Research reveals mental health toll for COVID survivors

The observational study, published in The Lancet Psychiatry, used electronic health records to track more than 236,000 COVID-19 patients, mostly from the US, following infection.
 
Anxiety (17%) and mood disorders (14%) were the most common issues found in the 34% of patients who developed a neurological or psychiatric condition within the six-month period.
 
Neurological diagnoses such as stroke and dementia were rarer, but not uncommon, in those who had been seriously ill during COVID-19 infection. Of those who had been admitted to intensive care, 7% had a stroke and almost 2% were diagnosed with dementia.
 
The diagnoses recorded in the research were more common in COVID-19 patients than in flu or respiratory tract infection patients over the same period, suggesting a specific impact of COVID-19.
 
Oxford University’s Professor Paul Harrison, lead author of the study, said primary and secondary healthcare systems need to be properly resourced to deal with the anticipated additional demand.
 
‘These are real-world data from a large number of patients,’ he said.
 
‘They confirm the high rates of psychiatric diagnoses after COVID-19, and show that serious disorders affecting the nervous system, such as stroke and dementia occur, too. While the latter are much rarer, they are significant, especially in those who had severe COVID-19.
 
‘Although the individual risks for most disorders are small, the effect across the whole population may be substantial for health and social care systems due to the scale of the pandemic and that many of these conditions are chronic.’
 
The research looked at 14 neurological and mental health disorders, and included patients older than 10 who became infected with SARS-CoV-2 after 20 January 2020 and were still alive on 13 December 2020.
 
This group was compared with 105,579 patients diagnosed with influenza and 236,038 diagnosed with any respiratory tract infection (including influenza).
 
Overall, the estimated incidence of being diagnosed with a neurological or mental health disorder following COVID-19 infection was 34%. For 13% of these people, it was their first recorded neurological or psychiatric diagnosis.
 
Outside of anxiety and mood disorders, substance misuse disorders (7%) and insomnia (5%) were the most common diagnoses. The incidence of neurological outcomes was lower, including 0.6% for brain haemorrhage, 2.1% for ischaemic stroke and 0.7% for dementia.
 
Risks of a neurological or psychiatric diagnosis were greatest in, but not limited to, patients who had severe COVID-19; compared to the overall 34% incidence, a neurological or psychiatric diagnosis occurred in 38% of those who had been admitted to hospital, 46% of those in intensive care, and 62% in those who had delirium (encephalopathy) during their COVID-19 infection.
 
After taking into account underlying health characteristics, such as age, sex, ethnicity, and existing health conditions, there was a 44% greater overall risk of neurological and mental health diagnoses after COVID-19 than after flu, and a 16% greater risk after COVID-19 than with respiratory tract infections.
 
Study co-author Dr Max Taquet said while the results indicate that brain diseases and psychiatric disorders are more common after COVID-19 than flu or other respiratory infections, more work is required.
 
‘We now need to see what happens beyond six months,’ he said.
 
‘The study cannot reveal the mechanisms involved, but does point to the need for urgent research to identify these, with a view to preventing or treating them.’
 
The study also had some limitations:

• Unknown completeness and accuracy of the electronic health records
• Many people with COVID-19 have mild or no symptoms and do not present for healthcare, therefore the people studied are likely to have been more severely affected than in the general population
• Severity and course of the neurological and psychiatric disorders is not known

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