Severe COVID-19 Linked To Increased Risk Of Adverse Mental Health Effects: Lancet Study

Long-term mental and physical health consequences of COVID-19 are a persistent public health concern. However, little is still known about the long-term mental health of non-hospitalised patients with COVID-19 with varying illness severities.

Now, a new study indicates that serious COVID-19 illness is linked to an increase in the risk of long-term adverse mental health effects.

A new study published in The Lancet Public Health journal suggests that non-hospitalised patients with a SARS-CoV-2 infection were likely to experience more depressive symptoms up to 16 months after diagnosis than those who were never infected. Patients who were bedridden for a week or more had higher depression rates and anxiety than those diagnosed with COVID-19 but never bedridden.

These findings call for increased vigilance of adverse mental health development among patients with the acute disease phase of COVID-19.

Anxiety And Depression Subsided Within 2 Months

Notably, the analysis finds that symptoms of anxiety and depression mostly subsided within two months for non-hospitalised patients infected with the virus. However, those bedridden for a week or more had higher chances of anxiety and depression over the 16-month study period.

The pandemic upended several aspects of daily life and the toll of social distancing requirements, coupled with a general uncertainty, that has taken on many people's mental health, is well-documented. Most studies have only examined adverse mental health effects for up to six months after a COVID diagnosis, and little is known about the long-term mental health impacts beyond that period.

To capture long-term mental health effects, the researchers looked at symptom-prevalence of anxiety, depression, COVID-19 related distress, and poor sleep quality among people with and without COVID diagnosis from 0–16 months. The analysis drew upon data from seven cohorts across Denmark, Estonia, Iceland, Norway, Sweden, and UK.

Of the 247,249 people, 9,979 (4%) were diagnosed with coronavirus infection between February 2020 and August 2021. Self-reports of confirmed positive antibody or PCR-tests for COVID-19 served as an indicator of diagnosis of the virus.

COVID Patients Have Higher Depression Rates

Overall, participants diagnosed with COVID-19 had higher rates of depression and poorer sleep quality compared to people who were never diagnosed (20.2% vs 11.3% experienced symptoms of depression; and 29.4% vs 23.8% had poor sleep quality), equivalent to an 18% and 13% rise in prevalence respectively, after adjusting for other factors but not limited to age, education, gender, body mass index, and previous psychiatric diagnosis. There were no overall differences between participants with or without COVID-19 in anxiety rates or related distress.

People having COVID-19 but never bedridden due to their sickness were less likely to experience symptoms of anxiety and depression than those not diagnosed who were never diagnosed. The authors state that one explanation for this is that returning to everyday lives is a relief for these individuals. At the same time, those still not infected are still anxious about the risk of infection and burdened by social isolation.

With time, the analysis finds an apparent reduction in mental health symptoms like depression and virus-related distress. By contrast, longer bedridden time was consistently associated with a higher prevalence of mental health impacts. During the study period, over 16 months, patients who were bedridden for a week or more continued to be 50-60% more likely to experience more depression and anxiety than people never infected.

"Our research is among the first to explore mental health symptoms after a serious COVID illness among people up to 16 months after diagnosis. It suggests that mental health impacts are not equal for all patients infected with COVID-19 and that time spent bedridden is an important factor in determining the severity of the impacts on mental health," study author Professor Unnur Anna Valdimarsdóttir, University of Iceland, said.

"As we are into the third year of the COVID-19 pandemic, higher clinical vigilance of adverse mental health among patients with a serious acute disease and follow-up studies beyond the initial year after infections are critical to ensure timely access to care," the professor said.

The quicker recovery of physical COVID-19 symptoms may partly explain why mental health symptoms decline similarly for those with a mild infection. However, patients with severe illness often experience inflammation which has previously been linked to chronic mental health effects, especially depression.

The higher occurrence of anxiety and depression among patients with COVID-19 who spent a week or longer bedridden could be because of the combination of worrying about long-term health impacts and the persistence of physical long COVID symptoms well beyond the sickness that limit social contact and may result in helplessness.

Equally, inflammatory responses among individuals with a severe diagnosis may contribute to more persistent mental health symptoms. In contrast, individuals with a mild COVID-19 infection can return to everyday lives sooner and only experience a benign condition likely contributes to the lower risk of adverse mental health impacts we observed," Ingibjörg Magnúsdóttir, Co-Author, University of Iceland said.

Limitations Of The Study

Several limitations were noted in the study. First, people diagnosed with COVID-19 were less likely to have past psychiatric disorders than people without a COVID-19 diagnosis, yet the absolute differences in the history of psychiatric disorders never exceeded four per cent in any of the cohorts and did not affect the interpretation of the findings.

Second, it reflects self-reported data of COVID diagnosis and mental health impacts – the coexistence of two or more interrelated conditions to a certain extent.

Third, most of the comparison group responded between April and June 2020, and responses from patients with COVID were accumulated between April 2020 and August 2021. This may have led to varying degrees of pandemic uncertainty that influenced the reporting of symptoms. Fourth, people diagnosed with COVID-19 were younger than those not having the disease, indicating that some older individuals with COVID might have been missed.

Furthermore, various recruitment strategies of the included cohorts impeded direct comparisons as national cohorts specifically targeted people tested for or diagnosed with COVID-19 in their recruitment, whereas others did not.

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