Covid-19: Nearly 20% of patients receive psychiatric diagnosis within three months of covid, study findsBMJ 2020; 371 doi: https://doi.org/10.1136/bmj.m4386 (Published 11 November 2020) Cite this as: BMJ 2020;371:m4386
Almost one in five people in the US with covid-19 received a psychiatric diagnosis in the three months afterwards, a study has shown.1
The rate of diagnosis was significantly higher than that seen after other health events such as other respiratory tract infections, researchers found.
For the study published in the Lancet Psychiatry,1 researchers from the University of Oxford, UK, and the health research network TriNetX examined the anonymised patient records of just over 62 000 people with covid-19 diagnosed from 20 January to 1 August 2020. Overall, 18.1% of patients received a psychiatric diagnosis in the 14 to 90 days after covid-19 was confirmed—a quarter of which were the first time a mental health condition had been observed.
The study reported that, in patients with no pre-existing psychiatric conditions, having covid-19 diagnosed was associated with an increased incidence of psychiatric diagnosis in the following 14 to 90 days, when compared with six other health events (hazard ratio 2.1 (95% confidence interval 1.8 to 2.5) v influenza; 1.7 (1.5 to 1.9) v other respiratory tract infections; 1.6 (1.4 to 1.9) v skin infection; 1.6 (1.3 to 1.9) v cholelithiasis; 2.2 (1.9 to 2.6) v urolithiasis; and 2.1 (1.9 to 2.5) v fracture of a large bone; all P<0.001).
Anxiety disorders were the most frequently reported psychiatric diagnosis (hazard ratios 1.59 to 2.62; all P<0.001). Among people aged over 65 the study also found an increased risk of dementia diagnosis when compared with the control health events, with an incidence of 1.6% (1.2% to 2.1%).
The team looked at the risk of covid-19 in people with pre-existing psychiatric disorders. They found that people with a current psychiatric diagnosis were more likely to contract covid-19 than those without (relative risk 1.65 (1.59 to 1.71); P<0.001) even after other risk factors for infection were accounted for. They said that lifestyle factors, such as smoking, and a reduced adherence to social distancing measures may explain this observation, although it could also be down to medicine or the “proinflammatory state postulated to occur in some forms of psychiatric disorder.”
The study has some limitations including that it did not look at the severity of covid-19, such as whether patients had been admitted to hospital or intensive care. Additionally, the researchers were unable to look at “long covid.”
Mental health support
Commenting on the paper, Til Wykes, vice dean of psychology and systems sciences at the Institute of Psychiatry, Psychology and Neuroscience at King’s College, London, said that similar levels of mental health disorders after covid-19 had been seen in the UK population. “This is clearly the tip of an iceberg,” she said. “We need to develop as many different, accessible forms of mental health support as possible.”
Jo Daniels, senior lecturer in clinical psychology at the University of Bath, said that some psychological distress after a life threatening infectious disease was to be expected.
She commented, “Further, longer term research is warranted before conclusions are firmly drawn, and it would benefit those most affected if, as researchers, our underpinning position is to support, acknowledge, and validate those experiencing ‘normal’ distress, resisting the urge to diagnose unless absolutely necessary.
“Education and de-stigmatisation of mental health is vital if we are to make gains in addressing and improving outcomes.”
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