Severe COVID-19 May Increase Risk of Mental Health Problems Months After Diagnosis

Adults who experience severe illness after contracting COVID-19 appear more likely to develop symptoms of depression, anxiety, and/or poor sleep in the months following their illness than adults without a COVID-19 diagnosis, reports a study published this week in The Lancet Public Health. The study—based on analysis of data from people living in six European countries and tracked for up to 16 months—also suggests that adults who experience mild COVID-19 symptoms may have a slightly lower risk of subsequent mental health problems compared with adults without a COVID-19 diagnosis.

The findings highlight the importance of continuing to closely monitor patients and conducting “follow-up studies beyond the first year among individuals with the most severe symptomology after COVID-19 infections,” wrote Ingibjörg Magnúsdóttir, M.Sc., of the University of Iceland; Anikó Lovik, Ph.D., of the Karolinska Institute in Sweden; and colleagues.

The study investigators compiled data from patient cohorts in Denmark, Estonia, Iceland, Norway, Sweden, and the United Kingdom. The data were collected between March 27, 2020, and August 13, 2021, and the study sample included 247,249 patients, including 9,979 with a COVID-19 diagnosis. Of the patients who had COVID-19, 31.6% had a mild illness (defined as never bedridden), 24.6% had a moderate illness (bedridden at home or in the hospital for one to six days), and 16.2% had severe illness (bedridden for seven or more days at home or in the hospital). There were no data on the severity of COVID-19 in 27.6% of the patients.

Overall, people diagnosed with COVID-19 of any severity had an 18% higher prevalence of depression symptoms and 13% higher prevalence of poor sleep within 16 months of diagnosis compared with individuals without a COVID-19 diagnosis; rates of anxiety symptoms were similar between the groups.

When focusing on the severity of illness, the investigators found that people with severe COVID-19 had a 61% higher prevalence of depression symptoms, 43% higher prevalence of anxiety symptoms, and 41% higher prevalence of poor sleep compared with people without a COVID-19 diagnosis. In contrast, people with mild COVID-19 had a 17% lower prevalence of depression symptoms and 23% lower prevalence of anxiety symptoms than those without a COVID-19 diagnosis.

“Several factors might contribute to this pattern,” Magnúsdóttir, Lovik, and colleagues wrote. “For example, individuals with a mild COVID-19 infection were able to return to somewhat more normal lives after the benign infection as compared with their more severely impacted counterparts who still could be restrained by fear of ongoing symptoms. Also, the extended duration of official gathering restrictions might have had less impact on the mental health of recovered asymptomatic COVID-19 patients than the general population. … It is also possible that individuals with a low risk of mental morbidities before the pandemic had a less severe disease course after being infected.”

To read more on this topic, see the Psychiatric News article “Expect a ‘Long Tail’ of Mental Health Effects From COVID-19.”

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Lyme Disease Heightens Risk of Mental Disorders, Suicidality, Study Finds

People in Denmark diagnosed with Lyme disease in a hospital went on to have 28% higher rates of mental disorders and were twice as likely to have attempted suicide, compared with those without the diagnosis, according to a study published Wednesday in AJP in Advance. Having more than one episode of Lyme disease was associated with a higher rate of mental disorders, affective disorders, and suicide attempts.

According to the CDC, nearly half a million people a year in the United States are treated for Lyme disease (also known as Lyme borreliosis), the most common vector-borne disease, and the areas where Lyme disease is common are expanding. Several studies have pointed to a connection between Lyme disease and psychiatric manifestations in people with untreated infection as well as months to years after antibiotic therapy, wrote Brian A. Fallon, M.D., M.P.H., of Columbia University and New York State Psychiatric Institute and colleagues. The current study is believed to be the first large population-based study examining the relationship between Lyme disease and psychiatric outcomes.

