An analysis of 11 longitudinal UK studies published today in The Lancet Psychiatry links symptomatic COVID-19 to psychological distress, depression, anxiety, and lower life satisfaction that didn't abate by 3 months.
As part of an ongoing study, a team led by King's College London and University College London researchers examined data from 11 longitudinal studies of 54,442 patients aged 16 years and older with repeated measurement of mental health and COVID-19 status published before and during the pandemic (April 2020 to April 2021). The studies conducted antibody testing until June 2021.
Women made up 61% of participants, and of the 40,819 patients with available race data, 90.2% were White.
Steep case trajectory
Weighted data showed that, from April to June 2020, numbers of self-reported COVID-19 infections ranged from 87 of 1,432 (5.4%) of participants in the National Survey of Health and Development (NSHD) to 324 of 1,678 (19.3%) in the Next Steps (NS) study. From November 2020 to April 2021, 173 of 1,536 (11.1%) NSHD participants to 1,523 of 3,837 (45.1%) Millennium Cohort Study (MCS) participants reported infections.
Serology testing revealed that those having SARS-CoV-2 antibodies, indicating previous infection, varied from 4.7% of NSHD participants to 22.7% of MCS participants. Among participants with information on COVID-19 and antibody status, from 2.6% of NSHD participants to 18.1% of MCS participants had both reported COVID-19 infection and antibodies.
The proportion who reported infection but were negative for antibodies ranged from 8.5% of NSHD participants to 31.7% of MCS participants. The percentage of participants who had SARS-CoV-2 antibodies but didn't report infection ranged from 2.1% in the NSHD to 17.3% in the UK Adult Twin Registry; the serology and test-confirmed, self-reported cases ranged from 0.86% in the NSHD to 46.1% in the NS study.
Social isolation, pandemic unknowns
COVID-19 was linked to psychological distress (standardized difference between those with and without COVID-19, 0.10), depression (0.08), anxiety (0.08), and lower life satisfaction (-0.06). There were no associations between COVID-19 and sex, educational achievement, race, or prepandemic mental health.
"The effects observed (6-10% change of a standard deviation for outcomes on a continuous scale and 9-15% increased risk of clinical caseness) have substantial implications when considered at the population level, especially given high infection rates," the researchers wrote.
Relative to never-infected people, those who reported having COVID-19 but had no SARS-CoV-2 antibodies reported more deterioration in mental health, while there was no such link for those who didn't report COVID-19 but had antibodies.
"These findings raise the possibility that the effects observed are not specific to SARS-CoV-2 infection but could still reflect the experience of illness during this period, or be explained by other factors," the authors wrote.
The associations didn't significantly lessen from less than 4 weeks after infection, 4 to 12 weeks, or more than 12 weeks and were observed in all age-groups, although the effects appeared stronger in participants aged 50 years and older.
The researchers said that COVID-19 infection may affect middle-aged and older people's mental health more because they are at higher risk for severe infections, may worry more about their physical condition, and are more likely to experience blood vessel or neurologic changes after infection.
The authors said that the negative impact of COVID-19 on mental health could be caused by social isolation, loss of pay, worry about spreading the virus, and the unpredictable course of the pandemic. The results, they said, "emphasise the need for greater post-infection mental health service provision, given the substantial prevalence of COVID-19 in the UK and worldwide."
"These findings suggest that there were prolonged mental health consequences of COVID-19 infection for some people at the beginning of this pandemic," first author Ellen Thompson, PhD, said in a King's College London press release. "Understanding why this is the case will be key to finding treatment strategies for those affected as well as preventing such effects in future pandemic waves."
