Research is also suggesting that having COVID-19 may result in psychological sequelae—secondary consequences of the virus. This could potentially stem from the anxiety and depression associated with having the virus and its sometimes lingering health symptoms, the biological effects of the disease itself, or a combination of both.
In a recent study1 published in The Lancet Psychiatry, an analysis of more than 236,000 COVID-19 survivors found that 34% of patients were diagnosed with neurological and mental health disorders—which included mood, anxiety, and psychotic disorders as well as substance use disorders—in the six months after infection. In an earlier study2 that included more than 62,000 patients diagnosed with COVID-19, the incidence of diagnosis of any psychiatric diagnosis in the 14 to 90 days after diagnosis was 18.1%, significantly higher than for all control health events. The elevated risk could not be readily explained by differences in illness severity.
This lack of correlation to disease severity rings true in the experience of Lorna Stanley, MD, Medical Director of Outpatient Programs at Princeton House Behavioral Health’s Princeton site. She has seen patients presenting with a first psychiatric diagnosis who had very few COVID-19 symptoms as well as those who had severe COVID-19 but little to no recollection of the hospital ICU stay.
When—and How—to Dig Deeper
While more research is needed to examine the relationship between COVID-19 and psychiatric disorders, Dr. Stanley stresses the need for mental health support—and the importance of digging deeper when treating patients who’ve had the disease.
“It’s difficult to separate the physical symptoms of the disease from the psychological experience and fear of what may happen when someone receives a COVID-19 diagnosis,” says Dr. Stanley. “Even for those who have only had minor symptoms, we must not lose sight of what someone may be going through both physically and mentally as a result.”
She recommends:
- Asking patients whether they’ve had COVID-19
- Having them describe the degree and intensity of symptoms
- Discussing whether associated distress differs from any prior mental health symptoms they may have had
Because the longer-term symptoms sometimes associated with COVID-19—such as fatigue, decreased appetite, and lack of motivation—tie in to mental health, Dr. Stanley also recommends that her patients follow up regularly with their primary care or infectious disease physician for a coordinated approach to care.
"The pandemic has been similar to a tsunami—a big wave of loss with effects that will likely stay with us for a long time,” she adds. “Our continued awareness of its fallout and our efforts to educate patients can help them navigate their experience and work through the mental health aspects."
- Taquet M, et al. Six-month neurological and psychiatric outcomes in 236,379 survivors of COVID-19. Lancet Psychiatry. 2021.8(5):416-427.
- Taquet M, et al. Bidirectional associations between COVID-19 and psychiatric disorder: Retrospective cohort studies of 62,354 COVID-19 cases in the USA. Lancet Psychiatry. 2020. 8(2)130-140.
Article as seen in the Fall 2021 issue of Princeton House Behavioral Health Today.
