Study suggests association between severe COVID-19 and long-term mental health outcomes 16 months after an illness
- International study examined the long-term mental health implications for patients who were bedridden for over seven days following a diagnosis of COVID-19, based on data from six countries.
- Overall, most mental health symptoms among people recovering from COVID-19 subsided within two months after diagnosis.
- But patients who were bedridden for seven days or more were more likely to experience depression and anxiety over the 16-month study period.
A new study indicates that serious COVID-19 illness is linked to an increase in the risk of long-term adverse mental health effects.
The findings suggest that, even if people were not hospitalised with COVID they were still more likely to experience depressive symptoms up to 16 months after diagnosis compared to those never infected. But the study found that these symptoms did mostly subside after two months.
However patients who were bedridden for seven days or more had higher rates of depression and anxiety, compared to people who only had mild infection, and remained at increased risk of depression and anxiety over the 16-month study period.
The pandemic upended many aspects of daily life and the toll of social distancing requirements, coupled with a general uncertainty has taken on many people’s mental health is well-documented. Many studies have only examined adverse mental health impacts for up to six months after a COVID-19 diagnosis, and much less is known about the long-term mental health impacts beyond that period, particularly for non-hospitalised patients with varying degrees of illness severity.
To capture long-term mental health impacts, the researchers looked at symptom-prevalence of depression, anxiety, COVID-19 related distress, and poor sleep quality among people with and without a diagnosis of COVID-19 from 0–16 months (mean follow-up 5.65 months). The analysis drew upon data from seven cohorts across Denmark, Estonia, Iceland, Norway, Sweden, and the UK.
Of the 247,249 people included, 9,979 (4%) were diagnosed with COVID-19 between February 2020 and August 2021. Overall, participants diagnosed with COVID-19 had a higher prevalence of depression and poorer sleep quality compared to individuals who were never diagnosed.
People diagnosed with COVID-19 but never bedridden due to their illness were less likely to experience symptoms of depression and anxiety than those not diagnosed with COVID-19. The authors state that one explanation for this is that the return to normal lives is a relief for these individuals while those still not infected are still anxious about the risk of infection and burdened by social isolation.
The analysis finds a clear reduction of some mental health symptoms such as depression and COVID-19 related distress with time. However the longer someone was bedridden with COVID the stronger the association with a higher prevalence of mental health effects. Over 16 months, patients who were bedridden for seven days or more continued to be 50-60% more likely to experience higher depression and anxiety compared to people never infected during the study period.
Study author Professor Unnur Anna Valdimarsdóttir, of the University of Iceland, says:
“Our research is among the first to explore mental health symptoms after a serious COVID-19 illness in the general population up to 16 months after diagnosis. It suggests that mental health effects aren’t equal for all COVID-19 patients and that time spent bedridden is a key factor in determining the severity of the impacts on mental health. As we enter the third year of the pandemic, increased clinical vigilance of adverse mental health among the proportion of patients with a severe acute disease of COVID-19 and follow-up studies beyond the first year after infections are critical to ensure timely access to care.”
The quicker recovery of physical COVID-19 symptoms may explain in part why mental health symptoms decline at a similar rate for those with a mild infection. However, patients with severe COVID-19 often experience inflammation which has previously been linked to chronic mental health effects, particularly depression.
Co-author Ingibjörg Magnúsdóttir, of the University of Iceland, adds: “The higher occurrence of depression and anxiety among patients with COVID-19 who spent seven days or longer bedridden could be due to a combination of worrying about long-term health effects as well as the persistence of physical long COVID symptoms well beyond the illness that limit social contact and may result in a sense of helplessness. Equally, inflammatory responses among patients with a severe diagnosis may contribute to more persistent mental health symptoms. In contrast, the fact that individuals with a mild COVID-19 infection can return to normal lives sooner and only experience a benign infection likely contributes to the lower risk of negative mental health effects we observed.”
The study echos the findings of the MQ supported PHOSP study, which found that a year after discharge from hospital the majority of COVID patients felt their health-related quality of life has significantly deteriorated due to physical and mental health problems.
The PHOSP study, run by the University of Leicester, examines the long term impact of COVID infection on patients hospitalised within the UK, and has found that five months after discharge the majority were still experiencing symptoms, or Long COVID. It is now estimated that 1.3 million people are living with Long COVID symptoms, with many people experiencing cognitive decline, or 'brain fog'. For this reason MQ is now supporting a brand new study at Oxford University which aims to identify the specific cognitive deficits underlying long-COVID induced brain fog, identify the mechanisms in the brain that cause the impairments and to develop and test interventions.
