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Observational Study
. 2022 May;7(5):e406-e416.
doi: 10.1016/S2468-2667(22)00042-1. Epub 2022 Mar 14.

Acute COVID-19 severity and mental health morbidity trajectories in patient populations of six nations: an observational study

Ingibjörg Magnúsdóttir  1 , Anikó Lovik  2 , Anna Bára Unnarsdóttir  1 , Daniel McCartney  3 , Helga Ask  4 , Kadri Kõiv  5 , Lea Arregui Nordahl Christoffersen  6 , Sverre Urnes Johnson  7 , Arna Hauksdóttir  1 , Chloe Fawns-Ritchie  8 , Dorte Helenius  6 , Juan González-Hijón  2 , Li Lu  9 , Omid V Ebrahimi  7 , Asle Hoffart  7 , David J Porteous  3 , Fang Fang  2 , Jóhanna Jakobsdóttir  1 , Kelli Lehto  5 , Ole A Andreassen  10 , Ole B V Pedersen  11 , Thor Aspelund  12 , Unnur Anna Valdimarsdóttir  13 ; COVIDMENT Collaboration
Collaborators, Affiliations
Observational Study

Acute COVID-19 severity and mental health morbidity trajectories in patient populations of six nations: an observational study

Ingibjörg Magnúsdóttir et al. Lancet Public Health. 2022 May.

Abstract

Background: Long-term mental and physical health consequences of COVID-19 (long COVID) are a persistent public health concern. Little is still known about the long-term mental health of non-hospitalised patients with COVID-19 with varying illness severities. Our aim was to assess the prevalence of adverse mental health symptoms among individuals diagnosed with COVID-19 in the general population by acute infection severity up to 16 months after diagnosis.

Methods: This observational follow-up study included seven prospectively planned cohorts across six countries (Denmark, Estonia, Iceland, Norway, Sweden, and the UK). Participants were recruited from March 27, 2020, to Aug 13, 2021. Individuals aged 18 years or older were eligible to participate. In a cross-sectional analysis, we contrasted symptom prevalence of depression, anxiety, COVID-19-related distress, and poor sleep quality (screened with validated mental health instruments) among individuals with and without a diagnosis of COVID-19 at entry, 0-16 months from diagnosis. In a cohort analysis, we further used repeated measures to estimate the change in mental health symptoms before and after COVID-19 diagnosis.

Findings: The analytical cohort consisted of 247 249 individuals, 9979 (4·0%) of whom were diagnosed with COVID-19 during the study period. Mean follow-up was 5·65 months (SD 4·26). Participants diagnosed with COVID-19 presented overall with a higher prevalence of symptoms of depression (prevalence ratio [PR] 1·18 [95% CI 1·03-1·36]) and poorer sleep quality (1·13 [1·03-1·24]) but not symptoms of anxiety (0·97 [0·91-1·03]) or COVID-19-related distress (1·05 [0·93-1·20]) compared with individuals without a COVID-19 diagnosis. Although the prevalence of depression and COVID-19-related distress attenuated with time, individuals diagnosed with COVID-19 but never bedridden due to their illness were consistently at lower risk of depression (PR 0·83 [95% CI 0·75-0·91]) and anxiety (0·77 [0·63-0·94]) than those not diagnosed with COVID-19, whereas patients who were bedridden for more than 7 days were persistently at higher risk of symptoms of depression (PR 1·61 [95% CI 1·27-2·05]) and anxiety (1·43 [1·26-1·63]) than those not diagnosed throughout the study period.

Interpretation: Severe acute COVID-19 illness-indicated by extended time bedridden-is associated with long-term mental morbidity among recovering individuals in the general population. These findings call for increased vigilance of adverse mental health development among patients with a severe acute disease phase of COVID-19.

Funding: Nordforsk, Horizon2020, Wellcome Trust, and Estonian Research Council.

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Conflict of interest statement

Declaration of interests OAA has received a grant to their institution from Nordforsk and Research Council of Norway for the present manuscript. OAA has also received a grant to the institution for an entity other than the present manuscript from South East Norway Health Authority, KG Jebsen Stiftelsen, and National Institutes of Health, EU. OAA has received royalties for a textbook in psychiatry, consulting fees from HealthLytix and Milken Institute, payment for lectures from Sunovion and Lundbeck, and payment for expert testimony from the Norwegian Court. Outside of this work, OAA has a patent for a devise for nasal delivery. OAA has participated at his institution on boards for local principal investigator Clinical Trial Janssen, local principal investigator Clinical Trial MAPS, and local principal investigator Clinical Trial Boehringer. UAV has received grants for the current work from Nordforsk and Horizon2020 as well as grants outside the current work from the Icelandic Research Fund, Swedish Research Council, Swedish Cancer Society, and the European Research Council. All other authors declare no competing interests.

Figures

Figure 1
Figure 1
Mental health indicators among individuals with a diagnosis of COVID-19 compared with individuals without a COVID-19 diagnosis C19-Resilience=The Icelandic COVID-19 National Resilience Cohort. DBDS=The Danish Blood Donor Study. EstBB-C19=The Estonian Biobank COVID-19 Cohort. MAP-19=The Norwegian COVID-19, Mental Health and Adherence Project. MoBa=The Norwegian Mother, Father and Child Cohort Study. PR=prevalence ratio.
Figure 2
Figure 2
Mental health indicators among individuals with a diagnosis of COVID-19 compared with individuals without a COVID-19 diagnosis by illness severity (time bedridden) C19-Resilience=The Icelandic COVID-19 National Resilience Cohort. DBDS=The Danish Blood Donor Study. EstBB-C19=The Estonian Biobank COVID-19 Cohort. MAP-19=The Norwegian COVID-19, Mental Health and Adherence Project. MoBa=The Norwegian Mother, Father and Child Cohort Study. PR=prevalence ratio.
Figure 3
Figure 3
Mental health indicators among individuals with a diagnosis of COVID-19 compared with individuals without COVID-19 by time since diagnosis C19-Resilience=The Icelandic COVID-19 National Resilience Cohort. DBDS=The Danish Blood Donor Study. EstBB-C19=The Estonian Biobank COVID-19 Cohort. MAP-19=The Norwegian COVID-19, Mental Health and Adherence Project. MoBa=The Norwegian Mother, Father and Child Cohort Study. PR=prevalence ratio.
Figure 4
Figure 4
Mental health indicators during the first 16 months after diagnosis of COVID-19 by time bedridden
See this image and copyright information in PMC

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