One-third of individuals diagnosed with COVID-19 developed a psychiatric or neurological problem within six months of their diagnosis, according to a study published Tuesday in The Lancet Psychiatry. The prevalence of a post-COVID neurologic or psychiatric diagnosis was even greater among individuals with severe illness who had required hospitalization.
“Given the size of the pandemic and the chronicity of many of the diagnoses and their consequences (for example, dementia, stroke, and intracranial hemorrhage), substantial effects on health and social care systems are likely to occur,” wrote Maxime Taque, Ph.D., of the University of Oxford and colleagues. “Our data provide important evidence indicating the scale and nature of services that might be required.”
Taque and colleagues used data from a multinational electronic health record (EHR) database to identify 236,379 patients diagnosed with COVID-19 on or after January 20, 2020, and who were still alive on December 13, 2020. This sample included 190,077 patients who did not require hospitalization and 46,302 who did (including 8,945 patients who required intensive care). For control groups, Taque and colleagues also examined the EHR records of patients diagnosed with influenza and patients diagnosed with any respiratory tract infection during the same period.
The researchers then investigated the occurrence of the following neuropsychiatric outcomes in the first 180 days after COVID-19 diagnosis: intracranial hemorrhage; ischemic stroke; Parkinson’s disease; Guillain-Barré syndrome; nerve, nerve root, and plexus disorders; neuromuscular disorders; encephalitis; dementia; psychotic disorders; mood disorders; anxiety disorders; substance use disorder; and insomnia.
Overall, 33.62% of COVID-19 patients received one of the above diagnoses within 180 days; this rate increased to 38.73% among patients who were hospitalized and 46.42% among patients admitted to intensive care. The rates of almost all these outcomes were higher in patients in the COVID-19 group compared with those in the influenza group or respiratory tract infection group. The exceptions were Parkinson’s disease and Guillain-Barré syndrome, which were similar in COVID-19 and influenza patients.
Anxiety disorders were the most common neuropsychiatric diagnoses among all patients, occurring in 17.39% of COVID-19 patients; they were followed by mood disorders in 13.66% of COVID-19 patients and substance use disorder at 6.58% of COVID-19 patients. Psychotic disorders were diagnosed in 1.40% of COVID-19 patients.
Compared with neurological disorders, the rates of mood and anxiety disorders did not significantly increase among hospitalized patients, Taque and colleagues noted. “This might indicate that their occurrence reflects, at least partly, the psychological and other implications of a COVID-19 diagnosis rather than being a direct manifestation of the illness,” they wrote.
For related information, see the Psychiatric News article “Expect a ‘Long Tail’ of Mental Health Effects From COVID-19.”