and patient, and that the psychological distress caused by COVID-19 to survivors is widespread and persistent. Promoting the return of survivors to society and family life is important for healthcare providers. Survivors should have access to more support in the battle against COVID-19. Future long-term follow-up studies are required to gain a deeper understanding of how the psychological needs of survivors evolve over time. (Appendix S1, Appendix S2, Appendix S3)
      Appendix S1Article retrieval strategy
      #1 “COVID-19” [MeSH Terms]
      #2 Coronavirus [Title/Abstract] OR COVID-19[Title/Abstract] OR 2019-ncov [Title/Abstract] OR SARS-cov-2[Title/Abstract]
      #3 #1 OR #2
      #4 “qualitative” [MeSH Terms]
      #5 qualitative*[Title/Abstract] OR phenomenology [Title/Abstract] OR grounded theory [Title/Abstract]
      #6 #4 OR #5
      #7 “Patient” [MeSH Terms]
      #8 Patient*[Title/Abstract] OR Client*[Title/Abstract] OR survivor*[Title/Abstract] OR Infected person [Title/Abstract]
      #9 #7 OR #8
      #10 #3 AND #6 AND #9
      Appendix S2Literature quality evaluation
      StudyQ1Q2Q3Q4Q5Q6Q7Q8Q9Q10Grade
      1Shaban, R. Z. et al.YYYYYNNYYYA
      2Guo, Q. et al.UYYUYNNYYYB
      3Sun, W. et al.UYYYYNNYYYB
      4Jing Yuan Wang et al.UYYYYNNYYYB
      5Fang Li, Li et al.UYYYYNNYYYB
      6Kong Shuzhen et al.UYYYYNNYYYB
      7Yu Feng et al.UYYYYNNYYYB
      8Moradi, Y. et al.UYYYYNNYYYB
      9Jesmi, A. A. et al.UYYYYNNYYYB
      10Sahoo, S. et al.UYYYYNNYUYB
      11Mukhtar, N. B. et al.UYYYYNNYYYB
      12Berends, K. et al.UYYYYNNYYYB
      13Sun, N. et al.UYYYYNNYYYB
      14Wu, C. et al.UYYYYNNYYYB
      15Missel, M. et al.YYYYYNNYYYA
      16Akbarbegloo, M. et al.UYYYYNNYYYB
      17Norouzadeh, R. et al.UYYYYNNYYYB
      18Jamili, S. et al.UYYYYNNYYYB
      19Aliyu, S. et al.UYYYYNNYYYB
      20Cervantes, L. et al.UYYYYNNYYYB
      21Santiago-Rodriguez, E. I. et al.UYYYYNNYYYB
      22Kürtüncü, M. et al.UYYYYNNYYYB
      23Son, H. M. et al.UYYYYNNYYYB
      Q1. Is there congruity between the stated philosophical perspective and the research methodology? Q2. Is there congruity between the stated philosophical perspective and the research methodology? Q3. Is there congruity between the research methodology and the methods used to collect data? Q4. Is there congruity between the research methodology and the representation and analysis of data? Q5. Is there congruity between the research methodology and the interpretation of results? Q6. Is there a statement locating the reseacher culturally or theoretically? Q7. Is the influence of the researcher on the research, and vice-versa, addressed? Q8. Are participant, and their voices, adequately represented? Q9. Is the research ethical according to current criteria or, for recent studies, and is there evidence of ethical approval by an appropriate body? Q10. Do the conclusions drawn in the research report flow from the analysis or interpretation, of the data?
      Y, Yes; N, NO; U, Unclear; Grade A: the quality standard is fully met, such that the possibility of bias is remote; Grade B: the quality standard is partially met, such that the possibility of bias is moderate.
      Appendix S3Included in the literature
      numberAuthorYearCountryMethodsSampleInteresting phenomenaLocationTheme
      1Shaban, R. Z. et al.2020AustraliaSemistructured interview by telephone11Explore the lived experience and perceptions of patients in isolation with COVID-19Hospital isolation ward5 themes: 1. Knowing about COVID-19, 2. Planning for and responding to COVID-19, 3. Being infected, 4. Life in the isolation and room, 5. Post-discharge life
      2Guo, Q. et al.2020ChinaMixed-methods5Explore the mental status of patients with COVID-19Hospital isolation ward3 themes: 1. Negative emotions, 2. Stigma, 3. Uncertainty regarding the virus
      3Sun, W. et al.2020ChinaSemistructured interview26Understand COVID patients’ experiences of and perspectives on disclosure of their illness, and explore and describe the factors affecting disclosure decisionsHospital isolation ward4 themes: 1. Person disclosed to, 2. Reasons for disclosure, 3. Reasons for nondisclosure, 4. Impact of disclosure
      4Jing Yuan Wang et al.2020ChinaSemistructured interview15Explore the experiences and feelings of patients with novel coronavirus pneumonia during the disease processHospital isolation ward3 themes: 1. Negative psychological experience, 2. Positive psychological experience, 3. Gratitude
      5Fang Li, Li et al.2020ChinaSemistructured interview by video clip13Investigating the psychological experience of patients with COVID-19 during their illnessHospital isolation ward3 themes: 1. Presence of varying degrees of anxiety in patients with novel coronavirus, 2. Acute stress in patients with novel coronavirus, 3. Post-traumatic growth in patients with novel coronavirus
      6Kong Shuzhen et al.2020ChinaSemistructured interview11Understanding the physical and mental experiences of patients with COVID-19 who have experienced infectionHospital isolation ward3 themes: 1. Effects of illness on the body, 2. The emotional experience of illness, 3. Feelings and thoughts post illness
      7Yu Feng et al.2020ChinaSemistructured interview18Explore factors influencing anxiety and depression in patients with COVID-19Hospital isolation ward3 themes: 1. Personal factors, 2. Family factors, 3. Environmental factors
