Covid-19 patients at higher risk of experiencing mental health issues, study suggests

People who have survived the acute stage of Covid-19 have a higher chance of experiencing mental health issues within a year, a study by Washington University suggests.

Those problems include anxiety, depression, suicidal thoughts and sleep disturbances, according to the research led by Dr Ziyad Al-Aly, a clinical epidemiologist at the university’s School of Medicine in St Louis.

The study – published in The BMJ on Wednesday – also found an increased risk of substance use disorders including opioids and non-opioids such as alcohol and illicit drugs.

The researchers analysed the anonymous medical records of nearly 154,000 Covid-19 patients who had survived and were in the US Veterans Health Administration system from March 2020 to January 2021.

They then tracked the patients’ medical outcomes from the period after the acute phase of Covid-19 until the end of November 2021, according to the paper.

This health information was compared with that of two control groups: more than 5.6 million patients who did not have Covid-19 during that period; and over 5.8 million people who were patients in 2017, before the pandemic.

None of the study participants had been diagnosed with or treated for a mental health condition in the two years before the start of the follow-up analysis.

The team found that – compared with those in the control groups who had not been infected – people who contracted Covid-19 were 35 per cent more likely to suffer from anxiety disorders and nearly 40 per cent more likely to experience depression or stress-related disorders.

They also found the Covid-19 patients were 55 per cent more likely to use antidepressants and 65 per cent more likely to use benzodiazepines to treat anxiety. The paper said people in this group were also 41 per cent more likely to have sleep disorders and 63 per cent more likely to take a prescribed sleeping medication.

Many of the Covid-19 patients also had “brain fog”, or neurocognitive decline. The study suggested they were 80 per cent more likely to experience neurocognitive decline, with symptoms such as forgetfulness, confusion and a lack of focus.

“The findings suggest that people with Covid-19 are experiencing increased rates of mental health outcomes, which could have far-reaching consequences,” Al-Aly wrote in an opinion piece published with the study in the medical journal.

“The increased risk of opioid use is of particular concern, especially considering the high rates of opioid use disorders pre-pandemic,” he said. “The increased risks of mental health outcomes in people with Covid-19 demands greater attention now to mitigate much more serious downstream consequences in the future.”

To better understand the link between Covid-19 and mental health problems, the researchers also compared the medical records of people who had been infected with seasonal influenza from October 2017 to February 2020.

The control group was divided in two: more than 60,000 people who had not been hospitalised and nearly 12,000 people who had. The researchers said the mental health risks remained higher – those who had mild Covid-19 were 27 per cent more likely to have mental health issues, and it was 45 per cent for serious cases.

“Mental health disorders represent one part of the multifaceted nature of long Covid, which can affect nearly every organ system including the brain, heart and kidneys … The body of evidence on long Covid – from our work and others – suggests the need to reframe our thinking about Sars-CoV-2,” Al-Aly said, referring to the virus that causes Covid-19.

“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.”

The study has limitations – most participants were older white men, and few were vaccinated since vaccines were not widely available at the time of enrolment. The researchers also noted that people with Covid-19 may get more medical attention than they otherwise would and would be more likely to be diagnosed with a mental illness.

“As the pandemic continues to evolve, new variants of the virus emerge, treatment strategies of acute Covid-19 improve, and vaccine uptake increases, it is likely that the epidemiology of mental health outcomes in the post-acute phase of Covid-19 might also vary over time,” the researchers said.

Scientists are still trying to understand what causes long Covid, with some looking at whether vaccination could reduce its incidence. A recent review of 15 studies by the UK Health Security Agency found people infected with Covid-19 who had received two doses of the Pfizer, AstraZeneca or Moderna vaccines or one dose of the Janssen vaccine were about half as likely to develop long Covid symptoms – lasting more than 28 days – than those who had received one dose or were unvaccinated.

Last week, Al-Aly and other researchers published a parallel study analysing the same population that suggested people who have had Covid-19 are at higher risk of developing heart problems.