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. 2023 May 1;6(5):e2312892.
doi: 10.1001/jamanetworkopen.2023.12892.

Comparison of Depression and Anxiety Following Self-reported COVID-19-Like Symptoms vs SARS-CoV-2 Seropositivity in France

Alexandra Rouquette  1   2 , Arthur Descarpentry  1 , Fallou Dione  1 , Bruno Falissard  1   2 , Stéphane Legleye  1   3 , Cécile Vuillermoz  1 , Anne Pastorello  1 , Laurence Meyer  1   2 , Josiane Warszawski  1   2 , Camille Davisse-Paturet  1 , Maria Melchior  4 ; EpiCoV Study Group
Collaborators, Affiliations

Comparison of Depression and Anxiety Following Self-reported COVID-19-Like Symptoms vs SARS-CoV-2 Seropositivity in France

Alexandra Rouquette et al. JAMA Netw Open. .

Abstract

Importance: The long-term consequences of COVID-19 on mental health are a critical issue given the number of people infected with SARS-CoV-2 worldwide since the beginning of the pandemic.

Objective: To investigate the associations between self-reported COVID-19-like symptoms or SARS-CoV-2 seropositivity and subsequent depression or anxiety.

Design, setting, and participants: This propensity score-matched cohort study began in May 2020, with follow-ups in November 2020 and July 2021. The study used data from a large, randomly selected, national population-based cohort from France, the EpiCoV (Epidémiologie et Conditions de Vie) study. Of 85 074 individuals 15 years or older who completed the questionnaires at the 3 collection times, 28 568 were excluded because they did not return a blood sample for serologic testing, 1994 because of missing data on outcomes or exposures, and 9252 to respect the temporal sequence (exposure must precede the outcome).

Exposures: Propensity scores based on various socioeconomic, lifestyle, and health variables were computed to match participants who experienced COVID-19-like symptoms between February and November 2020 or showed SARS-CoV-2 seropositivity in November 2020.

Main outcomes and measures: Logistic regression models were used to estimate associations between these occurrences and depression or anxiety assessed in July 2021 using the Patient Health Questionnaire 9-item and Generalized Anxiety Disorder 7-item scales, respectively.

Results: Among the 45 260 included participants (mean [SD] age, 51.1 [18.9] years; 52.4% women; 8.0% with depression and 5.3% with anxiety in July 2021), COVID-19-like symptoms were associated with subsequent depression (adjusted odds ratio, 1.70; 95% CI, 1.45-1.99) and anxiety (adjusted OR, 1.57; 95% CI, 1.29-1.92), whereas SARS-CoV-2 seropositivity was not. Furthermore, COVID-19-like symptoms, but not anosmia or dysgeusia alone, were associated with subsequent depression and anxiety in both the seropositive and seronegative subgroups.

