A new observational follow-up study in six European countries published in The Lancet Public Health links severe COVID-19 to long-term depression and anxiety.
University of Iceland at Reykjavik researchers led the study, which analyzed symptoms of depression, anxiety, COVID-related stress, and poor sleep quality among 247,249 adults, 4% of whom were diagnosed as having COVID-19 from Mar 27, 2020, to Aug 13, 2021.
Participants, who were followed up for as long as 16 months (average, 5.7), lived in Denmark, Estonia, Iceland, Norway, Sweden, or the United Kingdom. Most severely ill COVID-19 patients recuperated at home, but some spent time in a hospital.
Relative to uninfected participants, COVID-19 survivors had a higher prevalence of symptoms of depression (prevalence ratio [PR], 1.18, or 18% higher) and poor sleep quality (1.13) but not anxiety (0.97) or COVID-related distress (1.05).
The prevalence of depression and COVID-related distress lessened over time, but COVID-19 survivors who weren't bedridden during their illness were at consistently lower risk of depression (PR, 0.83) and anxiety (0.77) than their uninfected peers. COVID-19 survivors bedridden for more than 7 days (22.3% of infected patients), however, were at persistently higher risk for depression (PR, 1.61) and anxiety (1.43) than uninfected participants throughout the study period.
"Severe acute COVID-19 illness—indicated by extended time bedridden—is associated with long-term mental morbidity among recovering individuals in the general population," the researchers wrote. "These findings call for increased vigilance of adverse mental health development among patients with a severe acute disease phase of COVID-19."
Time spent bedridden key factor
Many pandemic-related factors could have contributed to worsened mental health, the researchers said. Examples include fear of having infected others, media coverage of the long-term effects of infection, severe COVID-19 and related inflammatory processes, and personal vulnerability to mental illness.
In a Lancet press release, lead author Ingibjorg Magnusdottir, MSc, of the University of Iceland, said that the long-term physical effects of long COVID may mean limited social contact and may cause a sense of helplessness.
"Equally, inflammatory responses among patients with a severe diagnosis may contribute to more persistent mental health symptoms," she said. "In contrast, the fact that individuals with a mild COVID-19 infection can return to normal lives sooner and only experience a benign infection likely contributes to the lower risk of negative mental health effects we observed."
The researchers said that continued clinical vigilance with survivors of severe COVID-19 and follow-up beyond the first year of symptoms are warranted.
Senior author Unnur Anna Valdimarsdottir, PhD, of the University of Iceland, said, "Our research is among the first to explore mental health symptoms after a serious COVID-19 illness in the general population up to 16 months after diagnosis.
"It suggests that mental health effects aren't equal for all COVID-19 patients and that time spent bedridden is a key factor in determining the severity of the impacts on mental health."