As we know, infection with SARS-CoV-2 is associated with an increased risk of many sequels neurological and psychiatric. However, more than two years after the start of the pandemic Covid-19it is still unclear how long these risks persist. A previous study published in The Lancet Psychiatry reported that 18.5% of patients with Covid-19 had developed mental illnesses after three months. The sequelae would persist even after six months, without knowing what happens afterwards.
Other shortcomings mentioned in the new study also appeared in The Lancet Psychiatry : the lack of inclusion of children and of the different variants of virus.
To study these three questions, researchers from the Department of Psychiatry at the University of Oxford used the electronic medical records made available by the TriXNet platform (specialized in the management of health data for research). They evaluated the risks up to two years of 14 neurological and psychiatric sequelae after infection with SARS-CoV-2, in three age groups: children under 18, adults aged 18 to 64. and adults over 65. They then compared the cohorts of study diagnosed with the disease before and after theemergence Alpha, Delta and Omicron.
A study of more than a million cured of Covid-19
The cohort studied of 1,284,437 patients (mean age 42.5 years; 57.8% women) was compared with a cohort of the same number of patients, this time suffering from another respiratory infection. The researchers thus represented the risk trajectories over two years using time-varying risk ratios. Demographic factors, risk factors of Covid-19 and vaccination status were included in the analysis.
According to the age groups, the risks of developing post-Covid-19 neurological and psychiatric disorders differed. The children did not have an increased risk of mood or anxiety disorders within six months of infection, and the risk of cognitive impairment (called brain fog) was transient. However, they shared the risk of adults for some diagnoses as’insomniaI’stroke ischemic orepilepsy.
Risks of mood and anxiety disorders are transient
The authors note that in adults, the risk of cognitive deficitof dementiapsychotic disorder and epilepsy remained high throughout the duration of the study (with the exception of encephalitis, Guillain-Barré syndromedisorders of nervesof the nerve roots and plexus, and parkinsonism). In contrast, the risks of common psychiatric disorders (such as mood and anxiety disorders) returned to normal after one to two months, eventually reaching a impact equal to that of the control group.
In addition, the neurological and psychiatric results remained similar regardless of the SARS-CoV-2 variants involved. As a result, the researchers indicate that the burden on the health care system could continue, even with less severe variants in other respects.
Covid-19 permanently weakens the mental health of patients
Article published on 1er February 2021 by Julie Kern
Those who have lived through Covid-19 still suffer from the after-effects physical disabling. Most of them are resilient and come out after long weeks of convalescence. For others, this stressful experience can be the trigger for psychiatric disorders such as anxiety or insomnia. Scientists are just beginning to estimate the extent of this phenomenon.
Shops and cultural places closed, masked population and confined, prohibited gatherings. Never have such health measures been taken in France to limit the spread of a deadly viral disease. Their establishment was a necessity to relieve the overwhelmed hospitals but they did not make the virus disappear. This hope, and that of regaining a semblance of normal life, now resides in the campaigns of vaccination that take place all over the world. This pandemic situation marked the iron red the spirits of the general population, caregivers, shopkeepers, bereaved families, isolated students, and even more that of those who have been at the heart of the storm : Covid-19 patients.
Psychiatrists are beginning to measure the impact of Covid-19 on the mental health of survivors. If some fight for a long time against physical sequelae, the experience of the disease makes them particularly susceptible to mood and anxiety disorders, and even to dementia for the oldest. A publication in The Lancet Psychiatry of November 9, 2020 was a first warning signal.
After three months, 18.5% of Covid-19 patients have developed mental illnesses
Researchers from the University of Oxford’s Department of Psychiatry tracked the progression of psychiatric diagnoses in people who had Covid-19 within 90 days of recovery. Their analysis based on data made available by the TriXNet platform, specialized in the management of health data for research. Of the 69 million entries in the hands of scientists, they only kept the 62,354 that mention a positive diagnosis for Covid-19.
