COVID-19 survivors three times more likely to report anxiety
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Data show that people who survived COVID-19 were more likely to report symptoms of anxiety, depression or both compared with those who did not have a history of the disease.
Most of the previous studies in this clinical area have used “unique samples,” such as people actively seeking care, older patients, individuals living outside the U.S. or those with comorbidities, study coauthor Jagdish Khubchandani, MBBS, PhD, a professor of public health at New Mexico State University, told Healio.
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“Such individuals may have a more serious illness from COVID‐19 and multiple health issues predisposing them to poorer outcomes from COVID‐19,” he said. “There were millions of individuals infected with COVID‐19 who were not hospitalized or did not seek specialized care.”
Khubchandani and colleagues analyzed survey responses from 3,633 U.S. adults. The researchers used Patient Health Questionnaires and the General Anxiety Disorder screening tool to evaluate clinical levels of anxiety, depression and psychological distress.
The researchers wrote in the European Journal of Internal Medicine that among all survey participants, 61% were white, 61% were men, 63% were married, 79% were working full time, 57% lived in urban areas and 65% had earned a bachelor’s degree or higher. In addition, 23% of respondents said they previously had COVID-19, 47% said they experienced symptoms of depression, 40% had anxiety symptoms and 38% experienced both depression and anxiety symptoms.
Unadjusted analyses showed that respondents with a history of COVID-19 were significantly more likely to have moderate or severe psychological distress (OR = 3.16; 95% CI, 2.7-3.71). Specifically, those who survived COVID-19 were more likely to report anxiety symptoms (OR = 3.49; 95% CI, 2.97-4.1) or depression symptoms (OR = 2.31; 95% CI, 1.97-2.72). After adjusting the data for socioeconomic factors, those who survived COVID-19 were still more likely than those without a history of COVID-19 to report moderate to severe psychological distress (adjusted OR = 2.58), anxiety symptoms (aOR = 2.93) and depression symptoms (aOR = 1.83).
Khubchandani and colleagues noted that previous research has shown that patients who were more likely to be depressed and anxious before the COVID-19 pandemic were more likely to be diagnosed with COVID-19. The researchers also pointed out that a large study showed that a “bidirectional relationship” may exist between COVID-19 and mental illness.
“Based on these reports and findings from our study, it can be assumed that there could be three broader etiological factors for high rates of psychological distress in COVID-19 infection survivors: neurobiological and pathophysiologic changes related to infection, psychosocial stressors associated with getting infected and preexisting mental illness and sociodemographic factors making individuals more vulnerable to COVID-19 infections and subsequent post-infection sequelae such as depression and anxiety,” Khubchandani and colleagues wrote.
If that is the case, the researchers said the new study findings “have major implications for clinical practice,” including the potential need for psychiatric consultations among COVID-19 survivors and “appropriate pharmacology or psychotherapy.”
“Before the pandemic, almost one in five U.S. adults had a diagnosable mental health issue, and less than half of these individuals sought care or services in any given year,” Khubchandani said. “Our study indicates that there will be an additional pool of individuals who will become a part of the group of individuals with mental illnesses and not seek care.”
Limitations to the study include the survey-based approach to ascertaining symptoms, not knowing when the participants had COVID-19 nor the severity of disease, lack of information on the clinical or psychiatric care that participants received and the limited range of ages and educational levels, according to the researchers.
“Despite these limitations, this is one of the largest population-based studies from the U.S. to have a high representation of racial and ethnic minorities and those who had COVID-19 infections,” they wrote.