Mental health risk increases for COVID-19 survivors

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Mental health risk increases even after mild COVID-19. Jonathan Knowles/Getty Images
  • A study tracking COVID-19 survivors found them more likely to develop mental health issues than other people over the year following diagnosis.
  • The researchers saw an increased risk even for those whose COVID-19 was mild enough that they did not require hospitalization.
  • Conditions the researchers investigated included anxiety, depression, opioid use, and cognitive decline.

Researchers continue to investigate the long-term health effects of COVID-19, or “long COVID.”

Using databases from the United States Department of Veterans Affairs (VA), a new study catalogs a range of mental health issues in the 12 months following a SARS-CoV-2 infection.

The study finds that people who have survived COVID-19 are at increased risk of mental health issues in the first year after the illness.

The study’s senior investigator is Dr. Ziyad Al-Aly, chief of research and development service at the VA Saint Louis Health Care System and a clinical epidemiologist and assistant professor at Washington University in St. Louis. In an opinion piece published alongside the research, he says:

“The body of evidence on long COVID — from our work and others — suggests the need to reframe our thinking about SARS-CoV-2. It is not only a respiratory virus; it is a systemic virus that may provoke damage and clinical consequences in nearly every organ system — including mental health disorders and neurocognitive decline.”

Psychiatrist Dr. Maura Boldrini of Columbia University Irving Medical Center in New York City is the lead author of the article “How COVID-19 Affects the Brain.” She commented on the new study for Medical News Today:

“This is a large study that sheds light on the prevalence of symptoms that reflect brain involvement in post-COVID patients. These symptoms can be classified by the [Diagnostic and Statistical Manual of Mental Disorders] into psychiatric categories, but their pathogenesis is unknown.”

Dr. Noortje Uphoff is a research fellow at the University of York in the United Kingdom and the lead author of a related review published in August 2021.

“The strengths of the study,” Dr. Uphoff told MNT, “are that many patients are included, COVID-19 patients are compared to people without evidence of the infection, and data were collected for a year. Whereas many studies measure mental health outcomes such as self-reported symptoms, in this study, medical records of diagnoses and prescriptions were used.”

The new study appears in the BMJ. Neither Dr. Boldrini nor Dr. Uphoff was involved in the new study.

The researchers analyzed health data from 153,848 veterans who had survived 30 days or more after receiving a positive PCR test result between March 1, 2020, and January 15, 2021. The research team followed their health until November 30, 2021.

The researchers also collected data from two control groups: 5,637,840 veterans who had not contracted SARS-CoV-2 during the same period, and 5,859,251 individuals who used the Veterans Health Administration during a period before the pandemic.

Dr. Uphoff cautioned MNT:

“As the study authors point out, their study sample was not representative of populations across the world. These were retired veterans, mostly white men, who had access to healthcare.”

The authors of the study calculated the post-COVID-19 incidence of developing various mental health issues by comparing outcomes for COVID-19 survivors with those of the control groups.

The overall risk of developing any mental health issue increased to 64.38 additional cases per 1,000 people after 1 year.

The researchers reported the following increased risk of incident mental health cases per 1,000 people in the year following COVID-19:

  • anxiety disorders: 11.06 additional cases
  • depressive disorders: 15.12 additional cases
  • stress and adjustment disorders: 13.29 additional cases
  • use of antidepressants: 21.59 additional cases
  • use of benzodiazepines: 10.46 additional cases
  • opioid prescriptions: 35.90 additional cases
  • opioid use disorders: 0.96 additional cases
  • other (non-opioid) substance use disorders: 4.34 additional cases
  • neurocognitive decline: 10.75 additional cases
  • sleep disorders: 23.80 additional cases.

While risks were higher for those hospitalized for COVID-19, the study also found that “risks were evident even among those who were not admitted to hospital during the acute phase of COVID-19.”

“The symptoms are most likely due to brain inflammation,” said Dr. Boldrini.

“We know brain inflammation is present in major depressive disorder and dementias,” she continued, “and brain symptoms are found in other inflammatory diseases like [systemic lupus erythematosus]. Even in people with mild COVID-19, there can be a protracted inflammatory response that disrupts brain vasculature and neurotransmitters synthesis, including serotonin.”

Dr. Uphoff suggested stress as an additional potential factor, saying, “It is easy to imagine why infection with [SARS-CoV-2] could cause distress.”

Dr. Uphoff added: “Not only do many patients experience symptoms of illness, ranging from inconvenient to severe, but self-isolation at home causes disruption to people’s lives. On top of this, worries about passing on the infection to loved ones and about the potential severity of the illness are likely to affect well-being at least in the short term.”

“As physicians,” said Dr. Boldrini, “we need to understand better the mechanisms of vascular strokes and protracted inflammation and their damage in the brain so that we can repair it.”

Dr. Boldrini concluded with a plea for help:

“As patients, I would encourage people to volunteer for research studies — clinical and brain imaging ones — and in the event of death, it is crucial that families donate the brain to research so we can study it. Medicine has made the most progress [studying] human organs after death. That’s what we do in my lab. We need brains to be donated so we can understand mechanisms of brain disorders and find new treatments.”

Eleanore Beatty

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