Half of COVID survivors note lingering signs of depression

More than half of a sample of US COVID-19 survivors reported symptoms of major depressive disorder months after recovery, a research letter today in JAMA Network Open reports.

A team led by researchers from Massachusetts General Hospital and Harvard University analyzed internet-based nonprobability survey and Patient Health Questionnaire-9 (PHQ-9) responses from 82,319 adult coronavirus survivors delivered in eight waves from June 2020 to January 2021.

The PHQ-9 is a nine-question depression screening tool with 0 to 27 possible points; 10 or more points indicate moderate depression.

Headache, severity of coronavirus symptoms

Of all respondents, 3,904 reported a previous coronavirus infection. Of that number, 2,046 (52.4%) met the criteria for major depressive disorder a mean of 4.2 months (standard deviation, 2.7) after coronavirus symptom onset.

After adjusting for sociodemographic factors such as age, sex, race, ethnicity, household income, and geographic region and type (ie, urban, suburban, or rural), recall of a headache during COVID-19 infection was tied to greater odds of moderate or greater depressive symptoms (adjusted odds ratio [aOR], 1.33; 95% confidence interval [CI], 1.10 to 1.62).

More severe COVID-19 symptoms also increased the chances of depression (somewhat vs not at all severe aOR, 2.59; 95% CI, 2.04 to 3.30; very vs not at all severe aOR, 5.08; 95% CI, 3.93 to 6.59). Compared with men, women were less likely to have depressive symptoms (aOR, 0.72; 95% CI, 0.61 to 0.84), and the odds of symptoms decreased with advancing age (aOR by decade, 0.76; 95% CI, 0.72 to 0.81).

"In regression models, these symptoms were more likely among younger respondents compared with older respondents and among men compared with women as well as among those with greater self-reported overall COVID-19 severity compared with those with lower severity," the researchers wrote.

"We did not replicate a prior finding among 114 individuals with COVID-19 that loss of smell and taste were associated with greater near-term depressive and anxious symptoms."

Mean respondent age was 38.1 years, 44.3% were women, 10.7% were Hispanic, 11.2% were Black, and 3.6% were Asian.

Mitigation strategies recommended

The authors noted studies finding that a subset of recovered COVID-19 patients reported lingering symptoms involving mood, sleep, anxiety, and fatigue, all of which can contribute to the high rates of major depressive disorder seen in epidemiologic studies during the pandemic.

"Our results add to a growing body of evidence suggesting the importance of considering potential neuropsychiatric sequelae of COVID-19 infection," the authors said. "Our results also suggest the importance of considering strategies that might mitigate the elevated risk of depressive symptoms following acute infection."

The researchers cautioned that it's possible that people with depression are more likely to remember or report headache. "A further caveat is that we cannot attribute these symptoms to new onset of depression; individuals with acute infection could be less likely to recover from prior depressive episodes or those with preexisting depressive symptoms could have greater risk of contracting COVID-19," they wrote.

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