COVID-19 survivors at higher risk for mental health disorders up to 1 year after infection
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Veterans who survived COVID-19 were at increased risk for mental health, substance use and sleep disorders up to 1 year later, data showed.
Previous studies of long-term risks in COVID-19 survivors have looked at fewer outcomes in shorter timeframes, Yan Xie, MPH, a biostatistician at the Clinical Epidemiology Center within the St. Louis Veterans Affairs Health Care System, and colleagues wrote in The BMJ.
“Improving our understanding of the long-term risk of mental health disorders in people with COVID-19 can help guide strategies for care during the post-acute phase,” they wrote.
Xie and colleagues used the U.S. Veterans Affairs health care database to compare outcomes among three cohorts. The first group consisted of 153,848 veterans who survived the first 30 days of COVID-19. A second group was comprised of 5,637,840 veterans who used the VA health system during the same timeframe but did not have evidence of COVID-19. A third group included 5,859,251 veterans who received care in 2017. According to the researchers, all three cohorts were followed for 1 year. They had a mean age of about 63 years, and most were white men who were obese and never smoked.
The researchers found that at 1 year, those who survived acute COVID-19 had an increased risk for:
- anxiety disorders (HR = 1.35; 95% CI, 1.3-1.39), with a risk difference of 11.06 per 1,000 people (95% CI, 9.64-12.53);
- depressive disorders (HR = 1.39; 95% CI, 1.34-1.43), with a risk difference of 15.12 per 1,000 people (95% CI, 13.38-16.91);
- stress and adjustment disorders (HR = 1.38; 95% CI, 1.34-1.43), with a risk difference of 13.29 per 1,000 people (95% CI, 11.71-14.92);
- opioid use disorder (HR = 1.34; 95% CI, 1.21-1.48), with a risk difference of 0.96 per 1,000 people (95% CI, 0.59- 1.37);
- non-opioid substance use disorders (HR = 1.2; 95% CI, 1.15-1.26), with a risk difference of 4.34 per 1,000 people (95% CI, 3.22-5.51);
- incident neurocognitive decline (HR = 1.8; 95% CI, 1.72-1.89), with a risk difference of 10.75 per 1,000 people (95% CI, 9.65-11.91); and
- sleep disorders (HR = 1.41; 95% CI, 1.38-1.45), with a risk difference of 23.8 per 1,000 people (95% CI, 21.65-26).
Xie and colleagues also reported that the acute COVID-19 survivors had a higher risk for:
- incident opioid prescriptions (HR = 1.76; 95% CI, 1.71-1.81), with a risk difference of 35.9 per 1,000 people (95% CI, 33.61-38.25);
- antidepressant use (HR = 1.55; 95% CI, 1.5-1.6), with a risk difference of 21.59 per 1,000 people (95% CI, 19.63- 23.6);
- benzodiazepine use (HR = 1.65; 95% CI, 1.58-1.72), with a risk difference of 10.46 per 1,000 people (95% CI, 9.37-11.61); and
- incident mental health diagnosis or prescription (HR = 1.6; 95% CI, 1.55-1.66), with a risk difference of 64.38 per 1,000 people (95% CI, 58.9-70.01).
“The risks of examined outcomes were increased even among people who were not admitted to hospital and were highest among those who were admitted to hospital during the acute phase of COVID-19,” Xie and colleagues wrote. “Results were consistent with those in the historical control group.”
The analysis also showed that the risk for incident mental health disorders was consistently higher in people with COVID-19 compared with those who had seasonal influenza.
Xie and colleagues said their findings should be used to promote awareness of the greater risk for mental health conditions among survivors of acute COVID-19. They also recommended incorporating mental health care as a core component of treatment strategies.
In a related editorial, Scott Weich, MSc, MRCPsych, a professor in the Mental Health Research Unit in the School of Health and Related Research at the University of Sheffield in England, wrote that it is time to “reflect on what we have learnt” about the mental health consequences of COVID-19 as well as “what we need to do next, and what we still do not know.”
“We continue to generate more heat than light as we reflect on the usual biopsychosocial suspects without cutting through to conclusive insights or effective interventions,” he wrote.
Areas of focus should include examining the consequences of long COVID, addressing disruptions to health and social care among those who have serious mental illness and assessing the effectiveness of nonpharmacological and pharmacological mental health interventions, according to Weich.
References:
Study suggests increased risk of mental health disorders after COVID-19 infection. https://www.eurekalert.org/news-releases/943409. Published Feb. 16, 2022. Accessed Feb. 17, 2022.
Weich S. BMJ. 2022;doi.org/10.1136/bmj.o326.
Xie Y, et al. BMJ. 2022;doi:10.1136/bmj-2021-068993.
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