Study finds few immediate mental health effects of COVID-19

Most people admitted to hospital with severe COVID-19 should recover without experiencing mental disease if infection with SARS-CoV-2 follows an identical course to the coronavirus epidemics of severe acute respiratory syndrome (SARS) in 2002 and Middle East respiratory syndrome (MERS) in 2012, per the first systematic review and meta-analysis observing the psychiatric consequences of coronavirus infections in over 3,550 patients hospitalized with SARS, MERS, and COVID-19, published in Lancet Psychiatry journal.

However, the findings suggest that delirium (a mental condition characterized by changes in consciousness, behavioral disturbance, and sometimes hallucinations) is also common in hospitalized patients within the acute stages of SARS, MERS, and COVID-19 illness.

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The study looks at severe cases within which individuals are treated in hospital, and doesn’t apply to milder cases or asymptomatic cases.

In the longer-term, the analysis suggests that SARS and MERS survivors is perhaps in danger for mental illnesses like depression, anxiety, fatigue, and post-traumatic stress disorder (PTSD) within the months and years following discharge from hospital. While there are not any available data on these diagnoses in COVID-19 patients, the authors say that the medical community should bear in mind of the potential for high rates of those common mental problems within the aftermath of the ongoing pandemic.

The authors caution that provided that the bulk (68/72) of studies included within the analysis were of either low or medium quality, and mainly involved data on patients with SARS and MERS treated in hospital, true mental health effects of COVID-19 infection can’t be precisely predicted and can require ongoing research.

Mental Health

A Palestinian artist puts a protective painted face mask on a girl as a precaution against the coronavirus disease (COVID-19), in Gaza City

“Our analysis of more than 3,550 coronavirus cases suggests that most people will not suffer from mental health problems following coronavirus infection”, says 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.”

He continues, “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.”

There are several reasons why severe coronavirus infections might need psychiatric consequences, including possible direct effects of virus infection (including on the central nervous system), the degree of physiological compromise (eg, low blood oxygen), the reaction, and medical interventions. Other reasons relate to the broader social impact, including social isolation, the psychological effect of a novel severe and potentially fatal illness, concerns about infecting others, and stigma.

Although the COVID-19 pandemic has affected a big proportion of the world’s population, relatively little is understood about its potential effects on mental state.

To provide more evidence, the authors of the new study conducted an organized review and meta-analysis of all studies and preprint articles (reporting data on the psychiatric and neuropsychiatric features of people with suspected or laboratory-confirmed coronavirus infection (SARS, MERS, or SARS-CoV-2).

In total, 65 peer-reviewed studies up to March 18, 2020, and 7 preprints between January 1 and April 10, 2020, reporting outcomes for patients admitted to hospital were included within the analyses. Pooled point prevalence (the proportion of individuals affected at a given time) from seven articles were included within the meta-analysis.

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 have been 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 specializing in COVID-19 looked as if it would show an identical picture, with evidence of delirium (confusion in 26/40 ICU 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 researchers estimate that the prevalence of PTSD among SARS and MERS survivors was 33% at an average of 34 months after the acute stage of illness (121/402 cases in four studies), whilst rates of depression and anxiety disorders was around 15% at an average of 23 months (77/517 cases from five studies) and one year (42/284 cases from three studies) after the acute stage respectively.

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