Post SARS-CoV-2 infection -psychiatric diagnoses

[jim mcnamara]

TL;DR Summary

Strong association between having had Covid-19 and and later a psychiatric diagnosis

https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(20)30462-4/fulltext

Summary
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.

Results

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.

Take away - It does not identify 'long haulers' - patients who have often severe symptoms of Covid-19 that persist for months after the infection has ended. Maybe there is some association there. But overall, this is not good news, especially dementia. Dementia could be explained in part by 'ICU psychosis' delirium and cognitive degradation seen after long ICU treatments. >maybe?

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5316795/

 

[Greg Bernhardt]

This is definitely concerning news, especially when it comes to the increased risk of dementia. It would be interesting to see if this trend holds true for long-haulers as well, since they may face a higher risk of developing a psychiatric disorder due to their longer battle with the virus. Unfortunately, this study does not provide any insights as to whether long-haulers are at a higher risk, but it could be worth investigating further.