Social isolation, economic strain, loss of loved ones and other hardships during the pandemic have contributed to an increase in mental health issues such as anxiety and depression.
But can having Covid-19 increase the risk of developing mental illness? A new study says yes.
Published Wednesday in the journal BMJ, the large study analyzed records of nearly 154,000 Covid patients in the Veterans Health Administration system and compared their experiences in the year following their recovery from the initial infection with the experiences of a similar group of people who have not contracted the virus.
The study included only patients who had no diagnosis or treatment of mental illness for at least two years before becoming infected with the coronavirus, allowing researchers to focus on psychiatric diagnoses and treatments that occurred after infection with the virus.
People who had Covid were 39% more likely to be diagnosed with depression and 35% more likely to be diagnosed with anxiety in the months following infection than people without Covid during the same period, the study concluded. Covid patients were 38% more likely to be diagnosed with stress and adjustment disorders and 41% more likely to have symptoms of sleep disturbances than uninfected people.
“There seems to be a clear over-diagnosis of mental illness in the months after Covid,” said Paul Harrison, a professor of psychiatry at the University of Oxford who was not involved in the study. He said the results reflect the picture that emerges from other research, including a 2021 study of which he was one of the authors, and “reinforces the thesis that there is something about Covid that is putting people at greater risk for common conditions of illness.” mental health”.
The data do not suggest that the majority of Covid patients will develop mental health symptoms. In the study, only between 4.4% and 5.6% of them received diagnoses of depression, anxiety or stress and adjustment disorders.
“It’s not an epidemic of anxiety and depression, thankfully,” Dr. Harrison said. “But it’s not trivial.”
The researchers also found that Covid patients were 80% more likely to develop cognitive problems such as brain fog, confusion and forgetfulness than those who did not have Covid. They were 34% more likely to develop opioid use disorders, possibly from prescription pain medications, and 20% more likely to develop non-opioid substance use disorders, including alcoholism, the study reported.
After having Covid, people were 55% more likely to take prescription antidepressants and 65% more likely to take prescription anti-anxiety medications than those without Covid, the study found.
Overall, more than 18% of Covid patients received a diagnosis or prescription for a neuropsychiatric problem in the following year, compared with less than 12% of the non-Covid group. Covid patients were 60% more likely to fall into these categories than people who didn’t have Covid, the study found.
The work found that patients hospitalized for Covid were more likely to be diagnosed with mental health problems than those with less severe coronavirus infections. But people with mild initial infections were still at greater risk than people without Covid.
“Some people always argue that ‘maybe people are depressed because they had to go to the hospital and spent a week in the ICU,'” said the study’s lead author, Dr. Ziyad Al-Aly, head of research and development at St. Louis of the Veterans Administration and clinical researcher in public health at Washington University in St. Louis (Missouri).
“In people who weren’t hospitalized for Covid-19, the risk was lower, but certainly significant. And most people don’t need to be hospitalized, so that’s really the group that represents the majority of people with Covid-19.”
The team also compared the mental health diagnoses of people hospitalized for Covid with those hospitalized for any other reason. “Whether people were hospitalized for a heart attack, chemotherapy or any other condition, the Covid-19 group was at increased risk,” Al-Aly said.
The study involved electronic medical records of 153,848 adults who tested positive for the coronavirus between March 1, 2020 and January 15, 2021 and survived for at least 30 days. Because it was at the beginning of the pandemic, very few had been vaccinated before the infection.
Patients were followed up until November 30, 2021. Al-Aly said his team planned to look at whether later vaccination modified people’s mental health symptoms, as well as other post-Covid medical issues the group studied.
Covid patients were compared with more than 5.6 million patients in the Veterans system who did not test positive for coronavirus and more than 5.8 million patients before the pandemic, from March 2018 to January 2019. .
To try to assess the health effect of Covid-19 compared to that of other viruses, patients were also compared with about 72,000 patients who had flu during the two and a half years before the pandemic. (Al-Aly said there were too few cases of flu during the pandemic to offer a proper comparison.)
The researchers tried to minimize differences between the groups by adjusting for many demographic characteristics, pre-Covid health conditions, residence in nursing homes and other variables.
In the year after infection, Covid patients had higher percentages of mental health diagnoses than the other groups.
“It’s not really surprising to me, because we’ve seen it,” said Dr. Maura Boldrini, an associate professor of psychiatry at Columbia University’s NewYork-Presbyterian Medical Center. “I think it’s amazing how often we’ve seen people with these new symptoms without a previous psychiatric history.”
Most of the veterans in the study were men, three-quarters were white, and their average age was 63, so the findings may not apply to all Americans. Still, the study included more than 1.3 million female patients and 2.1 million people of color, and Al-Aly said that “we found evidence of increased risk regardless of age, race or sex.”
There are several possible reasons for the rise in mental health diagnoses, according to Al-Aly and other experts. Boldrini said he believed the symptoms were likely influenced by both biological factors and the psychological stresses associated with an illness.
“There is no analysis that tells the whole story,” said Al-Aly. “Perhaps all or most of us have experienced some sort of emotional disturbance, mental health stress or some sleep problem,” he added. “But for people with Covid it was worse.”
Translated by Luiz Roberto M. Gonçalves.
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