COVID Infection Linked to Slew of Mental Health Conditions

People who battled COVID-19 infection had a higher risk of multiple mental health conditions, a new study found.

Among those who survived the first 30 days of COVID-19 infection, there was a 60% (HR 1.60, 95% CI 1.55-1.66) increased risk for having any new mental health diagnosis or a new mental health-related drug prescription compared with those who were never infected, reported Ziyad Al-Aly, MD, of the VA Saint Louis Health Care System in Missouri, and colleagues.

This heightened risk was largely driven by an uptick in mental health-related drug prescriptions, which increased by 86% (HR 1.86, 95% CI 1.78-1.95), the group wrote in The BMJ.

Of note, this higher risk for new mental health disorders was evident even in those who weren't hospitalized for COVID-19, the researchers noted.

In terms of the specific new mental health diagnoses, COVID-19 survivors saw significantly higher risks for developing anxiety disorders (HR 1.35, 95% CI 1.30-1.39), which included a higher risk for generalized anxiety disorder, mixed anxiety disorder, and panic disorder.

Likewise, these individuals carried a higher risk for depressive disorders (HR 1.39, 95% CI 1.34-1.43), including both single episode and recurrent major depressive disorder, as well as suicidal ideation. There was also a 38% higher risk for developing stress and adjustment disorders, which included both acute stress and adjustment disorder and PTSD.

COVID-19 infection was also significantly related with new substance use disorders (HR 1.20, 95% CI 1.15-1.26). This increased risk encompassed a higher risk of new-onset illicit drug disorder, alcohol use disease, and opioid use disorder, as well as sedative or hypnotics use disorder.

During the post-acute phase following COVID-19 infection, people also saw an 80% higher risk for neurocognitive decline. These individuals also struggled with sleep troubles, classified as a higher risk for both sleep disorders and new sleep-related medications.

People who were infected with COVID-19 had significantly higher risks for several new prescriptions versus individuals free of COVID infection:

• Any antidepressants: HR 1.55 (95% CI 1.50-1.60)

• Selective serotonin reuptake inhibitors: HR 1.54 (95% CI 1.49-1.60)

• Serotonin and norepinephrine reuptake inhibitors: HR 1.22 (95% CI 1.17-1.28)

• Benzodiazepines: HR 1.65 (95% CI 1.58-1.72)

• Any opioids: HR 1.76 (95% CI 1.71-1.81)

• Naloxone or naltrexone: HR 1.23 (95% CI 1.18-1.29)

• Methadone: HR 1.94 (95% CI 1.47-2.56)

• Buprenorphine: HR 1.34 (95% CI 1.12-1.62)

Al-Aly's group also found that COVID-19 survivors still carried significantly higher risks for new mental health disorders when compared with individuals with seasonal influenza. Also, those hospitalized for COVID-19 likewise were at a higher risk compared with patients hospitalized for any other cause.

"The findings suggest that people who survive the acute phase of Covid-19 are at increased risk of an array of incident mental health disorders. Tackling mental health disorders among survivors of Covid-19 should be a priority," Al-Aly and co-authors wrote.

An accompanying editorial noted that despite the significant -- and consistent -- relationships seen in the study between COVID-19 infection and increased risks for mental health conditions, the associations might eventually fade. Scott Weich, MBBS, MD, MSc, of the University of Sheffield in England, said that while the study showed persistent group differences for the first 12 months after infection, the absolute risk of experiencing a psychiatric disorder decreased sharply after the first month.

"Importantly, mental healthcare might have been more accessible to those known to have had Covid-19 than contemporaries without this condition or among historical cohorts, further biasing estimates away from the null," Weich wrote.

"The worst of the pandemic might be behind us in terms of mortality and social restrictions," he said, adding that "much of the research concerned with the mental health impacts of Covid-19 represents more hindsight than insight."

Weich suggested that the healthcare community focus less on "syndromal phenotypes" of mental health disorders and instead shift focus to effective interventions, including new clinical trials.

For the analysis, the researchers examined data from the U.S. Department of Veterans Affairs. This included 153,848 patients who survived at least 30 days after a positive COVID test between March 2020 and January 2021 -- 132,852 who were not admitted to the hospital and 20,996 who were.

New diagnoses were based on ICD-10 codes, and new medications were based on prescription records.

Comment