Covid-19 Correlation Revealed with Elevated Risk of Depression, Anxiety, PTSD, and Various Conditions, Findings Suggest, with the Unvaccinated Depicted as the Most Vulnerable Group, According to Research Study
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In a study published on Wednesday in the journal JAMA Psychiatry, the occurrence of mental health ailments was more frequent in the weeks following a COVID-19 diagnosis, but the increase was substantially lower in vaccinated individuals compared to unvaccinated individuals. Among the unvaccinated, the heightened incidence of mental health issues persisted for up to a year following severe COVID-19.
The study also revealed that the elevated incidence of mental health issues was higher and prolonged if an individual was hospitalized due to COVID-19, in contrast to those who were not hospitalized.
"The main surprise was that the association of COVID-19 with subsequent mental health issues appeared to be limited to severe COVID-19 that led to hospitalization. There was little association of COVID-19 that did not lead to hospitalization with subsequent mental health issues," Dr. Jonathan Sterne, an author of the study and professor of medical statistics and epidemiology at the University of Bristol Medical School, wrote in an email.
Researchers from the University of Bristol Medical School and other institutions in the United Kingdom found stronger associations in older adults and men compared to younger age groups and women.
"The most likely explanation for the stronger associations in older adults is that they are more likely to develop severe COVID-19 leading to hospitalization," Sterne explained. "This may also explain the somewhat stronger associations in men, but we do not have a definitive explanation."
The study analyzed electronic health record data for three groups of adults, ages 18 to 110, in England. One group included about 18.6 million people diagnosed with COVID-19 between January 2020 and June 2021, prior to vaccinations. The two other groups – including approximately 14 million people who were vaccinated and around 3.2 million people who were unvaccinated – were diagnosed with COVID-19 between June 2021 and December 2021.
The researchers identified the number of individuals in each group diagnosed with mental health issues in the weeks after their COVID-19 diagnoses. Conditions included depression, generalized anxiety disorders, post-traumatic stress disorder, eating disorders, addiction, self-harm, suicide, and other severe mental health issues such as schizophrenia, bipolar disorder, and psychotic depression.
Depression was the most frequently encountered mental health condition in the study.
The incidence of depression was 1.93 times higher in individuals who had COVID-19 before vaccines became available, 1.79 times higher among the unvaccinated group, and 1.16 times higher among the vaccinated group, according to the researchers.
The overall incidence of depression remained elevated for 28 weeks, and specifically up to 102 weeks in the group that had COVID-19 before vaccines were available, according to the data.
Individuals hospitalized for severe COVID-19 had the strongest association with depression. Among those who had COVID-19 before vaccines were available, the incidence of depression was 16.3 times higher following a COVID-19 diagnosis if the infection required hospitalization, contrasted with being 1.22 times higher without hospitalization.
"Our findings have significant implications for public health and mental health service provision, as serious mental health issues are associated with more intensive healthcare needs and longer-term health and other adverse effects," Dr. Venexia Walker, senior research fellow in epidemiology at the University of Bristol and one of the study's lead authors, stated in a press release.
The new study was released during a "significant COVID-19 wave" in the United States. Viral activity levels in wastewater have reached the highest recorded for a summer surge since July 2022, and the US Food and Drug Administration is expected to soon approve updated COVID-19 vaccines for the fall and winter season.
However, the new data may not reflect the current situation, suggested Dr. Dan Barouch, director of the Center for Virology and Vaccine Research at Beth Israel Deaconess Medical Center, who was not involved in the research.
"It's a study that only looks at individuals in 2020 and 2021, during the early pre-Omicron days of the pandemic. So the applicability of these data to the current epidemic is not clear, because in 2024, we have a much higher level of population immunity; most people have been infected or vaccinated multiple times," Barouch explained.
"It's a very different population now than it was in 2020 and 2021. So while this paper is interesting and important, it really reflects a population at a different time in the pandemic, when people's baseline immunity was very different. It's not clear the extent to which these data are applicable to the current epidemic we have in 2024."
The new research is not the first to demonstrate that COVID-19 is associated with an increased risk of mental illness, said Dr. Ziyad Al-Aly, a clinical epidemiologist at the Washington University School of Medicine in St. Louis who was not involved with the paper but has studied mental health outcomes in people with COVID-19.
"I think the picture here is clear from this paper, and it's aligned with what we have learned over the past several years on COVID's effect on the brain – and that is, it leaves its mark on the brain, and here, that's in the form of several mental health disorders," Al-Aly concluded.
The rise in mental health issues linked to serious Covid-19 cases might be due to the illness itself or just because of hospitalization. There are studies suggesting that extended hospital stays for any severe illness can lead to an enhanced possibility of new mental health disorders being diagnosed in the long term.
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Although this recent study doesn't pinpoint whether the association is Covid-19-specific or just being hospitalized in general, Al-Aly posits that both factors are likely contributing.
"When individuals end up in the hospital, they don't eat properly, they don't sleep well, it's an alien environment for them, it's extremely stressful. Does it put some people at risk for depression or stress disorders, among other issues? Indeed, yes," he said.
In a paper published in The Lancet Infectious Diseases last year, Al-Aly and his team examined over 92,000 individuals. They found that those hospitalized due to Covid-19 face an elevated risk of various mental health issues, whereas those hospitalized for the flu didn't show any increased risk.
"We discovered that the people who were hospitalized for Covid had a significantly higher risk of severe neurological problems, including neuropsychiatric disorders and mental health issues. When we compare individuals who were hospitalized for Covid against those hospitalized for the flu, it's quite clear that there's something unusual or peculiar about Covid that gives a higher risk of neurological and psychiatric issues," Al-Aly explained.
The study found that individuals who were hospitalized due to COVID-19 had a higher and prolonged incidence of mental health issues, including depression, compared to those who were not hospitalized. Maintaining good mental health is essential for overall well-being, and if you or someone you know is struggling, resources such as the 988 Suicide & Crisis Lifeline can offer support.