Conclusions and relevance: In this cohort study of more than 45 000 individuals drawn from the French general population, SARS-CoV-2 infection was not found as a risk factor of subsequent depression or anxiety. Moreover, self-reported COVID-19-like symptoms were associated with depression and anxiety assessed at least 8 months later in both seropositive and seronegative subgroups, suggesting that factors other than SARS-CoV-2 infection are implied in this association.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Rouquette reported receiving grants from the French Ministry for Research during the conduct of the study and grants from Santé Publique France, DREES (Direction de la Recherche, des Etudes, de l’Evaluation et des Statistiques), and the French Ministry for Research outside the submitted work. Prof Falissard reported receiving personal fees from AbbVie, Actelion, Allergan, Almirall, Alnylam, Amgen, Astellas, Astra Zeneca, Bayer, Biogen, Biopecs, Bioproject, Biotronik, BMS, Boehringer, Celgène, Daiichi-Sankyio, Ethypharm, Forestlab, Genevrier, Genzyme, Gilead, Grünenthal, GlaxoSmithKline, Guerbet, HRA Pharma, IDM Pharma, Idorsia, IMS Health, Indivior, IQVIA, Johnson and Johnson, Kephren, Lafon, Léo, Lilly, Lundbeck, Menarini, Merck Sharp and Dohme, Novartis, NovoNordisk, Otsuka, Pfizer, Pierre-Frabre, Recordati, Roche, Sanofi, Servier, Stallergene, Takeda, UCB Pharma, ViiV Healthcare, and Wellmera outside the submitted work. Mrs Pastorello reported receiving grants from Orchestra European H2020 during the conduct of the study. Prof Meyer reported receiving grants from Agence Nationale de la Recherche sur le Sida, les hépatites virales et les Maladies Infectieuses Emergentes and Sidaction outside the submitted work. Dr Warszawski reported receiving grants from Institut National de la Santé et de la Recherche Médicale ANRS-MIE and Région Ile de France during the conduct of the study and grants from Institut National de la Santé et de la Recherche Médicale ANRS-MIE outside the submitted work. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Study Population Flowchart
Figure 2.
Figure 2.. Results of the Propensity Score Analyses Concerning COVID-19–Like Symptoms, SARS-CoV-2 Serologic Test Results, and Anosmia or Dysgeusia
The adjusted odds ratios (aORs) were adjusted for the following covariates: sex, age, immigration status, highest educational level, main occupational status, deciles of household income per consumption unit, perceived financial situation, usual residence overcrowded, household structure, living in the usual residence during the first lockdown, access to a private exterior during the first lockdown, urban density of the area of residence, living in a priority neighborhood, quartile of the hospitalization rate during the first lockdown in the area of residence, body mass index, perceived health status, prepandemic chronic mental or physical conditions, tobacco use, and alcohol use. aReference group for COVID-19 symptoms was no symptoms. bReference group for anosmia or dysgeusia was no anosmia or dysgeusia. cReference group for SARS-CoV-2 seropositivity was seronegativity.
Figure 3.
Figure 3.. Results of the Propensity Score Analyses Concerning Time of Occurrence of COVID-19–Like Symptoms
The adjusted odds ratios (aORs) were adjusted for the following covariates: sex, age, immigration status, highest educational degree, main occupational status, deciles of household income per consumption unit, perceived financial situation, usual residence overcrowded, household structure, living in the usual residence during the first lockdown, access to a private exterior during the first lockdown, urban density of the area of residence, living in a priority neighborhood, quartile of the hospitalization rate during the first lockdown in the area of residence, body mass index, perceived health status, prepandemic chronic mental or physical conditions, tobacco use, and alcohol use. Reference group was no symptoms.
Figure 4.
Figure 4.. Results of the Propensity Score Analyses Concerning Duration of COVID-19–Like Symptoms
The adjusted odds ratios (aORs) were adjusted for the following covariates: sex, age, immigration status, highest educational degree, main occupational status, deciles of household income per consumption unit, perceived financial situation, usual residence overcrowded, household structure, living in the usual residence during the first lockdown, access to a private exterior during the first lockdown, urban density of the area of residence, living in a priority neighborhood, quartile of the hospitalization rate during the first lockdown in the area of residence, body mass index, perceived health status, prepandemic chronic mental or physical conditions, tobacco use, and alcohol use. Reference group was no symptoms.
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References

    1. Fumagalli C, Zocchi C, Tassetti L, et al. ; AOU Careggi COVID-19 Follow-up Study Group . Factors associated with persistence of symptoms 1 year after COVID-19: a longitudinal, prospective phone-based interview follow-up cohort study. Eur J Intern Med. 2022;97:36-41. doi:10.1016/j.ejim.2021.11.018 - DOI - PMC - PubMed
    1. Vanderlind WM, Rabinovitz BB, Miao IY, et al. . A systematic review of neuropsychological and psychiatric sequalae of COVID-19: implications for treatment. Curr Opin Psychiatry. 2021;34(4):420-433. doi:10.1097/YCO.0000000000000713 - DOI - PMC - PubMed
    1. Raman B, Cassar MP, Tunnicliffe EM, et al. . Medium-term effects of SARS-CoV-2 infection on multiple vital organs, exercise capacity, cognition, quality of life and mental health, post-hospital discharge. EClinicalMedicine. 2021;31:100683. doi:10.1016/j.eclinm.2020.100683 - DOI - PMC - PubMed
    1. Morin L, Savale L, Pham T, et al. ; Writing Committee for the COMEBAC Study Group . Four-month clinical status of a cohort of patients after hospitalization for COVID-19. JAMA. 2021;325(15):1525-1534. doi:10.1001/jama.2021.3331 - DOI - PMC - PubMed
    1. Mazza MG, Palladini M, De Lorenzo R, et al. ; COVID-19 BioB Outpatient Clinic Study group . One-year mental health outcomes in a cohort of COVID-19 survivors. J Psychiatr Res. 2021;145:118-124. doi:10.1016/j.jpsychires.2021.11.031 - DOI - PMC - PubMed

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