The Characteristics of Behavioral and Mental Disorders in Patients after COVID-19 Infection and Results of Hyperbaric Oxygen Therapy in Vietnam

Abstract Introduction: Post-COVID-19 condition commonly presents with persistent neuropsychiatric manifestations, including anxiety, depression, stress, and reduced quality of life. Hyperbaric oxygen therapy (HBOT) has been proposed as a non-pharmacological intervention that may enhance cerebral oxygenation and antioxidant function. This study aimed to characterize the clinical and subclinical features of patients with behavioral and mental disorders after COVID-19 infection and to evaluate treatment outcomes following HBOT. Materials and Methods: A descriptive case-series study was conducted on 51 patients aged ≥18 years who developed behavioral or mental symptoms within 3 months after confirmed recovery from COVID-19. Neuropsychiatric status was assessed using the Depression Anxiety Stress Scale-21 (DASS-21), and health-related quality of life (HRQoL) was measured using the EQ-5D-5L instrument. Cerebral blood flow (CBF) was evaluated using rheoencephalography, and superoxide dismutase (SOD) activity was quantified via ELISA. All participants completed 14 consecutive HBOT sessions according to the VINIMAM-1 protocol (2.2 ATA, 95 minutes per session). Clinical and paraclinical parameters were recorded at baseline and post-treatment. Results: Prior to HBOT, mild to moderate anxiety, depression, and stress were reported in 46.7%, 23.3%, and 30% of patients. Reduced CBF was observed in 62.7%, and mean SOD activity was 51.87% ± 8.69%. After HBOT, DASS-21 scores decreased significantly for anxiety (10.08 ± 2.34 to 7.13 ± 2.56), depression (11.73 ± 1.68 to 8.82 ± 2.71), and stress (18.31 ± 3.67 to 13.31 ± 3.81) (all P < 0.05). HRQoL improved markedly, with EQ-5D-5L scores increasing from 0.749 ± 0.155 to 0.942 ± 0.098 ( P < 0.001). Normal CBF increased from 37.3% to 78.4%, and mean SOD activity rose to 73.23 ± 8.48 ( P < 0.05). Conclusion: HBOT significantly alleviated neuropsychiatric symptoms and improved cerebral perfusion, antioxidant capacity, and quality of life, supporting its potential as a therapeutic option for post-COVID-19 behavioral and mental disorders.