      8Moradi, Y. et al.2020IranSemistructured interview by telephone14Explore psychological disturbances in COVID-19 survivors throughout the pandemicHospital isolation ward3 themes: 1. Living in limbo, 2. Psychological distress behind the wall, 3. Psychological burden of being a carrier
      9Jesmi, A. A. et al.2020IranSemistructured interview by telephone and face to face14Describe experiences of patients with COVID-19 infectionHospital isolation ward3 themes: 1. Mental strain, 2. Physical manifestations, 3. Coping mechanisms
      10Sahoo, S. et al.2020IndiaNarrativ3Discuss the experience of 3 persons diagnosed with COVID-19 infection admitted to a COVID wardHospital isolation ward3 themes: 1. Dilemma of being a leader, 2. The troubled family, 3. The computer savvy boy
      11Mukhtar, N. B. et al.2020NigeriaSemistructured interview by telephone11Patients’ experiences and perspectives about COVID-19 and its treatment.Patient's home4 themes: 1. Community and secondary transmission,2. Beliefs and precautionary measures against COVID-19, 3. Experiences of patients during COVID-19 hospitalization, 4. Suggestions for improvement of care and post-hospitalization experience
      12Berends, K. et al.2021BelgiumSemistructured interview19Understanding the experience of patients admitted to hospital for COVID-19Hospital isolation ward4 themes: 1. Experience, 2. Coping, 3. Integrating experience into life, 4 The importance of support systems
      13Sun, N. et al.2021ChinaSemistructured interview by telephone and face to face16Explore the psychology of COVID-19 patients during hospitalizationHospital isolation ward and Patient's home5 themes: 1. Attitude towards the disease, 2. Stressors, 3. Body and mind reactions, 4. Factors promoting epidemic prevention, 5. Psychological growth and outlook
      14Wu, C. et al.2021ChinaSemistructured interview by telephone16Explore the daily life and HRQoL of hospitalized COVID-19 survivors 3 months after being dischargedPatient's home8 themes: 1. Physical symptoms, 2. Anxiety, 3. Trauma, 4. Economic losses, 5. Place-based identity, 6. Self-stigma, 7. Health self-interventions, 8. Changing lifestyle
      15Missel, M. et al.2021DenmarkSemistructured interview by telephone15Explore the lived experiences of people infected with COVID-19 in Denmark during the first phase of the pandemicHospital isolation ward and Patient's home3 themes: 1. COVID-19 as a threat to the body, 2. Interference of COVID-19 with Ordinary social relationships
      16Akbarbegloo, M. et al.2021IranSemistructured interview30Examine the psychosocial experiences of patients with COVID- 19 after passing the crisis stage.Hospital isolation ward3 themes: 1. Social rejection, 2. Lack of support, 3 Efforts to gain mental tranquility
      17Norouzadeh, R. et al.2021IranSemistructured interview by telephone and face to face16Describe the experiences of patients with COVID-19 admitted to the intensive care unitsHospital isolation ward3 themes: 1. Captured by a challenging incident with subcategories, 2. Flourishing of life, 3. Coutning one's blessings (all with subcategories)
      18Jamili, S. et al.2021IranSemistructured interview by telephone17Understand the lived experience of inpatients hospitalized with COVID- 19Hospital isolation ward4 themes: 1. Denial of the disease, 2. Negative emotions upon arrival, 3. Perception of social and psychological supports, 4. Post-discharge concerns and problems
      19Aliyu, S. et al.2021The United StateSemistructured interview15Explore the lived experience of being diagnosed with COVID-19 of black patientsHospital isolation ward3 themes: 1. Panic due to a COVID-19 diagnosis, 2. The repercussion of the diagnosis, 3 Personal assessment of risks in one's environment
      20Cervantes, L. et al.2021The United StateSemistructured interview60Describe the experiences of Latinx individuals who were hospitalized with and survived COVID-19.Patient's home5 themes: 1. COVID-19 as a distant and secondary threat, 2. COVID-19 as a compounder of disadvantage, 3. Reluctance to seek medical care, 4. Healthcare system interactions, 5. Faith and community resiliency
      21Santiago-Rodriguez, E. I. et al.2021The United StateSemistructured interview24Characterize the variability in the COVID-19 experience and recovery processPatient's home3 themes: 1. Infection with COVID-19 was associated with psychological distress, 2. The illness experience was characterized by uncertainty in terms of managing symptoms and recovery, 3. Health information-seeking behavior facilitated by access to medical care, and uncertainty regarding the course of the illness and recovery
      22Kürtüncü, M. et al.2021TurkeySemistructured interview by telephone18To explore the lived experience of being diagnosed with COVID-19 as a black patientHospital isolation ward3 themes: 1. Panic due to COVID-19 diagnosis, 2. The repercussions of the diagnosis, 3. Personal assessment of risks in one's environment
      23Son, H. M. et al.2021South KoreaSemistructured interview16Provide an in-depth understanding and description of the disease experiences of COVID-19 patientsHospital isolation ward6 themes: 1. Desperate and uncertain times during COVID-19 diagnosis and treatment, 2. Shock and complaints related to the disinfection process, 3 Social stigma: my “scarlet letter”, 4. Mind and body deprived by COVID-19, 5. Rediscovering relationships through hardship

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