Increased risk of psychiatric sequelae of COVID-19 is highest early in the clinical course

Abstract

SummaryBackgroundCOVID-19 has been shown to increase the risk of adverse mental health consequences. A recent electronic health record (EHR)-based observational study showed an almost two-fold increased risk of new-onset mental illness in the first 90 days following a diagnosis of acute COVID-19.MethodsWe used the National COVID Cohort Collaborative, a harmonized EHR repository with 2,965,506 COVID-19 positive patients, and compared cohorts of COVID-19 patients with comparable controls. Patients were propensity score-matched to control for confounding factors. We estimated the hazard ratio (COVID-19:control) for new-onset of mental illness for the first year following diagnosis. We additionally estimated the change in risk for new-onset mental illness between the periods of 21-120 and 121-365 days following infection.FindingsWe find a significant increase in incidence of new-onset mental disorders in the period of 21-120 days following COVID-19 (3.8%, 3.6-4.0) compared to patients with respiratory tract infections (3%, 2.8-3.2). We further show that the risk for new-onset mental illness decreases over the first year following COVID-19 diagnosis compared to other respiratory tract infections and demonstrate a reduced (non-significant) hazard ratio over the period of 121-365 days following diagnosis. Similar findings are seen for new-onset anxiety disorders but not for mood disorders.InterpretationPatients who have recovered from COVID-19 are at an increased risk for developing new-onset mental illness, especially anxiety disorders. This risk is most prominent in the first 120 days following infection.FundingNational Center for Advancing Translational Sciences (NCATS).

Psychological distress, depression, anxiety, and life satisfaction following COVID-19 infection: evidence from 11 UK longitudinal population studies

“…Previous studies have been limited by small or unrepresentative samples, cross-sectional designs, and absence of control groups. 5 , 6 Although several studies using routine data reported elevated rates of psychiatric disorders following COVID-19 illness, 7 , 8 , 9 , 10 , 11 , 12 others have not found clear evidence of associations 13 , 14 and have mainly focused on more severe COVID-19 and recorded mental health disorders. 15 , 16 A study using data from six cohorts in Europe found that severe acute COVID-19 illness was associated with adverse mental health outcomes.…”

Associations between Recurrent COVID-19, Attention, and Mental Health: A Longitudinal Study

“…Study 2 provided initial evidence that recurrent COVID-19 diagnosis further magnifies detrimental mental health outcomes (Hypothesis 3), with participants diagnosed again showing markedly worse depression, anxiety, and incredibly high stress compared to those without new diagnosis; this evidence is also aligned with Coleman et al (2021); Toubasi et al (2021). Interestingly, the recurrent diagnosis was linked to enhanced attentional abilities, contrasting typical medical condition cognitive declines, though this is not aligned with studies mainly.…”

Mental health outcomes following COVID-19 infection: Evidence from 11 UK longitudinal population studies

“…Previous studies have been limited by small and/or unrepresentative samples, cross-sectional designs and absence of control groups. 5,6 Although several studies using routine data reported elevated rates of psychiatric disorders following COVID-19 illness, [7][8][9][10][11][12] others have not found clear evidence of associations. 13,14 Further, most studies using routine data lacked detailed information on pre-pandemic health and sociodemographic factors, and mainly focused on more severe COVID-19 and recorded mental health disorders.…”