Based on previous epidemics, most people admitted to the hospital with severe COVID-19 should recover without developing mental illness, according to a recent meta-analysis published in The Lancet Psychiatry journal.
In the longer term, however, some coronavirus survivors may be at risk for depression, anxiety, fatigue, and post-traumatic stress disorder (PTSD) in the months and years following discharge from hospital.
There are several reasons why severe coronavirus infections might have psychiatric consequences, including possible direct effects of viral infection (including on the central nervous system), the degree of physiological compromise (eg, low blood oxygen), the immune response, and medical interventions.
Other reasons relate to the wider social impact, including social isolation, the psychological impact of a novel severe and potentially fatal illness, concerns about infecting others, and stigma.
The review looked at coronavirus infections of severe acute respiratory syndrome (SARS) in 2002 and Middle East respiratory syndrome (MERS) in 2012. Researchers said the study only looked at severe cases in which individuals were treated in the hospital, and does not apply to milder cases or asymptomatic cases.
“Our analysis of more than 3,550 coronavirus cases suggests that most people will not suffer from mental health problems following coronavirus infection,” said Dr. Jonathan Rogers from University College London, UK, who co-led the research.
“While there is little evidence to suggest that common mental illnesses beyond short-term delirium are a feature of COVID-19 infection, clinicians should monitor for the possibility that common mental disorders such as depression, anxiety, fatigue, and PTSD could arise in the weeks and months following recovery from severe infection, as has been seen with SARS and MERS.”
Rogers said, “With few data yet for COVID-19, high quality, peer-reviewed research into psychiatric symptoms of patients infected with SARS-CoV-2 as well as investigations to mitigate these outcomes is needed. Monitoring for the development of symptoms should be a routine part of the care we provide.”
Although the COVID-19 pandemic has affected a large proportion of the world’s population, relatively little is known about its potential effects on mental health.
To investigate this further, the authors conducted a systematic review and meta-analysis of all studies and preprint articles (reporting data on the psychiatric and neuropsychiatric features of individuals with suspected or laboratory-confirmed coronavirus infection (SARS, MERS, or SARS-CoV-2).
In total, the authors looked at 65 peer-reviewed studies, and analyzed the psychiatric consequences of coronavirus infections in more than 3,550 patients hospitalized with SARS, MERS, and COVID-19,
Analysis of data from two studies that systematically assessed common symptoms of patients admitted to hospital with SARS and MERS found that confusion occurred in 28% (36/129) of patients, suggesting delirium was common during acute illness. There were also frequent reports of low mood (42/129; 33%), anxiety (46/129; 36%), impaired memory (44/129; 34%), and insomnia (34/208; 12%) during the acute stage.
Twelve studies focusing on COVID-19 seemed to show a similar picture, with evidence of delirium (confusion in 26/40 intensive care unit patients, 65%; agitation in 40/58 ICU patients, 69%; and altered consciousness in 17/82 patients who subsequently died, 21%) while acutely ill.
Six studies looking at SARS and MERS patients after recovery from initial infection found frequent reports of low mood (35/332 patients, 11%), insomnia (34/208, 12%), anxiety (21/171, 12%), irritability (28/218, 13%), memory impairment (44/233, 19%), fatigue (61/316, 19%), and frequent recall of traumatic memories (55/181, 30%) over a follow-up period ranging from 6 weeks to 39 months.
The research team estimates that the prevalence of PTSD among SARS and MERS survivors was 33% at an average of 34 months after the acute stage of illness, while rates of depression and anxiety disorders was around 15% at an average of 23 months and one year after the acute stage respectively.
However, the authors warn that these may be overestimates of the true mental health burden resulting from these outbreaks.
“It is likely that the apparently high rates of anxiety disorders, depression, and PTSD seen in SARS and MERS patients overestimate the actual burden,” said co-lead author Dr. Edward Chesney from King’s College London, UK.
“The lack of adequate comparison groups or assessment of patients’ previous psychiatric history means that it is hard to separate the effects of coronavirus infections from pre-existing conditions, the impact of an epidemic on the population as a whole, or that selection bias (the possibility that patients were recruited into studies on the basis of factors that were associated with subsequent development of psychiatric illness) led to high prevalence figures.”
The authors note several limitations in the analysis, including the use of preprint articles that had not been subject to peer review; the exclusion of non-English-language articles; and the small sample size of several studies.
In addition, systematic assessment of psychiatric symptoms was rare, and the use of self-reported data (which might not be accurate) was common, while few studies included objective biological measures, such as blood markers of genetic, inflammatory, and immune function, or brain imaging.
Finally, follow-up time for the post-illness studies varied between 60 days and 12 years, which makes direct comparison between studies difficult.
“Findings from previous coronavirus outbreaks are useful, but might not be exact predictors of prevalences of psychiatric complications for patients with COVID-19,” writes Dr. Iris Sommer (who was not involved in the study) from the University Medical Centre Groningen in the Netherlands.
“The warning from Rogers and colleagues that we should prepare to treat large numbers patients with COVID-19 who go on to develop delirium, posttraumatic stress disorder, anxiety, and depression is an important message for the psychiatric community.”
“Treatment of patients admitted to the hospital for SARS-CoV-2 infection seems to be different from treatment of those admitted for SARS-CoV and MERS-CoV infections. Furthermore, the social situation to which COVID-19 survivors return is completely different from that of SARS and MERS survivors. These differences are relevant for the prevalence of psychiatric disorders in both acute and post-illness stages.”
Source: The Lancet
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