It appears that 18.5% of Covid-19 survivors were diagnosed with a mental disorder, whatever its nature, between 14 and 90 days after their death. healing. For 5% of them, it is the first psychiatric diagnosis of their life. Anxiety disorders are the most frequent in the workforce considered (4.7%), followed by mood disorders (2%) and finally, insomnia (1.9%). Among those over 65, dementia represents 1.6% of cases of psychiatric disorders diagnosed against 0.44% in the overall workforce.
Scientists have also turned the question the other way: are mental illnesses an aggravating factor for Covid-19? Data analysis indicates that this is indeed the case. In the same way as thehypertension, age or obesity, mental illness is a risk factor. According to researchers from the University of Oxford, people who had a psychiatric diagnosis less than a year ago have a 65% increased risk of contracting Covid-19. This risk was calculated independently of other risk factors. comorbidity patients and is the same regardless of the nature of the mental illness diagnosed.
Six months after the illness, the sequelae are still there
In a study published more recently in pre-publication and not peer-reviewed, the same group of scientists continued their research by extending the follow-up period to six months. These results were obtained from 236,379 Covid-19 survivors, hospitalized or not, from the TriXNet database. At six months, the psychiatric sequelae of the disease are still present and even more frequent. The incidence of psychiatric diagnoses at six months is 33% versus 18.5% at three months, and that of first diagnoses is 12.8% versus 5% at three months. Anxiety disorders explode and then concern 24% of diagnoses. The trend is the same for mood disorders and insomnia, which represent respectively 13 and 5% of diagnoses. More disturbing disturbances, reminiscent of the Parkinson disease and Guillain-Barré syndrome, have also been identified.
A question then arises, are these observations characteristic of Covid-19 or are they the same for other diseases? The Oxford team grappled with the question. The researchers carried out the same analyzes in patients who had the flurespiratory infection other than Covid-19 and influenza, skin infection, gallstonesof the kidney stones and finally, a bone fracture. None of these conditions are linked to an increased incidence of psychiatric diagnoses in survivors, as is the case with Covid-19.
Respiratory infections (other than the flu and Covid-19) are the diseases tested that mentally weaken people the most. In this cohort, the incidence of psychiatric diagnoses is 3.4% against 2.5% for the flu or a bone fracture. Gallstones and skin infections are also particularly distressing, the incidence rate of psychiatric illnesses being 3.2 and 3.4% respectively.
There is therefore an intimate link between Covid-19 and mental health sick people. How to explain it?
A new pandemic looming?
The first avenue to explore is that of the etiological agent of Covid-19, SARS-CoV-2. This coronavirus causes symptoms neurological (headaches, loss of taste andsmellloss of landmark, etc.), and the most recent research attests to its ability to infect neuronsin mice so far. brain damage have been observed in tissue sections from patients who died of the disease.
In addition, the presence of SARS-CoV-2 provokes a systemic and intense inflammatory reaction which also seems to reach the braindespite the fact that it is protected by the blood-brain barrier. The link between these physiological observations and neurological symptoms has not yet been clearly established. It is therefore difficult to conclude that infection with SARS-CoV-2 is the cause of the mental sequelae observed in survivors of Covid-19, especially since there are no major differences in the incidence of psychiatric diagnoses between hospitalized and non-hospitalized people, witnesses of the severity of the infection.
In addition to the stress of knowing that you are sick, the confinement and the pandemic atmosphere of the past year are probably at the origin of this worrying increase in psychiatric diagnoses among survivors of Covid-19. And they are not the only ones to suffer from it, the students, the nursing staff and the general population have also shared their fatigue and their anguish. Scientists, who work in the field of psychology and neuroscience, have also shared their concerns in a number ofpublished articles in prestigious scientific journals for several months. The Oxford team could not determine the temporality of anxiety, mood and insomnia disorders; after the six months, they were still present. When the coronavirus pandemic has ended, it will be a question of facing a second one: that of mental illness.
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