Contracting Covid-19 is “robustly associated” with an increased risk of developing mental health and neurological conditions in the six months after a diagnosis, a study suggests.

Researchers at the University of Oxford looked at the TriNetX electronic 2020 health records of more than 230,000 Covid-19 patients, mostly from the US.

Their study, published in The Lancet Psychiatry journal and said to be the largest of its kind to date, estimated that one in three Covid-19 survivors (34%) were diagnosed with a neurological or psychiatric condition within six months of being infected.

For 13% of people it was their first recorded neurological or psychiatric diagnosis, researchers found.


The findings also suggested that the incidence of such conditions rose with the severity of a coronavirus case, with a neurological or psychiatric diagnosis occurring in 39% of those who were admitted to hospital, 46% of those in intensive care, and 62% in those who had encephalopathy – described as “delirium and other altered mental states” – during their Covid-19 infection.

When comparing the data with a control group and taking into account underlying health characteristics such as age, sex, ethnicity, and existing health conditions, researchers also found that overall there was a 44% greater risk of neurological and mental health diagnoses after Covid-19 than after flu, and a 16% greater risk after Covid-19 than with other respiratory tract infections such as pneumonia.

Given the scale of the coronavirus pandemic and chronic nature of some neurological and psychiatric diagnoses, the study’s authors concluded that “substantial effects on health and social care systems are likely to occur”.

They argued that “urgent” research was needed to understand how and why such disorders occur and how they can be treated.

The Moderna vaccine is the third coronavirus jab to be approved for use in the UK, following the Pfizer and Oxford/AstraZeneca ones. Credit: PA Images

Paul Harrison, professor of psychiatry at the University of Oxford and the study’s lead author, said: “These are real-world data from a large number of patients. They confirm the high rates of psychiatric diagnoses after Covid-19, and show that serious disorders affecting the nervous system (such as stroke and dementia) occur too.

“While the latter are much rarer, they are significant, especially in those who had severe Covid-19.

“Although the individual risks for most disorders are small, the effect across the whole population may be substantial for health and social care systems due to the scale of the pandemic and that many of these conditions are chronic.

“As a result, health care systems need to be resourced to deal with the anticipated need, both within primary and secondary care services.”

For the peer-reviewed observational study, researchers looked at the incidence of 14 neurological and mental health disorders among 236,379 patients over the age of 10 who were infected with Covid-19 on or after January 20 2020 and who were still alive on December 13 that year.

This group was compared with 105,579 patients diagnosed with influenza and 236,038 patients diagnosed with any respiratory tract infection, including influenza.

In the Covid-19 group, researchers found anxiety disorders occurred among 17% of all patients, while 14% developed mood disorders, 7% had substance misuse disorders and 5% insomnia.

Meanwhile, the incidence of neurological conditions appeared lower, with 0.6% having a brain haemorrhage, 2.1% ischaemic stroke and 0.7% dementia.

(PA Graphics/PA) Credit: PA Graphics/PA

Report co-author Dr Max Taquet, NIHR academic clinical fellow in psychiatry at the University of Oxford, said that while a diagnosis such as psychosis or dementia was less likely to occur in all patients with Covid-19, the rate “increased quite dramatically” with a more severe Covid-19 illness.

He highlighted that one in 14 patients (7%) with encephalopathy were found to have a psychosis diagnosis and one in 20 (5%) had dementia, compared to 1.4% and 0.7% of all patients with Covid-19 respectively.

Dr Taquet said another “concerning” finding was that one in 50 patients (2%) with Covid-19 went on to have an ischaemic stroke within six months – where a blood clot affects the brain – which increased to one in 11 patients (9%) with encephalopathy.

Overall the authors concluded that Covid-19 does lead to a greater risk of neurological and psychiatric disorders when compared with flu and other respiratory tract infections, but there was no clear evidence this was the case for some conditions such as parkinsonism and Guillain-Barré syndrome.

Prof Harrison told a briefing of journalists on Tuesday: “Our view is that a lot of the mental health consequences of Covid are… to do with the stress of knowing that one has had Covid and all the implications that go with that, rather than it being a direct effect, for example, of the virus on the brain, or the immune response to the virus on the brain.”



Another study author, Masud Husain, professor of neurology and cognitive neuroscience at the University of Oxford, added that although it was known coronavirus “can access the brain”, the evidence it affects neurons is “quite low”.

He added there was a need to be “careful” over whether conditions such as dementia and strokes were “a direct consequence of the virus or whether the effects of being ill on clotting, for example, on the immune system can have an effect”.

Researchers noted that their study was limited by the unknown completeness and accuracy of the electronic health records and that the results may not apply to people who had Covid-19 but were not diagnosed with the illness.

The severity of the neurological and psychiatric disorders was also not known, nor whether patients recovered and what happened to them after six months.

Professor Paul Crawford, director of the Centre for Social Futures, Institute of Mental Health, Nottingham University, said there was a need to determine whether the study’s finding of “substantial neurological and psychiatric morbidity in the six months after Covid-19 infection” were the result of the infection or “the effects of prolonged confinement and isolation… endured during the pandemic”.

He said: “We know from penal, remote living and aerospace studies, not least in relation to long-duration flight, that such conditionality can affect mental state in terms of experiencing anxiety, depression, lassitude, irritability and other cognitive disturbances.”

On the finding of higher likelihood of neurological and psychiatric conditions among those with Covid-19, Dr Musa Sami, clinical associate professor in psychiatry at Nottingham University, commented: “What we do not fully understand at the moment is the mechanism by which Covid-19 has this effect: psychological stress, longer stays in hospital and characteristics of the illness itself may play a part.”


Who to contact if you or someone you know needs help

  • Samaritans operates a 24-hour service available every day of the year, by calling 116 123. If you prefer to write down how you’re feeling, or if you’re worried about being overheard on the phone, you can email Samaritans at jo@samaritans.org

  • Papyrus offer support for children and young people under the age of 35 over the phone on 0800 068 41 41 between 9am – midnight every day of the year. If you would rather text you can do so on 07786 209697 or send an email to pat@papyrus-uk.org

  • Rethink Mental Illness offer practical advice and information for anyone affected by mental health problems on a wide range of topics including treatment, support and care. Phone 0300 5000 927 (Mon-Fri 9.30am-4pm) or visit rethink.org

  • Mind also offer mental health support between 9am and 6pm, Monday to Friday. You can call them on 0300 123 3393 or text them on 86463. There is also lots of information available on their website.

  • Campaign Against Living Miserably’s (CALM) helpline and webchat are open from 5pm until midnight, 365 days a year. Call CALM on 0800 58 58 58 or chat to their trained helpline staff onlineNo matter who you are or what you’re going through, it’s free, anonymous and confidential.

Categories:

Tags:

Comments are closed