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Meta-Analysis
. 2024 May-Jun:88:10-22.
doi: 10.1016/j.genhosppsych.2024.02.009. Epub 2024 Feb 27.

Prevalence of mental health conditions and brain fog in people with long COVID: A systematic review and meta-analysis

Christina van der Feltz-Cornelis  1 , Fidan Turk  2 , Jennifer Sweetman  2 , Kamlesh Khunti  3 , Mark Gabbay  4 , Jessie Shepherd  2 , Hugh Montgomery  5 , W David Strain  6 , Gregory Y H Lip  7 , Dan Wootton  8 , Caroline Leigh Watkins  9 , Daniel J Cuthbertson  10 , Nefyn Williams  4 , Amitava Banerjee  11
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Free article
Meta-Analysis

Prevalence of mental health conditions and brain fog in people with long COVID: A systematic review and meta-analysis

Christina van der Feltz-Cornelis et al. Gen Hosp Psychiatry. 2024 May-Jun.
Free article

Erratum in

Abstract

Objective: Long COVID can include impaired cognition ('brain fog'; a term encompassing multiple symptoms) and mental health conditions. We performed a systematic review and meta-analysis to estimate their prevalence and to explore relevant factors associated with the incidence of impaired cognition and mental health conditions.

Methods: Searches were conducted in Medline and PsycINFO to cover the start of the pandemic until August 2023. Included studies reported prevalence of mental health conditions and brain fog in adults with long COVID after clinically-diagnosed or PCR-confirmed SARS-CoV-2 infection.

Findings: 17 studies were included, reporting 41,249 long COVID patients. Across all timepoints (3-24 months), the combined prevalence of mental health conditions and brain fog was 20·4% (95% CI 11·1%-34·4%), being lower among those previously hospitalised than in community-managed patients(19·5 vs 29·7% respectively; p = 0·047). The odds of mental health conditions and brain fog increased over time and when validated instruments were used. Odds of brain fog significantly decreased with increasing vaccination rates (p = ·000).

Conclusions: Given the increasing prevalence of mental health conditions and brain fog over time, preventive interventions and treatments are needed. Research is needed to explore underlying mechanisms that could inform further research in development of effective treatments. The reduced risk of brain fog associated with vaccination emphasizes the need for ongoing vaccination programs.

Keywords: Brain fog; COVID-19; Long COVID; Mental health conditions; Meta-analysis; SARS-CoV-2.

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Conflict of interest statement

Declaration of competing interest Unless otherwise stated, funding for this project was paid to author institutions. In addition, CFC has had recent or current involvement with grants from the British Medical Association (CANDO Study), EU Horizon (EMPOWER Study), the Netherlands Organisation for Health Research and Development (Regional systems intervention for suicide prevention (SUPREMOCOL) in Noord -Brabant, the Netherlands), and NIHR HS&DR (Frequent Users of the Emergency Department: Improving and Standardising Services-a mixed methods study). CFC has received royalties for books on Psychiatry, an honorarium payment related to a lecture at the Big Questions in Neuroscience Annual meeting from Janssen UK, and has received travel and accommodation in the UK for a lecture from The Lloyd Register Foundation. CFC is an International member of the Scientific Advisory Board on the IMPACT in South Asia Research project, funded by the NIHR Global Health Program. KK is a past Chair of the Ethnicity Subgroup of the UK Scientific Advisory Group for Emergencies (SAGE) and a past Member of SAGE. KK is supported by the National Institute for Health Research (NIHR) Applied Research Collaboration East Midlands (ARC EM) and the NIHR Leicester Biomedical Research Centre (BRC). MG is part-funded by NIHR applied Research Collaboration North West Coast. HM has consulted for Astra Zeneca on covid vaccines and monoclonal therapies. HM has accepted lecture fees and conference support from Astra Zeneca relating to covid vaccines and monoclonal therapies. GYHL is a consultant and speaker for BMS/Pfizer, Boehringer Ingelheim, Daiichi-Sankyo, Anthos; no fees are received personally. DW holds an NIHR Advanced Fellowship to study hospital acquired pneumonia; this is held at University of Liverpool. CLW receives support from Applied Research Collaboration (ARCNWC): NIHR ARC NWC, PARticipation And engagement in Life and LEisure activities foLlowing stroke (PARALLEL): developing of a complex intervention: NIHR ARC NWC Mental Health Early Career Researcher Development Fellowship, NIHR HTA (EASE: Evaluating Antidepressants for emotionaliSm after strokE: A multi-centre, randomised, double-blind, placebo-controlled trial to establish the effect(s) of administration of sertraline (50 mg once daily for Six Months) in people with a recent stroke and post-stroke emotionalism; Should we use post-operative antibiotics following surgery for patients with mandible fractures? The MANTRA trial (MANdibular TRauma and Antibiotic use); Acceptability and feasibility of using the Virtual Engagement Rehabilitation Assistant (VERA) for community-based neurological rehabilitation). CLW receives support from NIHR Palliative and End of Life Care Research Partnerships for Living well and Dying Well in the last year of life for older people in rural and remote communities across the UK, and from NIHR Programme Grants for Applied Research for PREPARE: imPRoving End of life care Practice in stroke cARE. CLW is a member of Data Monitoring and Ethics Committees (Clinical and cost-effectiveness of a personalised health promotion intervention enabling independence in older people with mild frailty (‘HomeHealth’): A Randomised Controlled Trial; The Metoclopramide for Avoiding Pneumonia after Stroke (MAPS-2) Trial: a single-blind, randomised controlled trial of metoclopramide for the prevention of pneumonia in patients with dysphagia after an acute stroke), a Study Steering Committee 7 - Predicting AF after Cardiac Surgery - the PARADISE Score A Clinical Prediction Rule for Post-operative Atrial Fibrillation in Patients Undergoing Cardiac Surgery, and sat on a Trial Steering Committee - COVID NURSE: evaluation of the effects of a COVID-specific fundamental nursing care protocol compared to care as usual on experience of care for non-invasively ventilated patients in hospital with the SARS-CoV-2 virus: a randomised controlled trial. DJC has received investigator-initiated research funding, conference and/or consultancy fees and support for attending meetings/travel from NovoNordisk, Astra Zeneca and Ipsen. NW is Deputy Chair NIHR HTA Programme Funding Committee (Commissioned Research); payments are paid to institution. NW is GP partner in Llanfairfechan Group Practices; drawings are made to NW. AB has had recent or current involvement with NIHR, BMA, Astra Zeneca and UKRI research grants. AB is an unpaid Trustee for the South Asian Health Foundation. All other authors have no COIs to report.

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