Psychiatry

COVID-19 Doubles the Risk for New Psychiatric Illness

Research on over 62,000 patients highlights a looming mental health crisis.

Posted Nov 18, 2020

As the death toll from COVID-19 continues to rise, and the number of cases skyrockets in the U.S. and around the world, the sheer weight of concrete suffering, the strain on healthcare systems and the economy, and the disorganized response from government and community threatens to eclipse awareness of important mental health implications. 

Mental Health Advocacy

The likelihood of long-range problems increases exponentially with every passing moment that mental health issues remain only partially addressed. As of the writing of this article, President-Elect Joe Biden’s COVID-19 Advisory Board has yet to appoint a member with a background in psychiatry and mental health, a worrisome situation. Healthcare workers are thought to be at particular risk for mental health problems after COVID, including but not limited to PTSD. The effect on the general population cannot be overstated.

There has been an avalanche of research on COVID-19 addressing both physical and mental health consequences. While specific findings vary around the world depending on local factors and statistical variations, there is a clear consensus that mental illness is increased by COVID-19. Psychiatric leaders have called for action given high rates of psychiatric illness and suicide following COVID-19 based on earlier studies. Accumulating evidence suggests that COVID-19 may uniquely affect the brain and immune system to contribute to mental illness along with other conditions. One respected research group has suggested a unique constellation of problems related to the pandemic they have called “COVID Stress Syndrome.”

Large-scale study of psychiatric illness and COVID-19

While smaller studies are important, and easier to complete on a shorter time frame, research with larger data sets has taken longer to develop both due to the logistics of conducting those studies and the need to track data for a longer time span to get reliable results.

Filling the gap, Maxime Taquet, Sierra Luciano, John R. Geddes and Paul J. Harrison published in the journal Lancet Psychiatry (2020) a detailed analysis of over 62,000 COVID-19 patients' electronic health records. They looked at comparison records from the prior year, and recent COVID-19 survivors to get a statistically vigorous before-and-after snapshot.

They analyzed a database of medical records to determine whether coronavirus infection was correlated with increased rates of mental health issues, especially first psychiatric diagnosis in the three months following infection. They compared psychiatric diagnoses for anxiety, mood, psychotic, and related disorders among patients with COVID-19 and several other major categories of non-COVID illness, including influenza, pneumonia, and other conditions. They also looked at how prior psychiatric illness influenced the chances of having COVID-19. They looked at demographic information and factors including external stress and illness severity, for example in hospitalized vs. non-hospitalized patients, to ensure results were reliable.

Findings

They found that first episode psychiatric illness was doubled in COVID survivors—5.8 percent of COVID survivors, compared with 2.5 to 3.4 percent of patients with other illnesses, had a first diagnosis. The most common diagnoses were anxiety disorders, found in 4.7 percent of COVID survivors, including adjustment disorder, generalized anxiety disorder, PTSD and panic disorder.

Rates of new mood disorders (e.g. depression, bipolar disorder) were 2 percent, significantly higher than after other illnesses, and rates of psychotic disorders were the same. Patients reported insomnia and dementia (among older adults) at higher rates than after other illnesses, at 1.9 and 1.6 percent, respectively. 

The risk of any psychiatric diagnosis (versus new diagnosis) was significantly increased after COVID-19 as well, with over 18 percent of patients with documented mental illness. Anxiety was most common, at 12.8 percent, followed by mood disorders at nearly 10 percent. Psychotic disorders were present in almost 1 percent, higher than after other illnesses. Importantly, patients who had a psychiatric diagnosis in the prior 12 months had a 65 percent increased risk of catching COVID-19, a risk even higher for older patients.

Implications 

This study is one of the first high-powered large studies looking at a large sample of US COVID-19 survivors, comparing thousands of medical records of COVID-19 patients with matched patients with other illnesses to determine whether their increased risk of new, and overall, psychiatric diagnosis was increased after having coronavirus. 

The study found that the risk of new mental illness was doubled, with the highest risk for anxiety disorders, insomnia, and dementia. The risk of any mental illness, new or recurrent, was nearly 20 percent, highlighting the effect on psychological and emotional well-being from COVID-19. These findings were robust, remaining significant after controlling for factors including ethnicity, gender, environmental factors, illness severity, and others.

The long-term impact of mental illness is considerable, affecting people years later in the form of personal and professional impairment and higher risk of future medical problems and substance use disorders, especially for people in lower socioeconomic groups.

It is not clear why COVID-19 increases the risk of psychiatric illness, but it is likely to involve specific biological factors related to how the virus affects the central nervous system and vascular system (blood clotting), how the virus impacts the Renin-Angiotensin-Aldosterone System (RAAS, an important endocrine sub-system involved in blood pressure and stress responses), and inflammatory and immune responses, along with the general effects of environmental stress and disruption to normal life.

Likewise, it is unclear why prior psychiatric illness increases the risk of COVID-19 infection, but the risk, if confirmed in future research, is likely due to a combination of factors including differences in health-protective behavior (e.g. reduced mask use and social-distancing related to personality and related factors), biological aspects of psychiatric illness including inflammation, and potential vulnerability related to medication. Other studies, such as recent research in South Korea (2020), have not found a strong association with positive tests but did see more severe COVID-19, once infected, though the size of the sample was smaller.

Future research will look more closely at causal factors in larger patient populations, but it is clear that the neuropsychiatric dimensions of COVID-19 are considerable, and likely to outlast other issues for years to come. Understanding the biology of how COVID-19 unique impacts brain health is critical to determining the unique constellation of symptoms, and how this coronavirus can cause prolonged problems ("long COVID") well after many other infections would have fully resolved. From an advocacy point of view, it is imperative that resources be devoted to addressing the mental health impact of COVID-19 to prevent amplified future illness and loss of function.

These efforts will be most effective when mandated by the highest authorities and supported on the level of local government, communities, and healthcare systems. Individuals can advocate for greater attention to COVID-related mental illness by reaching out to our elected officials, and sharing constructive information on social media—which can be leveraged for post-traumatic growth—and via other channels.

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