Nearly 1 in 5 Develop Mental Illness Following COVID-19

Megan Brooks

November 13, 2020

Editor's note: Find the latest COVID-19 news and guidance in Medscape's Coronavirus Resource Center.

One in five COVID-19 patients are diagnosed with a psychiatric disorder such as anxiety or depression within 3 months of testing positive for the virus, new research suggests.

Dr Paul Harrison

"People have been worried that COVID-19 survivors will be at greater risk of psychiatric disorders, and our findings in a large and detailed study show this to be true," principal investigator Paul Harrison, BM, DM, professor of psychiatry, University of Oxford, Oxford, United Kingdom, said in a statement.

Health services "need to be ready to provide care, especially since our results are likely to be underestimates of the actual number of cases," said Harrison.

The study also showed that having a psychiatric disorder independently increases the risk of getting COVID-19 ― a finding that's in line with research published earlier this month.

"Having a psychiatric illness should be added to the list of risk factors for COVID-19," study co-author Maxime Taquet, PhD, University of Oxford, said in the release.

The study was published online November 9 in The Lancet Psychiatry.

Double the Risk

The investigators took advantage of the TriNetX analytics network, which captured de-identified data from electronic health records of a total of 69.8 million patients from 54 healthcare organizations in the United States.

Of those patients, 62,354 adults were diagnosed with COVID-19 between January 20 and August 1, 2020.

To assess the psychiatric sequelae of COVID-19, the investigators created propensity score-matched cohorts of patients who had received a diagnosis of other conditions that represented a range of common acute presentations.

In 14 to 90 days after being diagnosed with COVID-19, 5.8% of patients received a first recorded diagnosis of psychiatric illness. Among patients with health problems other than COVID, 2.5% to 3.4% of patients received a psychiatric diagnosis, the authors report. The risk was greatest for anxiety disorders, depression, and insomnia.

Table. Disorders That Were Followed 14 – 90 Days Later by a First Psychiatric Diagnosis

COVID-19 5.8%
Influenza 2.8%
Other respiratory tract infection 3.4%
Skin infection 3.3%
Cholelithiasis 3.2%
Urolithiasis 2.5%
Fracture 2.5%

 

Older COVID-19 patients had a two- to threefold increased risk for a first dementia diagnosis, a finding that supports an earlier UK study.

Some of this excess risk could reflect misdiagnosed cases of delirium or transient cognitive impairment due to reversible cerebral events, the authors note.

The study also revealed a bidirectional relationship between mental illness and COVID-19. Individuals with a psychiatric diagnosis were about 65% more likely to be diagnosed with COVID-19 in comparison with their counterparts who did not have mental illness, independently of known physical health risk factors for COVID-19.

"We did not anticipate that psychiatric history would be an independent risk factor for COVID-19. This finding appears robust, being observed in all age strata and in both sexes, and was substantial," the authors write.

At present, "we don't understand what the explanation is for the associations between COVID and mental illness. We are looking into this in more detail to try and understand better what subgroups are particularly vulnerable in this regard," Harrison told Medscape Medical News.

"Ambitious" Research

Commenting on the findings for Medscape Medical News, Roy H. Perlis, MD, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, said this is "an ambitious effort to understand the short-term consequences of COVID in terms of brain diseases."

Perlis said he's not particularly surprised by the increase in psychiatric diagnoses among COVID-19 patients.

"After COVID infection, people are more likely to get close medical follow-up than usual. They're more likely to be accessing the healthcare system; after all, they've already had COVID, so they're probably less fearful of seeing their doctor. But, that probably also means they're more likely to get a new diagnosis of something like depression," he said.

Dementia may be the clearest illustration of this, Perlis said. "It seems less likely that dementia develops a month after COVID; more likely, something that happens during the illness leads someone to be more likely to diagnose dementia later on," he noted.

Perlis cautioned against being "unnecessarily alarmed" by the findings in this study.

"We know that rates of depression in the UK and the US, as in much of the world, are substantially elevated right now. Much of this is likely a consequence of the stress and disruption that accompanies the pandemic," said Perlis.

The study was funded by the National Institute for Health Research. Harrison has disclosed no relevant financial relationships. One author is an employee of TriNetX. Perlis has received consulting fees for service on scientific advisory boards of Belle Artificial Intelligence, Burrage Capital, Genomind, Psy Therapeutics, Outermost Therapeutics, RID Ventures, and Takeda. He holds equity in Psy Therapeutics and Outermost Therapeutics.

Lancet Psychiatry. Published online November 9, 2020. Full text

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