What is Covid-19's toll on mental health? Nearly 1 in 5 are diagnosed with psychiatric disorder within 90 days
People with pre-existing psychiatric diagnosis are 65% more likely to be diagnosed with coronavirus than those without
Having coronavirus may increase the risk of adverse mental health consequences in people and having a psychiatric disorder could raise the chances of getting Covid-19, according to researchers who looked at the medical records of 69 million people in the US, of which over 62,000 had the disease. They found that nearly one in five people who have had Covid-19 are diagnosed with a psychiatric disorder such as anxiety, depression, or insomnia within three months of testing positive for the virus. The analysis also reveals that people with a pre-existing psychiatric diagnosis are 65% more likely to be diagnosed with coronavirus than those without, even when the known risk factors for Covid-19 were taken into account.
“People have been worried that Covid-19 survivors will be at greater risk of psychiatric disorders, and our findings in a large and detailed study show this to be true. Services need to be ready to provide care, especially since our results are likely to be underestimates of the actual number of cases. We urgently need research to investigate the causes and identify new treatments,” writes Dr Paul Harrison, professor of psychiatry at the University of Oxford, who led the study. The findings have been published in The Lancet Psychiatry.
Starting that the finding regarding people with pre-exsitng psychiatric diagnosis was unexpected and needs to be further explored, Dr Max Taquet, NIHR Academic Clinical Fellow, who conducted the analyses, recommends that “in the meantime, having a psychiatric illness should be added to the list of risk factors for Covid-19”.
The team used the TriNetX Network — a global health research network to access de-identified electronic medical records data of 62,254 patients diagnosed with coronavirus between January 20, 2020, and August 1, 2020, in the US. They compared psychiatric diagnoses in Covid-19 survivors with patients who had influenza, other respiratory tract infections, skin infections, large bone fractures, gallstones and kidney stones. The findings show that a diagnosis of coronavirus was associated with an increased incidence of a first diagnosis of anxiety, depression, or insomnia in the following 14 to 90 days (hazard ratio 2.1) compared to any other group of patients. It also reveals an increase in the rate of dementia and more relapses in people with a history of psychiatric problems in Covid-19 patients.
“The incidence of any psychiatric diagnosis in the 14 to 90 days after Covid-19 diagnosis was 18.1%. In the period between 14 and 90 days after Covid-19 diagnosis, 5.8% of Covid-19 survivors had their first recorded diagnosis of psychiatric illness compared with 2.5-3.4% of patients in the comparison cohorts. Thus, adults have an approximately doubled risk of being newly diagnosed with a psychiatric disorder after Covid-19 diagnosis. The most common psychiatric diagnosis after Covid-19 diagnosis was anxiety disorder (12.8%), followed by mood disorders (9.9%),” the findings state. It adds, “The incidence of a first diagnosis of dementia in the 14 to 90 days after Covid-19 diagnosis was 1.6% 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.”
According to the team, while preliminary, the findings have implications for clinical services. “Prospective cohort studies and longer-term follow-up studies are urgently needed to support and extend the findings of our study. Furthermore, enhanced psychiatric follow-up should be considered for patients who survive Covid-19. Finally, psychiatric history should be queried during the assessment of a patient presenting with Covid-19 symptoms to adjust pre-test probability,” they suggest.
What are other experts saying?
Dr Ciara McCabe, associate professor of neuroscience at the University of Reading, said that while he authors examined the risk of Covid-19 against other infections like the flu, it would be good to compare psychiatric risk factors for coronavirus against other health issues with similar death rates to covid which are suggested as much higher than the flu.
According to Professor David Curtis, retired consultant psychiatrist and an honorary professor at University College London and the Queen Mary University of London, emphasizes that it is difficult to judge the importance of the study findings. “For example, they show that there is an 18% chance of getting a psychiatric diagnosis after Covid-19 compared with 13% after influenza. These psychiatric diagnoses get made quite commonly when people present to doctors and it may be unsurprising that this happens a bit more often in people with Covid-19, who may understandably have been worried that they might become seriously unwell and who will also have had to endure a period of isolation,” he adds.
Dr Ciara McCabe, associate professor of neuroscience at the University of Reading, argues that the data support the importance of examining psychiatric risk factors for poor physical health and in particular serious infections like coronavirus. “As the authors note, this study cannot speak to the underlying mechanisms thus further investigation into this is urgently needed. The data suggest possible biological factors but again at present, these are only speculative. The authors don’t mention 'long Covid'. It would be interesting to examine how psychiatric risk factors relate to various forms of Covid-19,” says McCabe.
Professor Sir Simon Wessely, Regius professor of psychiatry, King’s College London, explains that it is known from previous pandemics that having depression, for example, before infection increases the risk of depression after infection. “It would have been very surprising if this proved not to be the case for Covid-19. Covid-19 affects the central nervous system, and so might directly increase subsequent disorders. But this research confirms that is not the whole story, and that this risk is increased by previous ill health. We now have an opportunity to find out why,” says Wessely.