Tackling mental health disorders among survivors of COVID-19 should be a priority, say researchers.
A study published by The BMJ today finds that COVID-19 is associated with an increased risk of mental health disorders, including anxiety, depression, substance use, and sleep disorders, up to one year after initial infection.
The findings suggest that tackling mental health disorders among survivors of COVID-19 should be prioritised.
Some studies have suggested that people with COVID-19 might be at increased risk of anxiety and depression. Still, they included only a small selection of mental health outcomes and tracked patients over a maximum of six months.
A comprehensive assessment of the mental health manifestations in people with COVID-19 at one year has not yet been undertaken.
To address this, researchers used data from the US Department of Veterans Affairs national healthcare databases to estimate the risks of mental health outcomes in people who survived at least 30 days after a positive polymerase chain reaction (PCR) test result between March 2020 and January 2021.
They identified data for 153,848 individuals and matched them to two control groups without covid-19: 5,637,840 contemporary controls and 5,859,251 historical controls who predated the pandemic.
Participants were primarily white men with an average age of 63 years.
The COVID-19 group was further divided into those who were or were not admitted to hospital during the acute phase of infection. Information was collected on potentially influential factors, including age, race, sex, lifestyle, and medical history.
The researchers then followed all three groups for one year to estimate the risks of a set of prespecified mental health outcomes, including anxiety, depression and stress disorders, substance use disorders, neurocognitive decline, and sleep disorders.
Compared with the non-infected control group, people with COVID-19 showed a 60% higher risk of mental health diagnosis or prescription at one year (equivalent to an additional 64 per 1,000 people).
When the researchers examined mental health disorders separately, they found that COVID-19 was associated with an additional 24 per 1,000 people with sleep disorders at one year, 15 per 1,000 with depressive disorders, 11 per 1,000 with neurocognitive decline, and 4 per 1,000 with any (non-opioid) substance use disorders.
Similar results were found when the COVID-19 group was compared with the historical control group.
The risks were highest in people admitted to the hospital during the initial (acute) phase of COVID-19 but were evident even among those not admitted to the hospital.
People with COVID-19 also showed higher risks of mental health disorders than people with seasonal influenza. In contrast, those admitted to the hospital for COVID-19 showed increased risks of mental health disorders than those admitted to the hospital for any other reason.
People with COVID-19 also showed higher risks of mental health disorders than people with seasonal influenza.
This is an observational study, so it can’t establish cause, and the researchers acknowledge that some misclassification bias may have occurred. What’s more, the study included mostly older white men, so results may not apply to other groups.
Nevertheless, their findings suggest that people who survive the acute phase of COVID-19 are at increased risk of an array of incident mental health disorders and that tackling mental health disorders among survivors of COVID-19 should be a priority.
In a linked editorial, we now have a clearer picture of the mental health impacts of the COVID-19 pandemic, says Scott Weich, professor of mental health at the University of Sheffield.
Drawing on results from previous studies, he explains that for the general population, COVID and lockdown caused transient distress (related to threat) and those who contracted COVID-19 were at moderately increased risk of anxiety and depression for the first six months or so (though the risk was most significant in month 1).
“Taking stock, it could be argued that much of the research concerned with the mental health impacts of COVID-19 represents more hindsight than insight,” he adds. And he says we now need to focus on advancing our understanding of the causes of mental ill-health or undertaking research that evaluates treatments for mental disorders more generally."
“This is a well-conducted study which confirms the findings from several previous studies showing that after COVID-19 infection, patients are at an increased risk of developing mental health disorders",
says Dr Maxime Taquet, NIHR Oxford Health BRC Senior Research Fellow.
Read more about Maxime's MQ funded study into COVID induced cognitive decline here.
"While the data is limited to US Veterans, other studies representative of the larger population have found similar findings. The fact that patients appear to still be at an increased risk 12 months after their COVID-19 diagnosis is concerning. But whether this represents delayed diagnoses or new onset of mental illness remains to be determined."
Paul Harrison, Chair of the Oxford Neuroscience Committee, said "the study builds on prior work of this kind, which had shown that COVID-19 is followed by an increased risk of common mental disorders, more so in those hospitalized during the acute infection.
"The main advance of this study is that it extends the follow-up period to twelve months. The study is well conducted and analysed, and the authors acknowledge several limitations. One is that people recovering from COVID-19 might have a lower threshold for presenting for health care, or their doctors might be more likely to make a diagnosis. Nevertheless, the findings strengthen the case for adequate resourcing of mental health care in COVID-19 survivors, and for research into the causes and treatment of the disorders."
