Not surprisingly, anxiety, depression, posttraumatic stress disorder, and other mental health issues became more prevalent during the COVID-19 pandemic—and after. Studies have found that neurologic and psychiatric sequelae may last up to 6 months following COVID-19 infection.
It appears that COVID-19 infection—even past the acute stage—could put hospitalized patients at risk of exacerbating existing mental health conditions or even developing new conditions. Researchers from Salem Veterans Affairs Health Care System conducted a retrospective observational study from January 1, 2020, through January 1, 2022, of 50,805 veterans hospitalized with COVID-19 and 50,805 patients hospitalized for other reasons.
The researchers found that veterans with COVID-19 group had significantly higher rates of psychiatry-related hospitalization at both 90 and 180 days, as well as a significant increase in the incidence of outpatient mental health visits at 180 days. They also noted a significantly higher risk of new-onset depression and new-onset dementia in the COVID-19 patients at 180 days compared with the non-COVID-19 cohort.
The exact mechanism of the impact of COVID-19 hospitalization on new or worsening depression has yet to be uncovered, the researchers say, but it is known to be complex and interrelated. They point to post-COVID-19 follow-up studies that have found that even mild and asymptomatic infection may lead to cognitive impairment, delirium, extreme fatigue, and clinically relevant mood symptoms. The residual effects of COVID-19 appear to span multiple organ systems.
The researchers also cite current hypotheses about the psychiatric sequelae of COVID-19 that suggest sustained neuroinflammatory processes disrupt the blood-brain barrier, leading to damaged neurons and glia in the brain. In a systematic review , roughly one-third of patients developed neurologic symptoms in the acute phase of the disease, with brain abnormalities “suggestive of COVID-19 etiology.” What’s more, multiple studies have found that anxiety and depression worsen the clinical course of chronic disease, indicating that this mechanism is bidirectional.
Future studies should, among other things include outcomes assessed by COVID-19 disease severity, as well as various psychiatric adverse effects, to enhance provider vigilance and promote closer monitoring.