We conducted a survey in a tertiary care hospital in Karachi, Pakistan, using the PHQ-9 GAD-7 questionnaire to evaluate dengue patients for anxiety and depression following their signs and symptoms, amid the dengue epidemic in Pakistan in late 2019. Dengue fever is the most frequently spreading mosquito borne disease and is a considerable health problem in tropical and subtropical areas around the globe.1 Dengue fever is caused by the dengue virus, that is an enveloped single stranded RNA virus belonging to the genus Flavivirus and family Flaviviridae. Transmission of dengue virus to a human takes place via bite of infected female mosquito of the genus Aedes, mostly Aedes aegypti (Ae. aegypti) and rarely Aedes albopictus. The Ae. aegypti mosquito particularly bites during the day, and is found in tropical and subtropical areas and is known to breed in collected stagnant water.2 The incubation period of the dengue fever is 3 to 14 days (4 to 7 days on average). Dengue fever can result on infection with any of the four serotypes of dengue virus (DENV 1–4) that can go on to produce an array of symptoms, ranging from asymptomatic infection to a severe life-threatening illness. Symptomatic dengue illness is typically classified into dengue fever (DF), which is a self-limiting febrile illness, or a more severe form, dengue hemorrhagic fever (DHF)/dengue shock syndrome (DSS).3 The deteriorating physical health of the patients puts a strain on their psychological health as well. This could potentially lead to psychiatric manifestations during the course of the illness and cause dengue patients to be at a significant risk of experiencing multiple psychological manifestations such as depression, anxiety, and distress, that too at twice the rate of the general population.4,5 Similar findings have been reported from a study conducted in Pakistan, that suggests a significant prevalence of anxiety and depressive symptoms in patients with dengue fever.6 A study by Anurag et al reported, multiple dengue patients showing significant psychiatric morbidity. Fear of death was the most prominent symptom encountered in the acute phase of the disease followed by anxiety. Even after recovering from dengue, the element of death phobia remained, while the remaining psychiatric symptoms started to fade away.7 The Patient Health Questionannire-9 scale8 (PHQ-9) and the Generalized Anxiety Disorder-7 scale9 (GAD-7) closely follow the DSM-IV diagnostic criteria for depression and generalized anxiety disorder, respectively. Additionally, GAD-7 demonstrates sensitivity to the presence of social phobia, panic disorder and post-traumatic stress disorder (PTSD) 9. The PHQ-9 and GAD-7 have strong internal and test-retest reliability as well as construct and factor-structure validity.10 Conclusion Our survey reports the delayed psychological morbidity outcomes for 43 patients diagnosed with dengue fever, with respect to their PHQ-9 GAD-7 Scores. This may warrant the healthcare professionals to incorporate mental health assessment and counselling for dengue patients alongside the symptomatic treatment to help improve the disease prognosis.

{"references": ["WHO. Dengue guidelines for diagnosis, treatment, prevention, and control. New edition. Geneva: WTO; 2009.", "Sherin A. Dengue fever: A major public health concern in Pakistan. KMUJ 2011:3(1): 1-3.", "Guzm\u00e1n MG, Kouri GP, Bravo J, Soler M, Vazquez S, Morier L. Dengue hemorrhagic fever in Cuba, 1981: a retrospective seroepidemiologic study. Am J Trop Med Hyg. 1990;42(2):179\u2013184. doi: 10.4269/ajtmh.1990.42.179.", "Mushtaq M, Zahir M. Depression, anxiety, stress, and their effect upon the self-efficacy in dengue patients. J Postgrad Med Inst (Peshawar-Pakistan) 2016;30(1):62\u201365.", "Jhanjee A, Bhatia MS, Srivastava S, Rathi A. A study of psychiatric symptomatalogy in dengue patients. Delhi Psychiatry J. 2013;16(1):21\u201323.", "Hashmi AM, Butt Z, Idrees Z, Niazi M, Yousaf Z, Haider SF, Bhatti MR. Anxiety, and depression symptoms in patients with dengue fever and their correlation with symptom severity. Int J Psychiatry Med. 2012;44(3):199\u2013210. doi: 10.2190/PM.44.3. b.", "Anurag Jhanjee, MS Bhatia, Shruti Shrivastava et al. A Study of Psychiatric Symptomatology in Dengue Patients. Delhi Pyschiatry Journal. 2013;16(01).", "K. Kroenke, R.L. Spitzer, J.B. Williams The PHQ-9: validity of a brief depression severity measure J Gen Intern Med, 16 (2001), pp. 606-613", "Kroenke K, Spitzer RL, Williams JB, Lowe B. The Patient Health Questionnaire Somatic, Anxiety, and Depressive Symptom Scales: a systematic review. Gen Hosp Psychiatry. 2010;32(4):345\u201359.R.L. Spitzer, K. Kroenke, J.B. Williams, B. Lowe A brief measure for assessing generalized anxiety disorder: the GAD-7 Arch Intern Med, 166 (2006), pp. 1092-1097"]}

Corrospondance may please be directed to Mr Uzzam Ahmed Khawaja, Student 4th year MBBS, Jinnah Medical and Dental College, Sindh, Karachi.