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Severe COVID Associated With Long-Term Symptoms of Depression, Anxiety

NEW YORK (Reuters Health) – People who have been bedridden for seven days or more with COVID-19 are at increased risk of experiencing symptoms of anxiety and depression, a new study of data from several countries shows.

However, those with a mild infection appear to be at lower risk of the mental-health problems compared with people not diagnosed with the virus, researchers report in The Lancet Public Health.

“A key message: the severity of the acute COVID-19 illness period may be informative of the risks of long-term adverse long-COVID mental-health symptoms,” said senior author Dr. Unnur Anna Valdimarsdottir of the University of Iceland.

“While most individuals seem to recover quickly in terms of mental health after COVID-19, a minority (in our study 22%) that suffers a severe acute illness (bedridden for a week or longer) show a persistently high prevalence of anxiety and depressive symptoms throughout the 16 months of observation,” she told Reuters Health by email. “Obviously these results need to be replicated in future studies, yet, the similar results across the participating countries/cohorts offer quite compelling evidence.”

The findings should alert clinicians to the possibility of long-term mental-health symptoms in their patients who suffer severe acute illness, Dr. Valdimarsdottir said.

The researcher and her colleagues analyzed data from seven prospectively planned cohorts across six nations (Denmark, Estonia, Iceland, Norway, Sweden and the U.K.). Patients were 18 and older and had been recruited between March 27, 2020, and August 13, 2021.

Of the more than 247,000 people included in the analysis, 9,979 were diagnosed with COVID-19 between February of 2020 and August of 2021.

Overall, those diagnosed with COVID-19 had a higher prevalence of depression symptoms (prevalence ratio, 1.18; 95% CI, 1.03 to 1.36) and poorer sleep quality (PR, 1.13; 95% CI, 1.03 to 1.24), but not symptoms of anxiety or COVID-19-related distress compared to those without a COVID-19 diagnosis.

When the researchers broke the sample down by disease severity, they found striking differences. Those diagnosed COVID-19 but never bedridden due to the disease were consistently at significantly lower risk of depression (PR, 0.83) and anxiety (PR, 0.77) than those not diagnosed with COVID-19, but those who were bedridden for seven days or more had a significantly higher risk of symptoms of depression (PR, 1.61) and anxiety (PR, 1.43) for as long as 16 months after their diagnosis.

The finding of a lower prevalence of mental-health problems among people with limited COVID-19 symptoms might seem counterintuitive.

“This group may experience a relief after recovery from the relatively benign infection and are able to return to somewhat normal lives as compared to those not yet diagnosed with COVID-19, perhaps still fearing infection and therefore still limiting social contact,” Dr. Valdimarsdottir speculated.

The results are probably applicable to U.S. patients, said Dr. Jacqueline Becker, an assistant professor of medicine at the Icahn School of Medicine at Mount Sinai, in New York City, and a neuropsychologist at Mount Sinai’s Center for Post COVID CARE and COVID-19 Registry.

While it’s not surprising that bedridden patients might sustain mental-health problems, “I think it’s becoming more and more clear over time that the inflammation from COVID-19 can cause these sorts of long-haul issues,” Dr. Becker told Reuters Health by email. “That said, it doesn’t mean that inflammation couldn’t happen after other disease processes. But this is happening on such a huge, unprecedented scale. We’re capturing a large portion of the population having these symptoms.”

“This does present a huge public-health issue,” Dr. Becker said. “The reality is many of these people aren’t able to get back to baseline functioning. Many have long-haul issues. This is now considered a disability under the Americans With Disabilities Act. For this reason I think it’s going to be really important to figure out a way to systematically evaluate these patients for disability benefits and accommodations.”

SOURCE: The Lancet Public Health, online March 14, 2022.

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