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After COVID-19, Risk Increases for Wide Range of Mental Health Disorders


Among persons who survived COVID-19, a new study found a 60% increased risk for any new mental health diagnosis during the year following infection.


People who recovered from COVID-19 had higher risk of a range of mental health conditions, according to findings from a new study published in the BMJ.

Investigators found that among those who survived the first 30 days of infection with SARS-CoV-2, there was an increase in risk of 60% (HR 1.60, 95% CI 1.55-1.66) for having any new mental health diagnosis or a new mental-health related medication prescription during the year following infection compared to those who were never infected.

The research team, led by Ziyad Al-Aly, MD, of the VA Saint Louis Health Care System in Missouri Study, emphasize that even when compared to the contemporaneous control group of individuals who were not infected but were exposed to the same adverse forces of the pandemic—including economic, social, and other stressors—those with COVID-19 exhibited increased risk of mental health outcomes. Further, the increased risk for new mental health disorders was seen whether or not an individual was hospitalized for COVID-19.

The results, they write “…call for the integration of mental health care as a core component of post-acute COVID-19 care strategies.”

Al-aly and colleagues used data from the US Veterans Health Administration to create 3 groups: from an initial group of those who had at least one positive PCR test for COVID-19 between March 1, 2020, and January 15, 2021 (n=169 240), investigators selected those surviving at 30 days (n=153 848) to examine mental health outcomes during the post-acute phase. A contemporary control group comprised individuals who used the VA during 2019 but were not infected (n=5 637 840) and a third group of individuals included those who used the VA in 2017 for any reason to serve as an historical control group who did not experience the pandemic (n=5 859 251). The majority of individuals were men and mean age was 63 years.

Median follow-up for the COVID-19 group, 377 days; for the non-infected control group 378 days, and for the historical control group 378 days. Total person years of follow-up were 13 052 788.

Anxiety. When data were analyzed for incident mental health diagnoses during the year following the index positive PCR test for COVID-19, there was a significantly higher risk among COVID-19 survivors than non-infected control group members for developing any anxiety disorder (HR 1.35, 95% CI 1.30-1.39) including generalized anxiety disorder, mixed anxiety disorder, and panic disorder.

Increased risk for new mental health prescriptions

Any antidepressants: HR 1.55 (95% CI 1.50-1.60)

Selective serotonin reuptake inhibitors: HR 1.54 (95% CI 1.49-1.60)

Serotonin and norepinephrine reuptake inhibitors: HR 1.22 (95% CI 1.17-1.28)

Benzodiazepines: HR 1.65 (95% CI 1.58-1.72)

Depression, PTSD. COVID-19 survivors also were found at higher risk for any depressive disorder (HR 1.39, 95% CI 1.34-1.43), including both single episode and recurrent major depressive disorder, as well as suicidal ideation. An increased risk also was seen for developing overall stress and adjustment disorders (HR 1.38, 95% CI 1.34-1.43), which included acute stress and adjustment disorder and PTSD.

New substance use. Risk increased significantly among those who recovered from COVID-19 for new substance use disorders of any type (HR 1.20, 95% CI 1.15-1.26), with the greatest risk for new sedative/hypnotic use disorder, followed by alcohol use disorder, and illicit drug disorder.

Investigators also found a significant increased risk among COVID-19 survivors for incident opioid use disorder (OUD) (HR 1.34, 95% CI 1.21-1.48).

Opioids. The increase in OUD may or may not be linked to the observed increase in risk for incident opioid prescriptions (HR 1.76, 95% CI 1.71-1.81) and the parallel risk in new use of naloxone or naltrexone (HR 1.23, 95% CI 1.18-1.29), buprenorphine, (HR 1.34, 95% CI 1.12-1.62), and methadone (HR 1.94, 95% CI 1.47-2.56) in the year following recovery from COVID-19 infection.

Sleep. An increase in the risk for new onset sleep disorders (HR 1.41, 95% CI 1.38-1.45) was paralleled by that for new use of sleep medication (HR1.63, 95% CI 1.58-1.67). Persons recovered from COVID-19 also were found to be at greater risk vs those not infected for neurocognitive decline (HR 1.80, 95% CI 1.72-1.89).

Any mental health impact. When investigators analyzed the date for the study’s composite endpoints, they found the risk of any incident mental health disorder was 1.46 (95% CI 1.40 to 1.52); of any incident mental-health related drug prescription was 1.86 (95% CI 1.78 to 1.95); and any incident mental health diagnosis or prescription was 1.60 (95% CI 1.55 to 1.66)

In other prespecified analyses the authors report that

  • People admitted to the hospital during the acute phase of COVID-19 had higher risks for mental health disorders than those not admitted for the infection
  • People with covid-19 showed consistently higher risks for mental health disorders than people with seasonal influenza who both were/were not admitted to the hospital.
  • People admitted to hospital for COVID-19 showed increased risks for mental health disorders compared with those admitted to hospital for any other cause.

In conclusion, Al-Aly et al write

"Despite evidence showing that the burden of mental health disorders might have increased among the general population during the COVID-19 pandemic, our results suggested that people with covid-19 are at even higher risk of incident mental health disorders than their contemporaries without COVID-19...the findings suggest enhanced vulnerability to these outcomes in people with COVID-19."

They also note that given the large and growing number of people who have, have had, or whil have had COVID-19, "the absolute risks of incident mental health disorders might translate into large numbers of potentially affected people around the world."

A notable limitation to the study that may restrict the generalizability of the results, the authors write, is the demographic composition of the cohort – primarily older White men.

Reference: Xie Y, Xu E, Al-Aly Z. Risks of mental health outcomes in people with covid-19: cohort study. BMJ. 2022;376:e068993.

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