COVID-19 survivors at increased risk for psychiatric sequelae
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COVID-19 survivors appeared at increased risk for psychiatric sequelae, according to results of an analysis of retrospective cohort studies published in The Lancet Psychiatry.
Further, researchers found that a psychiatric diagnosis may be an independent risk factor for COVID-19.
“From the early stages of the COVID-19 pandemic, concerns have been raised about its effect on mental health and on patients with mental illness,” Maxime Taquet, PhD, of the department of psychiatry at the University of Oxford in the U.K., and colleagues wrote. “Yet several months later, we still know little about the mental health consequences of COVID-19 (its psychiatric sequelae) and the susceptibility of patients with mental illness to COVID-19 (its psychiatric antecedents).”
According to the investigators, cohort studies of individuals with COVID-19 with adequate control groups and follow-up are necessary to assess the incidence and relative risks of post-infection psychiatric sequelae.
Taquet and colleagues sought to address these research gaps by conducting the current EHR network cohort study. They analyzed anonymized EHR data in 54 health care organizations in the United States of 69.8 million patients who were included in a global federated network. Data were available of 62,354 patients diagnosed with COVID-19 between January 20 and August 1. The investigators created cohorts of patients who had received a diagnosis for COVID-19 or a range of other health events and controlled for confounding by COVID-19 risk factors using propensity score matching. Further, they determined the incidence of and HRs for psychiatric disorders, dementia and insomnia during the first 14 to 90 days following a COVID-19 diagnosis.
Results showed patients with no prior psychiatric history who were diagnosed with COVID-19 were at increased risk for a first psychiatric diagnosis in the following 14 to 90 days vs. six other health events, including influenza (HR = 2.1; 95% CI, 1.8-2.5); other respiratory tract infections (HR = 1.7; 95% CI, 1.5-1.9); skin infection (HR = 1.6; 95% CI, 1.4-1.9); cholelithiasis (HR = 1.6; 95% CI, 1.3-1.9); urolithiasis (HR = 2.2; 95% CI, 1.9-2.6); and fracture of a large bone (HR = 2.1; 95% CI, 1.9-2.5). Taquet and colleagues noted an estimated probability of having been diagnosed with any psychiatric illness in the 14 to 90 days after COVID-19 diagnosis of 181% (95% CI 176–186). Anxiety disorders, insomnia and dementia had the greatest HRs. Although HRs were smaller, Taquet and colleagues noted similar findings when measuring relapses and new diagnoses. In the 14 to 90 days after COVID-19 diagnosis, the incidence of any psychiatric diagnosis was 18.1% (95% CI, 17.6-18.6), of which 5.8% (95% CI, 5.2-6.4) were a first diagnosis. Also during this time period, the incidence of a first dementia diagnosis was 1.6% (95% CI, 1.2-2.2) among individuals older than 65 years. A previous-year psychiatric diagnosis was linked to a higher incidence of COVID-19, with a relative risk of 1.65 (95% CI, 1.59-1.71). This risk was not related to known physical health risk factors for COVID-19; however, the investigators noted that they could not exclude possible residual confounding by socioeconomic factors.
“As COVID-19 sample sizes and survival times increase, it will be possible to refine these findings and to identify rarer and delayed psychiatric presentations,” Taquet and colleagues wrote. “Prospective cohort studies and inclusive case registers will be valuable to complement electronic health record analyses. It will also be important to explore additional risk factors for contracting COVID-19, and for developing psychiatric disorders thereafter, as some elements might prove to be modifiable.”
In a related editorial, Robert Yolken, MD, of the department of pediatrics at Johns Hopkins School of Medicine, emphasized the potential importance of EHR data for addressing the COVID-19 pandemic.
“Learning to use new tools, such as electronic medical records efficiently should provide some of the essential information needed to understand and control the psychiatric consequences of this pandemic and plan for future ones,” Yolken wrote. “In these efforts, we should keep in mind the words of Sir William Osler that, ‘the best preparation for tomorrow is to do today’s work superbly well’.”