Many COVID-19 patients have psychiatric morbidity within 6 months of infection
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A significant proportion of patients who had COVID-19 experienced neurological and psychiatric morbidity in the 6 months following infection, according to results of a retrospective cohort study published in The Lancet Psychiatry.
“We need large scale, robust and longer-term data to properly identify and quantify the consequences of the COVID-19 pandemic on brain health,” Maxime Taquet, PhD, of the department of psychiatry at the University of Oxford in the U.K., and colleagues wrote. “Such information is required both to plan services and identify research priorities.”
The investigators conducted the current study to estimate incidence rate and relative risks for neurological and psychiatric diagnoses among 236,379 patients with COVID-16 in the 6 months after diagnosis. They gathered data via the TriNetX electronic health records network and created a primary cohort of patients with a COVID-19 diagnosis, a matched control cohort with patients with an influenza diagnosis and another matched control cohort of patients diagnosed with any respiratory tract infection, including influenza, during the same timeframe. They excluded those diagnosed with COVID-19 or who tested positive for SARS-CoV-2 from the control cohorts. Cohort participants included individuals aged older than 10 years with an index event on or after Jan. 20, 2020, and who were still living on Dec. 13, 2020.
Taquet and colleagues estimated the incidence of the following neurological and psychiatric outcomes in the 6 months after confirmed COVID-19 diagnosis: intracranial hemorrhage; ischaemic stroke; parkinsonism; Guillain-Barré syndrome; nerve, nerve root and plexus disorders; myoneural junction and muscle disease; encephalitis; dementia; psychotic, mood and anxiety disorders, both separately and grouped; substance use disorder; and insomnia. They used a Cox model to compared incidences with those in propensity score-matched of individuals with influenza or other respiratory tract infections. Further, they assessed the impact of COVID-19 severity on these estimates as determined by hospitalization, intensive therapy unit admission and encephalopathy, as well as the robustness of between-cohort outcome differences by using different scenarios to repeat the analysis.
By comparing the primary cohort with four cohort of patients diagnosed during the same timeframe with additional index events, which were skin infection, urolithiasis, fracture of a large bone and pulmonary embolism, the researchers provided benchmarking for the incidence and risk for neurological and psychiatric sequelae.
Results showed an estimated incidence of 33.62% (95% CI, 33.17-34.07) for a neurological or psychiatric diagnosis in the 6 months after a COVID-19 diagnosis. A total of 12.84% (95% CI, 12.36-13.33) received their first neurological or psychiatric diagnosis during this timeframe. Patients admitted to an intensive therapy unit had an estimated incidence of a diagnosis of 46.42% (95% CI, 44.78-48.09) and for a first diagnosis of 25.79% (95% CI, 23.5-28.25). Among the whole COVID-19 cohort, estimated incidence was 0.56% for intracranial hemorrhage, 2.1% for ischaemic stroke, .11% for parkinsonism, 0.67% for dementia, 17.39% for anxiety disorder and 1.4% for psychotic disorder, among others. The group with intensive therapy unit admission had estimated incidence of 2.66% for intracranial hemorrhage, 6.92% for ischaemic stroke, 0.26% for parkinsonism, 1.74% for dementia, 19.15% for anxiety disorder and 2.77% for psychotic disorder. Those with COVID-19 more often experienced most diagnostic categories vs. those who had influenza (HR for any diagnosis = 1.44; 95% CI, 1.4-1.47) and those who had other respiratory tract infections (HR for any diagnosis = 1.16; 1.14-1.17). Patients with more severe COVID-19 had higher HRs and incidences. The researchers noted that the findings were robust to multiple sensitivity analyses and benchmarking against the additional index health events.
“The present data show that COVID-19 is followed by significant rates of neurological and psychiatric diagnoses over the subsequent 6 months,” Taquet and colleagues wrote. “Services need to be configured, and resourced, to deal with this anticipated need.”
In a related editorial, Jonathan P Rogers, MRCPsych, of the division of psychiatry at the University College London, and Anthony S. David, FMedSci, of the Institute of Mental Health at the University College London, highlighted the implications of the current study on future research.
“Taquet and colleagues’ study points us towards the future, both in its methods and implications,” Rogers and David wrote. “Researchers need to be able to observe and anticipate the neurological and psychiatric outcomes of future emerging health threats by use of massive, international, real-world clinical data. Selection biases will remain an issue, not necessarily mitigated by sample size, and thus the onus should be on countries with public health care systems to enable truly comprehensive national data to be available for research. Sadly, many of the disorders identified in this study tend to be chronic or recurrent, so we can anticipate that the impact of COVID-19 could be with us for many years.”