Risks of mental health outcomes in people with covid-19: cohort study
BMJ 2022; 376 doi: https://doi.org/10.1136/bmj-2021-068993 (Published 16 February 2022) Cite this as: BMJ 2022;376:e068993Linked Editorial
Mental health after covid-19
Linked Opinion
Mental health in people with covid-19
- 1Clinical Epidemiology Center, Research and Development Service, VA Saint Louis Health Care System, Saint Louis, MO 63106, USA
- 2Department of Epidemiology and Biostatistics, College for Public Health and Social Justice, Saint Louis University, Saint Louis, MO, USA
- 3Veterans Research and Education Foundation of Saint Louis, Saint Louis, MO, USA
- 4Department of Medicine, Washington University School of Medicine, Saint Louis, MO, USA
- 5Nephrology Section, Medicine Service, VA Saint Louis Health Care System, Saint Louis, MO, USA
- 6Institute for Public Health, Washington University in Saint Louis, Saint Louis, MO, USA
- Correspondence to: Z Al-Aly zalaly{at}gmail.com (or @zalaly on Twitter)
- Accepted 8 January 2022
Abstract
Objective To estimate the risks of incident mental health disorders in survivors of the acute phase of covid-19.
Design Cohort study.
Setting US Department of Veterans Affairs.
Participants Cohort comprising 153 848 people who survived the first 30 days of SARS-CoV-2 infection, and two control groups: a contemporary group (n=5 637 840) with no evidence of SARS-CoV-2, and a historical control group (n=5 859 251) that predated the covid-19 pandemic.
Main outcomes measures Risks of prespecified incident mental health outcomes, calculated as hazard ratio and absolute risk difference per 1000 people at one year, with corresponding 95% confidence intervals. Predefined covariates and algorithmically selected high dimensional covariates were used to balance the covid-19 and control groups through inverse weighting.
Results The covid-19 group showed an increased risk of incident anxiety disorders (hazard ratio 1.35 (95% confidence interval 1.30 to 1.39); risk difference 11.06 (95% confidence interval 9.64 to 12.53) per 1000 people at one year), depressive disorders (1.39 (1.34 to 1.43); 15.12 (13.38 to 16.91) per 1000 people at one year), stress and adjustment disorders (1.38 (1.34 to 1.43); 13.29 (11.71 to 14.92) per 1000 people at one year), and use of antidepressants (1.55 (1.50 to 1.60); 21.59 (19.63 to 23.60) per 1000 people at one year) and benzodiazepines (1.65 (1.58 to 1.72); 10.46 (9.37 to 11.61) per 1000 people at one year). The risk of incident opioid prescriptions also increased (1.76 (1.71 to 1.81); 35.90 (33.61 to 38.25) per 1000 people at one year), opioid use disorders (1.34 (1.21 to 1.48); 0.96 (0.59 to 1.37) per 1000 people at one year), and other (non-opioid) substance use disorders (1.20 (1.15 to 1.26); 4.34 (3.22 to 5.51) per 1000 people at one year). The covid-19 group also showed an increased risk of incident neurocognitive decline (1.80 (1.72 to 1.89); 10.75 (9.65 to 11.91) per 1000 people at one year) and sleep disorders (1.41 (1.38 to 1.45); 23.80 (21.65 to 26.00) per 1000 people at one year). The risk of any incident mental health diagnosis or prescription was increased (1.60 (1.55 to 1.66); 64.38 (58.90 to 70.01) per 1000 people at one year). The risks of examined outcomes were increased even among people who were not admitted to hospital and were highest among those who were admitted to hospital during the acute phase of covid-19. Results were consistent with those in the historical control group. The risk of incident mental health disorders was consistently higher in the covid-19 group in comparisons of people with covid-19 not admitted to hospital versus those not admitted to hospital for seasonal influenza, admitted to hospital with covid-19 versus admitted to hospital with seasonal influenza, and admitted to hospital with covid-19 versus admitted to hospital for any other cause.
Conclusions The findings suggest that people who survive the acute phase of covid-19 are at increased risk of an array of incident mental health disorders. Tackling mental health disorders among survivors of covid-19 should be a priority.
Footnotes
Contributors: YX, EX, and ZAA conceived and designed the study. YX, EX, and ZAA analyzed and interpreted the data. ZAA drafted the manuscript. YX, EX, and ZAA critically revised the manuscript. ZAA provided administrative, technical, and material support. ZAA provided supervision and mentorship. ZAA is the guarantor. Each author contributed important intellectual content during manuscript drafting or revision and accepts accountability for the overall work by ensuring that questions pertaining to the accuracy or integrity of any portion of the work are appropriately investigated and resolved. All authors approved the final version of the report. The corresponding author attests that all the listed authors meet the authorship criteria and that no others meeting the criteria have been omitted
Funding: This research was funded by the US Department of Veterans Affairs (for ZAA) and an American Society of Nephrology and KidneyCure fellowship award (for YX). The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. The contents do not represent the views of the US Department of Veterans Affairs or the US government.
Competing interests: Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare support from the US Department of Veterans Affairs and the American Society of Nephrology for the submitted work. ZAA reports receiving consultation fees from Gilead Sciences and receipt of funding (unrelated to this work) from Tonix pharmaceuticals.
The study guarantor (ZAA) affirms that the manuscript is an honest, accurate, and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned have been explained.
Provenance and peer review: Provenance and peer review: Not commissioned; externally peer reviewed.
Dissemination to participants and related patient and public communities: The study results will be disseminated by press release and on Twitter, and shared with patient advocacy groups.
Data availability statement
All data are available through the US Department of Veterans Affairs.
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