One in eight people who have had COVID-19 are diagnosed with their first psychiatric or neurological illness within six months of testing positive for the virus, found a large UK data analysis, adding heft to an emerging body of evidence that stresses the toll of the virus on mental health and brain disorders cannot be ignored.
The Guardian reports that the analysis – which is still to be peer-reviewed – also found that those figures rose to one in three when patients with a previous history of psychiatric or neurological illnesses were included.
It found that one in nine patients were also diagnosed with things such as depression or stroke despite not having gone to hospital when they had COVID-19, which was surprising, said the lead author, Dr Max Taquet of the department of psychiatry at the University of Oxford.
The researchers used electronic health records to evaluate 236,379 hospitalised and non-hospitalised US patients with a confirmed diagnosis of COVID-19 who survived the disease, comparing them with a group diagnosed with influenza, and a cohort diagnosed with respiratory tract infections between 20 January and 13 December 2020.
The analysis, which accounted for known risk factors such as age, sex, race, underlying physical and mental conditions and socio-economic deprivation, found that the incidence of neurological or psychiatric conditions post-COVID within six months was 33.6%. Nearly 13% received their first such diagnosis.
The data adds to prior research by Taquet and others that showed nearly one in five people who have had COVID-19 are diagnosed with a psychiatric disorder within three months of testing positive for the virus.
In the prior study, researchers at the University of Oxford, department of psychiatry and NIHR Oxford Health Biomedical Research Centre, report the first large-scale evidence that COVID-19 survivors are at an increased risk of psychiatric disorders. The study used the TriNetX electronic health records of 69m people in the US including over 62,000 cases of COVID-19.
In the 3 months following testing positive for COVID-19, 1 in 5 survivors were found to get a diagnosis of anxiety, depression, or insomnia, for the first time. This is about twice as likely as for other groups of patients over the same period. A diagnosis of dementia may also be commoner. COVID-19 was also associated with more new psychiatric diagnoses in people who already had a history of psychiatric problems. Overall, almost 20% of people received a psychiatric diagnosis within 90 days of getting COVID-19.
Paul Harrison, professor of psychiatry, University Oxford, Theme Lead – NIHR Oxford Health BRC, who led the study, commented: “People have been worried that COVID-19 survivors will be at greater risk of mental health problems, and our findings in a large and detailed study show this to be likely. Services need to be ready to provide care, especially since our results are likely to be underestimates of the actual number of cases. We urgently need research to investigate the causes and identify new treatments.”
The researchers also found that people with a pre-existing psychiatric diagnosis were 65% more likely to be diagnosed with COVID-19 than those without, even when the known risk factors for COVID-19 were taken into account.
Taquet, who conducted the analyses, remarked: “This finding was unexpected and needs investigation. In the meantime, having a psychiatric disorder should be added to the list of risk factors for COVID-19.”
This study was supported by the NIHR Oxford Health Biomedical Research Centre.
Study details
Six-month Neurological and Psychiatric Outcomes in 236,379 Survivors of COVID-19
M Taquet, JR Geddes, M Husain, S Luciano, PJ Harrison
Published in medRxiv on 24 January 2021
Abstract
Background
Neurological and psychiatric sequelae of COVID-19 have been reported, but there are limited data on incidence rates and relative risks.
Methods
Using retrospective cohort studies and time-to-event analysis, we estimated the incidence of ICD-10 diagnoses in the 6 months after a confirmed diagnosis of COVID-19: intracranial haemorrhage; ischaemic stroke; Parkinsonism; Guillain-Barré syndrome; nerve/nerve root/plexus disorders; myoneural/muscle disease; encephalitis; dementia; mood, anxiety, and psychotic disorders; substance misuse; and insomnia. Data were obtained from the TriNetX electronic health records network (over 81 million patients). We compared incidences with those in propensity score-matched cohorts of patients with influenza or other respiratory infections using a Cox model. We investigated the effect on incidence estimates of COVID-19 severity, as proxied by hospitalization and encephalopathy (including delirium and related disorders).
Findings
236,379 patients survived a confirmed diagnosis of COVID-19. Among them, the estimated incidence of neurological or psychiatric sequelae at 6 months was 33.6%, with 12.8% receiving their first such diagnosis. Most diagnostic categories were commoner after COVID19 than after influenza or other respiratory infections (hazard ratios from 1.21 to 5.28), including stroke, intracranial haemorrhage, dementia, and psychotic disorders. Findings were equivocal for Parkinsonism and Guillain-Barré syndrome. Amongst COVID-19 cases, incidences and hazard ratios for most disorders were higher in patients who had been hospitalized, and markedly so in those who had experienced encephalopathy. Results were robust to sensitivity analyses, including comparisons against an additional four index health events.
