Long-Term Mental Health Consequences of COVID-19

This post was co-authored by Eugene Rubin, M.D., Ph.D., and Charles Zorumski, M.D.

Long-term sequelae of COVID-19 have become a public health concern. Nevertheless, there are limited data addressing the prevalence, characteristics, and duration of symptoms that persist after recovery from the acute phase of COVID-19. A recent systematic review, published in the journal Molecular Psychiatry by Na Zeng and colleagues, provides important information about this topic. These investigators searched the literature for studies examining recovery from COVID-19 that were published before September 30, 2021. They identified 151 studies that met specific criteria and combined those data utilizing meta-analytic techniques. The analyses involved data from over 1.2 million individuals from 32 countries.

The study team found that the most common long-term consequences of COVID-19 involve the respiratory system. Over 25 percent of patients experienced subjective (self-reported) respiratory symptoms during the year after remission of acute COVID-19. Over 45 percent had abnormal pulmonary function tests. Fatigue was the next most common consequence, with more than 28 percent experiencing this symptom during the year following infection.

Both psychiatric and neurological sequelae were common during the year following remission of an acute infection. About 20 percent of individuals developed psychiatric sequelae, and almost 19 percent developed neurological sequelae. With respect to psychiatric symptoms, over 18 percent of individuals had depression, almost 18 percent had post-traumatic stress disorder (PTSD), and over 16 percent had anxiety. In addition, more than 13 percent experienced a sleep disorder. With respect to neurological symptoms, over 19 percent of individuals demonstrated cognitive symptoms, and more than 17 percent had memory changes. About 15 percent lost their sense of taste and/or smell. Furthermore, over 12 percent noted concentration difficulties and over 11 percent headaches.

The authors investigated the duration of symptoms and reported the prevalence of symptoms during the first three months, 3-6 months, and 6-12 months following acute infections. Anxiety and depression were present in 12-15 percent of individuals at 6-12 months, and cognitive and/or memory deficits were present in over 20 percent at that time. Loss of taste or smell was noted in about 17 percent of individuals 6-12 months after acute infection. Symptoms of PTSD decreased by two-thirds over time, with about 7.4 percent being symptomatic 6-12 months after remission of acute infection.

By combining information from over 150 studies, these investigators provide important analyses demonstrating that COVID-19 is associated with substantial mental and physical consequences during the year following acute infection. Such consequences influence the lives of a large number of individuals as well as society as a whole.

Do these long-term sequelae eventually resolve? Do these symptoms respond to treatments? Can effective preventative strategies be developed? What mechanisms underlie these long-term symptoms? Further research is necessary to answer these questions.