Mental health disorders are more common one year after an acute infection with COVID-19 compared to those who were uninfected.

The risk of having any mental health disorders one year later is higher among patients who suffered an acute infection with COVID-19 compared to those who did not become infected with the virus. This was the conclusion of a study by researchers from the Clinical Epidemiology Center, VA Saint Louis Health Care System, Missouri, US.

Several studies have reported on the presence of mental health disorders after infection with COVID-19. For example, in one study with 236 379 patients the estimated incidence of a neurological or psychiatric diagnosis in the following 6 months was 33·62%. However, whether or not these disorders persist in the longer term is unclear but such data is of potential value and could help to guide management strategies for affected individuals where symptoms persist.

For the present study, the US team used the Veterans Affairs national healthcare databases to estimate the risks of developing a number of mental health disorders among individuals who had survived an acute infection with COVID-19 and for which the infection had been confirmed with a PCR test. For comparative purposes, the team also longitudinally examined the outcomes for patients who had no documented evidence of infection with COVID-19 and a historical group of patients from 2017 before the pandemic. The team also explored the possible effect of disease severity on the development of mental health problems by further categorising those who had tested positive, into either a hospitalised and non-hospitalised cohort. The outcomes of interest were a number of pre-defined incident mental health disorders including anxiety and depression disorders, use of antidepressants, opioid prescriptions, substance use disorders and sleep disorders.

Mental Health disorders one year on from COVID-19

A total of 153,848 individuals with a mean age of 63.1 years (89.2% male) infected with COVID-19, were compared with a contemporary group of 5,637, 840 individuals and who were followed-up for a median of 377 and 378 days respectively.

Compared to the contemporary group, those with COVID-19 had an increased risk of anxiety disorders (hazard ratio, HR = 1.35, 95% CI 1.30 – 1.39) and depressive disorders (HR = 1.39). This was coupled with an increased use of antidepressant drugs (HR = 1.55) and opioids (HR = 1.76).

In fact, using a composite endpoint of any incident mental health diagnosis, there was a 46% increased risk (HR = 1.46) or any incident mental health-related prescription (HR = 1.86).

When considering the setting for treatment, in comparison to the contemporary group, the risk of developing mental health disorders was higher for all of the mental health conditions examined for patients treated either in or outside of a hospital. For example, it was higher for generalised anxiety disorders (HR = 1.76 vs 2.28, non-hospital vs hospital) and use of antidepressants (HR = 2.04 VS 3.05, non-hospital vs hospital).

The authors concluded that the risks of incident mental health disorders were substantial after infection with COVID-19, irrespective of whether patients had mild or severe disease. They suggested that tackling mental health problems among COVID-19 survivors should be a priority.

Citation
Xie Y et al. Risks of mental health outcomes in people with covid-19: cohort study BMJ 2022