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‘Staggeringly High’ Rates of Psychiatric Symptoms After COVID-19

DENVER — Neurocognitive and psychiatric symptoms of mental illness, including posttraumatic stress disorder (PTSD), are alarmingly high among patients who have previously had COVID-19 — even among those who were not hospitalized with the virus, new research shows.

The findings are from an online survey of more than 800 respondents.

“Regardless of how long ago they had been infected with COVID-19, all respondents had persistent symptoms,” co-investigator Beth Patterson, MSc, adjunct clinical professor at McMaster University, MacAnxiety Research Centre, Hamilton, Canada, told Medscape Medical News.

“The take-home message for clinicians is to be aware that if you have patients who had COVID-19, it’s quite likely that they may also experience a psychiatric issue, and that they may have reduced resilience and lower quality-of-life [issues],” Patterson said.

The survey results were presented here at the Anxiety and Depression Association of America (ADAA) Conference 2022.

100% Report Symptoms

The study included 827 respondents (81% women) to an online survey who had contracted COVID.

Using validated symptom severity scores, respondents were assessed for mental health and neurocognitive issues, as well as some physical and quality-of-life factors.

Remarkably, all participants (100%) reported having current, persistent symptoms of COVID. In addition, 88% (n = 729) reported persistent neurocognitive symptoms, even though only 15.5% reported they had been hospitalized for COVID.

Of those hospitalized, 28.9% were treated in the intensive care unit; 42.2% stayed in hospital for less than 1 week and 13.3% remained hospitalized for at least 3 weeks.

Data were not available on how long it had been since the patients were diagnosed or hospitalized, but most participants (68%) said they had not returned to normal functioning since contracting COVID.

The most common persistent symptoms were fatigue (75.9%), brain fog (67.9%), difficulty concentrating (61%), and weakness (51.2%).

More than half of respondents reported neurocognitive symptoms, including poor memory (57.4%) and word-finding problems in processing information (46.9%). Only 11% reported no persistent neurocognitive symptoms.

A total of 41.7% of respondents reported anxiety using the Generalized Anxiety Disorder-7 (GAD-7) scale and rates of depression were 61.4% assessed with the Patient Health Questionnaire (PHQ-9).

Rates of probable posttraumatic stress disorder (PTSD) were 40.5% as assessed via the PTSD checklist (PCL-5).

Although it wasn’t possible to use diagnostic screens, the assessment scores suggest strikingly high rates of mental health disorders among the respondents, Patterson said.

“When we look at the mean scores on the validated scales, we see percentages of probable diagnoses that are staggeringly higher than you would find in the population,” she added.

Of note, about 44% of respondents reported having had mental health treatment in the past, and 33.7% were receiving current mental health treatment.

Although the study had no control group, the findings are consistent with larger studies that have had comparator groups, including research recently published in the BMJ.

Poor Understanding of COVID’s Fallout

In an editorial accompanying the BMJ study, Scott Weich, MD, Mental Health Research Unit, School of Health and Related Research, University of Sheffield, United Kingdom, emphasized the need to better understand the lingering mental health aspects of COVID-19 infection.

“Our attachment to syndromal phenotypes means that we have learned remarkably little about the causes of mental ill health — in this case psychopathology associated with a viral pandemic,” Weich writes.

Weich called for improved efforts to understanding long COVID, as well as the establishment of more effective responses to the mental health fallout from the pandemic.

Commenting on the current study for Medscape Medical News, Weich elaborated on the challenges in disentangling the causes of mental health effects in illness.

“In terms of other viruses, etc, there is a long history of debate and pitched battles between those that attribute mental health effects to predominantly biological processes, [involving] immunological and other responses, and those who understand these responses are mediated by psychological and social processes,” he noted

“The story of myalgic encephalomyelitis/chronic fatigue syndrome speaks volumes about these different positions, and how difficult it can be to find a middle ground,” he said.

“This has been going on for centuries and may never be fully resolved, at least until we have clearer and more definitive evidence of pathophysiology, though this seems incredibly elusive,” Weich said.

The authors and Weich have disclosed no relevant financial relationships.

Anxiety and Depression Association of America (ADAA) Conference 2022: Abstract 219B. Presented March 20, 2022.

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