The researchers analyzed patient medical records for the nearly 7 million people living in Denmark and compared individuals diagnosed with Lyme disease in a hospital setting (n=12,616) with those without this diagnosis. Specifically, they examined cases of various mental disorders and suicidality among all individuals and adjusted the results based on known risk factors for mental illness such as sex, age, education level, socioeconomic status, and comorbidities. Patients who had a history of mental disorder or suicidality prior to the Lyme disease diagnosis were excluded from the analysis.

The analysis revealed that in addition to patients with Lyme disease being at greater risk of mental disorders and suicide attempts compared with those without this disease, they also had a 42% higher rate of affective disorders and a 75% higher rate of death by suicide. “Notably, the rate for affective disorders was highest during the first year after diagnosis and highest for completed suicide during the first 3 years after diagnosis,” Fallon and colleagues wrote.

“Our study focused on those whose Lyme disease was severe enough to require hospital contact,” Fallon told Psychiatric News. “Our results are therefore not surprising, given that individuals with hospital-based diagnoses of serious infections are known to have an increased risk of subsequent affective disorders and suicide.” The study results may not be generalizable to potentially less severe cases of Lyme disease that were handled outside the hospital.

Despite the findings, hospital-diagnosed cases of Lyme disease were not a major contributor to the overall rate of mental disorders or suicide in the general population, the authors noted. For example, the absolute rate for suicide of patients who were diagnosed with Lyme disease in the hospital was low, accounting for 25 fatalities over a 22-year period, representing 0.2% of all suicides during that time.

“Although the absolute population risk is low, clinicians should be aware of the potential psychiatric sequelae of this global disease,” Fallon and colleagues concluded.

For more on this topic, see the chapter on infectious diseases in The American Psychiatric Association Publishing Textbook of Psychosomatic Medicine and Consultation-Liaison Psychiatry from APA Publishing.

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Youth With Congenital Heart Disease at Elevated Risk of Depression, Anxiety, ADHD, Study Finds

Children and adolescents with a congenital heart disease are at greater risk than those without of developing depression, anxiety, or attention-deficit/hyperactivity disorder (ADHD), according to a report in Pediatrics.

“Our data support the notion that the population of patients with [congenital heart disease], regardless of disease severity, would likely benefit from mental health screening and evidence-based therapy earlier in childhood,” wrote Vincent Gonzalez, M.D., of Baylor College of Medicine and colleagues.

Gonzalez and colleagues compiled electronic health record data from 118,785 youth aged 4 to 17 years who were hospitalized or seen in the emergency department at Texas Children’s Hospital between 2011 and 2016. They compared the rates of depression, anxiety, and ADHD among children with or without congenital heart disease, based on receiving a diagnosis and/or medication for one of these disorders. (Since anxiety and depression are treated with similar medications, the authors condensed these disorders into one category.)

Of the 118,785 youth in the sample, 1,164 had congenital heart disease, split roughly equally between simple and complex defects, as defined by the American Heart Association/American College of Cardiology guidelines. Overall, 18.2% and 5.1% of youth with congenital heart disease had a diagnosis or medication for anxiety/depression and ADHD, respectively, compared with 5.2% and 2.1%, respectively, of youth with no congenital heart disease. The prevalence of anxiety/depression or ADHD was statistically higher in children with congenital heart disease across all age groups studied: 4 to 9 years, 10 to 13 years, and 14 to 17 years. The odds of depression/anxiety or ADHD was about the same in children with simple or complex congenital heart disease.

Gonzalez and colleagues also found that minority and uninsured youth were significantly less likely to be diagnosed or treated for anxiety/depression or ADHD compared with white and insured youth, respectively, regardless of congenital heart disease severity. “[T]hese data underscore the importance of recognizing potential racial or ethnic bias in diagnosing mental health in children with [congenital heart disease], as well as enabling insurance coverage for treating these disorders,” they wrote.

For related information, see the Psychiatric News article “Acquired Mutations Link Congenital Heart Disease, Neurodevelopmental Disorders.”

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