Interpretation
The study provides evidence for substantial neurological and psychiatric morbidity following COVID-19 infection. Risks were greatest in, but not limited to, those who had severe COVID-19. The information can help in service planning and identification of research priorities.
Funding
National Institute for Health Research (NIHR) Oxford Health Biomedical Research Centre.
Study details
Bidirectional associations between COVID-19 and psychiatric disorder: retrospective cohort studies of 62 354 COVID-19 cases in the USA
Maxime Taquet, Sierra Luciano, John R Geddes, Paul J Harrison
Published in The Lancet Psychiatry on 9 November 2020
Abstract
Background
Adverse mental health consequences of COVID-19, including anxiety and depression, have been widely predicted but not yet accurately measured. There are a range of physical health risk factors for COVID-19, but it is not known if there are also psychiatric risk factors. In this electronic health record network cohort study using data from 69 million individuals, 62 354 of whom had a diagnosis of COVID-19, we assessed whether a diagnosis of COVID-19 (compared with other health events) was associated with increased rates of subsequent psychiatric diagnoses, and whether patients with a history of psychiatric illness are at a higher risk of being diagnosed with COVID-19.
Methods
We used the TriNetX Analytics Network, a global federated network that captures anonymised data from electronic health records in 54 health-care organisations in the USA, totalling 69·8 million patients. TriNetX included 62 354 patients diagnosed with COVID-19 between Jan 20, and Aug 1, 2020. We created cohorts of patients who had been diagnosed with COVID-19 or a range of other health events. We used propensity score matching to control for confounding by risk factors for COVID-19 and for severity of illness. We measured the incidence of and hazard ratios (HRs) for psychiatric disorders, dementia, and insomnia, during the first 14 to 90 days after a diagnosis of COVID-19.
Findings
In patients with no previous psychiatric history, a diagnosis of COVID-19 was associated with increased incidence of a first psychiatric diagnosis in the following 14 to 90 days compared with six other health events (HR 2·1, 95% CI 1·8–2·5 vs influenza; 1·7, 1·5–1·9 vs other respiratory tract infections; 1·6, 1·4–1·9 vs skin infection; 1·6, 1·3–1·9 vs cholelithiasis; 2·2, 1·9–2·6 vs urolithiasis, and 2·1, 1·9–2·5 vs fracture of a large bone; all p<0·0001). The HR was greatest for anxiety disorders, insomnia, and dementia. We observed similar findings, although with smaller HRs, when relapses and new diagnoses were measured. The incidence of any psychiatric diagnosis in the 14 to 90 days after COVID-19 diagnosis was 18·1% (95% CI 17·6–18·6), including 5·8% (5·2–6·4) that were a first diagnosis. The incidence of a first diagnosis of dementia in the 14 to 90 days after COVID-19 diagnosis was 1·6% (95% CI 1·2–2·1) in people older than 65 years. A psychiatric diagnosis in the previous year was associated with a higher incidence of COVID-19 diagnosis (relative risk 1·65, 95% CI 1·59–1·71; p<0·0001). This risk was independent of known physical health risk factors for COVID-19, but we cannot exclude possible residual confounding by socioeconomic factors.
Interpretation
Survivors of COVID-19 appear to be at increased risk of psychiatric sequelae, and a psychiatric diagnosis might be an independent risk factor for COVID-19. Although preliminary, our findings have implications for clinical services, and prospective cohort studies are warranted.
Funding
National Institute for Health Research.
[link url="https://www.theguardian.com/world/2021/jan/25/covid-linked-to-risk-of-mental-illness-and-brain-disorder-study-suggests"]Full report in The Guardian (Open access)[/link]
[link url="https://www.medrxiv.org/content/10.1101/2021.01.16.21249950v1.full.pdf"]medRxiv study (Restricted access)[/link]
[link url="https://www.research.ox.ac.uk/Article/2020-11-10-almost-20-of-covid-19-patients-receive-a-psychiatric-diagnosis-within-90-days"]University of Oxford material[/link]
[link url="https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(20)30462-4/fulltext"]The Lancet Psychiatry study (Open Access)[/link]
See also MedicalBrief archives:
[link url="https://www.medicalbrief.co.za/archives/covid-19-increases-risk-of-new-psychiatric-disorders-data-analysis-of-69m-americans/"]COVID-19 increases risk of new psychiatric disorders — Data analysis of 69m Americans[/link]
[link url="https://www.medicalbrief.co.za/archives/who-survey-covid-19s-devastating-effect-on-mental-health-services/"]WHO survey: COVID-19’s ‘devastating’ effect on mental health services[/link]
[link url="https://www.medicalbrief.co.za/archives/covid-19-lockdowns-tied-to-an-increase-in-binge-drinking-us-study/"]COVID-19 lockdowns tied to an increase in binge drinking — US study[/link]