Mental Issues Can Linger More Than a Year After Severe COVID
People who have severe COVID-19 are at higher risk for depression and other mental woes that can last more than a year, a large study suggests.
Researchers reported that COVID patients who were bedridden but not hospitalized for a week or more can experience depression, anxiety, distress and trouble sleeping up to 16 months after being ill. People with mild COVID infections were less likely to develop mental problems.
"These data suggest that a SARS-CoV-2 infection is not associated with long-term adverse mental health symptoms for the majority of infected individuals, whilst alertness is needed for risks of long-term adverse mental health symptoms among the proportion of patients suffering a severe acute illness," said lead researcher Unnur Anna Valdimarsdóttir, a professor of epidemiology at the University of Iceland in Reykjavik.
These findings suggest that increased vigilance for long-term mental health symptoms is essential for those with severe COVID-19 illness, she said.
This study doesn't prove that COVID causes these mental health problems, only that they appear to be connected.
For the study, Valdimarsdóttir and her colleagues examined data on more than 247,000 people in Denmark, Estonia, Iceland, Norway, Sweden and the United Kingdom. Of those, 4% were diagnosed with COVID-19 between late March 2020 and August 2021.
People diagnosed with COVID-19 had a higher rate of depression, compared with those who weren't sick (20% versus 11%). And 29% of COVID patients slept poorly compared to 24% who didn't have the virus.
That's equivalent to an 18% and 13% increase in rates of depression and poor sleep after adjusting for factors such as age, sex, education, weight and a history of psychiatric disorders.
The researchers found no differences between participants with and without COVID in rates of anxiety or COVID-related distress.
But patients who had been bedridden for a week or more struggled with lasting issues, the study found. Over 16 months, they remained up to 60% more likely to experience higher depression and anxiety, compared with people who were never infected, Valdimarsdóttir noted.
David Putrino, associate professor of rehabilitation and human performance at the Icahn School of Medicine at Mount Sinai in New York City, reviewed the findings.
"It's unsurprising that if you have more severe disease, you're more likely to experience significant mental health outcomes at long-term follow-up," he said.
Putrino said it isn't clear if these problems are caused by the trauma of being very sick or by COVID itself.
"It may be that individuals with more severe disease are experiencing more persistent symptoms that have interfered with their ability to just get back to their pre-infection life, and that's causing mental health concerns," he said.
Dr. Scott Krakower, a psychiatrist at Northwell Health Zucker Hillside Hospital in Glen Oaks, N.Y., said COVID may cause brain inflammation that results in the problems.
He added that stresses of the pandemic have taken a toll, and people are at risk for feeling depressed and anxious.
"There were a lot of psychosocial factors that could affect the prognosis in people with COVID-19 more than just getting sick," said Krakower, who wasn't part of the study.
Putrino urged people who feel depressed or have trouble sleeping after having COVID to talk with their doctor about it.
"Help is available for post-traumatic stress disorder, help is available for anxiety and depression," he said. "These are treatable conditions that can be managed."
The findings were published online March 14 in The Lancet Public Health.
For more about COVID-19 and mental health, visit the Kaiser Family Foundation.
SOURCES: Unnur Anna Valdimarsdóttir, PhD, professor, epidemiology, University of Iceland, Reykjavik; David Putrino, PhD, director, rehabilitation innovation, Mount Sinai Health System, New York City, and associate professor, rehabilitation and human performance, Icahn School of Medicine at Mount Sinai; Scott Krakower, DO, psychiatrist, Northwell Health Zucker Hillside Hospital, Glen Oaks, N.Y.; The Lancet Public Health, online, March 14, 2022