Bidirectional associations between COVID-19 and psychiatric disorder: retrospective cohort studies of 62 354 COVID-19 cases in the USA

Abstract

Background Adverse mental health consequences of COVID-19, including anxiety and depression, have been widely predicted but not yet accurately measured. There are a range of physical health risk factors for COVID-19, but it is not known if there are also psychiatric risk factors. In this electronic health record network cohort study using data from 69 million individuals, 62 354 of whom had a diagnosis of COVID-19, we assessed whether a diagnosis of COVID-19 (compared with other health events) was associated with increased rates of subsequent psychiatric diagnoses, and whether patients with a history of psychiatric illness are at a higher risk of being diagnosed with COVID-19. Methods We used the TriNetX Analytics Network , a global federated network that captures anonymised data from electronic health records in 54 health-care organisations in the USA, totalling 69·8 million patients. TriNetX included 62 354 patients diagnosed with COVID-19 between Jan 20, and Aug 1, 2020. We created cohorts of patients who had been diagnosed with COVID-19 or a range of other health events. We used propensity score matching to control for confounding by risk factors for COVID-19 and for severity of illness. We measured the incidence of and hazard ratios (HRs) for psychiatric disorders, dementia, and insomnia, during the first 14 to 90 days after a diagnosis of COVID-19. Findings In patients with no previous psychiatric history, a diagnosis of COVID-19 was associated with increased incidence of a first psychiatric diagnosis in the following 14 to 90 days compared with six other health events (HR 2·1, 95% CI 1·8–2·5 vs influenza; 1·7, 1·5–1·9 vs other respiratory tract infections; 1·6, 1·4–1·9 vs skin infection; 1·6, 1·3–1·9 vs cholelithiasis; 2·2, 1·9–2·6 vs urolithiasis, and 2·1, 1·9–2·5 vs fracture of a large bone; all p<0·0001). The HR was greatest for anxiety disorders, insomnia, and dementia. We observed similar findings, although with smaller HRs, when relapses and new diagnoses were measured. The incidence of any psychiatric diagnosis in the 14 to 90 days after COVID-19 diagnosis was 18·1% (95% CI 17·6–18·6), including 5·8% (5·2–6·4) that were a first diagnosis. The incidence of a first diagnosis of dementia in the 14 to 90 days after COVID-19 diagnosis was 1·6% (95% CI 1·2–2·1) in people older than 65 years. A psychiatric diagnosis in the previous year was associated with a higher incidence of COVID-19 diagnosis (relative risk 1·65, 95% CI 1·59–1·71; p<0·0001). This risk was independent of known physical health risk factors for COVID-19, but we cannot exclude possible residual confounding by socioeconomic factors. Interpretation Survivors of COVID-19 appear to be at increased risk of psychiatric sequelae, and a psychiatric diagnosis ...

Identity change, uncertainty and mistrust in relation to fear and risk of COVID-19

“…Longitudinal studies of identity change relating to experiences of COVID-19 are needed. This is certainly supported by the discovery that having suffered COVID-19 is associated with anxiety and depression after recovery (Taquet et al 2020).…”

A Nosological Exploration of PTSD and Trauma in Disaster Mental Health and Implications for the COVID-19 Pandemic

“…Another possibility might be that the psychological syndrome related to SARS-CoV-2 exposure or infection or COVID-19 illness might actually be part of another well-established psychiatric illness such as anxiety or depressive disorders, which have been well documented [ 47 ]. Such disorders may include both pre-existing (either continuous or recurrent) disorders and disorders arising for the first time (incident disorders).…”

The roles of a psychiatrist in the COVID-19 pandemic

“…Prior to the SARS-CoV-2 (COVID-19) pandemic, previous coronavirus epidemics had been associated with high rates of psychiatric morbidity. 1 There is accumulating evidence of higher rates of symptoms of common mental health problems such as anxiety and insomnia 2 , 3 , 4 associated with the current pandemic, with some reports of severe psychiatric disorders including mania and psychosis. 5 , 6 , 7 These may arise directly from the effects of infection with enforced isolation and quarantine after viral exposure, or indirectly from additional stressors such as complicated bereavement, job losses, intra-familial tension and sudden impoverishment.…”

“…The potential adverse psychological impact of viral infection in patients with established psychiatric illnesses is uncertain: individuals with known mental health problems may be particularly vulnerable to infection, 3 , 20 this increased risk being independent of known physical health factors for COVID-19. 3 There is a bi-directional impact as those with mental health problems have increased morbidity.…”

“…The potential adverse psychological impact of viral infection in patients with established psychiatric illnesses is uncertain: individuals with known mental health problems may be particularly vulnerable to infection, 3 , 20 this increased risk being independent of known physical health factors for COVID-19. 3 There is a bi-directional impact as those with mental health problems have increased morbidity. Comparative studies suggest that patients with pre-existing psychiatric illness are more likely to experience suicidal thoughts and to behave impulsively; 21 and less likely to use adaptive strategies such as taking exercise and contacting friends but more likely to increase their cigarette smoking.…”