COVID-19 raises risk of mental health problems in year after infection
A large study has found high rates of mental health problems in COVID-19 patients up to a year after their acute infection. Looking at health records from millions of Americans the research found mild or severe COVID-19 increased a person's risk of developing anxiety, depression, substance use disorders, cognitive decline, and sleep disorders.
“We know from previous studies and personal experiences that the immense challenges of the past two years of the pandemic have had a profound effect on our collective mental health,” said senior author Ziyad Al-Aly, from Washington University. “But while we’ve all suffered during the pandemic, people who have had COVID-19 fare far worse mentally. We need to acknowledge this reality and address these conditions now before they balloon into a much larger mental health crisis.”
The new study follows on from a similar analysis conducted by Al-Aly and colleagues published recently that looked at the relationship between COVID-19 and cardiovascular complications. That prior study, published in Nature Medicine, found COVID-19 survivors were 55 percent more likely to experience a serious cardiovascular event in the year after recovering.
The current research focused on medical records gathered from the U.S. Department of Veterans Affairs. Around 150,000 subjects with COVID-19 diagnosed between March 2020 and January 2021 were compared against two control groups, each composed of more than five million people. One control looked at people who did not catch COVID-19 in the same time frame, and the other control looked at patients spanning an 18-month period before the pandemic began.
The researchers incorporated a variety of conditions under the general umbrella of mental health disorders. These included clinically diagnosed depression, anxiety or stress disorders, sleep problems, and neurocognitive declines including dementia, fatigue and brain fog, as well as newly diagnosed substance use disorders such as opioid addiction.
Overall, the researchers found more than 18 percent of COVID patients developed one or more mental health problems in the year after recovering from an acute infection. This compared to around 12 percent of people developing similar problems in the control groups. This means those with COVID are over 50 percent more likely to experience mental health problems compared to those without COVID.
“To put this in perspective, COVID-19 infections likely have contributed to more than 14.8 million new cases of mental health disorders worldwide and 2.8 million in the U.S.,” said Al-Aly. “Our calculations do not account for the untold number of people, likely in the millions, who suffer in silence due to mental health stigma or a lack of resources or support.”
More specifically, the study found, compared to those without a history of COVID, recovered patients were 40 percent more likely to develop depression, 35 percent more likely to develop anxiety, and 41 percent more likely to experience sleep disorders. Opioid use disorders were 34 percent more likely in COVID patients and they were 55 percent more likely to be prescribed antidepressants at some point in the year following infection.
Additionally, COVID patients were 80 percent more likely to experience some kind of neurocognitive problem in the year following their acute infection. This includes more serious cases of dementia progression and more milder instances of things like fatigue, confusion and brain fog.
The more severe the initial case, the higher the likelihood of subsequent mental health problems. However, Al-Aly stressed the association was still consistently detected in mild and even asymptomatic cases.
“People who were hospitalized had it worse, but the risk in non-hospitalized [patients] is significant and absolutely not trivial – and that represents the majority of people in the US and the world,” Al-Aly said recently to The Guardian.
Julia Faulconbridge, from the British Psychological Society, says the new findings are certainly interesting but unpacking exactly what could be causing this uptick in mental health problems will be challenging. Al-Aly and his team hypothesize a number of viral-induced physiological mechanisms that plausibly could be playing a role, “including peripheral T cell infiltration of brain parenchyma, dysregulated microglia and astrocytes, and disturbances in synaptic signaling of upper layer excitatory neurons.”
But Al-Aly and colleagues do recognize a number of non-physiological mechanisms could also be influencing the development of mental health problems, from social stresses to changes in diet or physical activity. Faulconbridge also noted that those living in poverty or with insecure work are more predisposed to mental health problems and known to be at higher risk of catching COVID, so it will take a lot more work to better understand exactly what is contributing to these problems arising.
“There is no data on the impact that having COVID has had on their lives, for example their ability to work, and the subsequent impact on their mental health,” said Faulconbridge. “This is particularly important given that estimates of the incidence of long COVID are in the area of 10 percent of infections. There will be people who were coping with problems before the illness, who may have been tipped over the edge by the impact of the illness.”
Regardless of the specific cause of these newly developed mental health problems, Al-Aly says it is clear society will have to deal with this emerging problem over the coming months and years. And, he says that means more work by governments and health services to diagnose and treat those experiencing these issues.
“What I’m absolutely certain about is that urgent attention is needed to identify and treat COVID-19 survivors with mental health disorders,” said Al-Aly. “There needs to be greater recognition of these issues by governments, public and private health insurance providers, and health systems to ensure that we offer people equitable access to resources for diagnosis and treatment.”
The new study was published in The BMJ.