British study links COVID-19 symptoms to poorer mental health

An analysis of 11 longitudinal studies in the UK, published today in The Lancet Psychiatry associated symptomatic COVID-19 with psychological distress, depression, anxiety, and lower life satisfaction that did not decrease for up to 3 months.

As part of an ongoing study, a team led by King’s College London and University College London examined data from 11 longitudinal studies of 54,442 patients aged 16 and over with multiple measures of mental health and COVID-19 status published before and during the pandemic (April 2020 to April 2021). The studies ran antibody tests until June 2021.

Women comprised 61% of participants, and of the 40,819 patients with available race data, 90.2% were white.

Steep trajectory of the case

The weighted data show that from April to June 2020, the number of self-reported COVID-19 infections ranged from 87 of 1,432 (5.4%) of National Survey of Health and Development (NSHD) participants to 324 of 1,678 (19, 3%) in the Next Steps study (NS). From November 2020 to April 2021, 173 of 1536 (11.1%) participants in the NSHD to 1523 of 3837 (45.1%) participants in the Millennium Cohort Study (MCS) reported infections.

Serological testing revealed that those who had antibodies to SARS-CoV-2, indicating previous infection, ranged from 4.7% of NSHD participants to 22.7% of MCS participants. Among participants with information on COVID-19 and antibody status, from 2.6% of NSHD participants to 18.1% of MCS participants reported both COVID-19 infection and antibodies.

The proportion reporting infection but negative for antibodies ranged from 8.5% of NSHD participants to 31.7% of MCS participants. The proportion of participants who had antibodies to SARS-CoV-2 but did not report infection ranged from 2.1% in the NSHD to 17.3% in the UK Adult Twin Registry; serological and test-confirmed, self-reported cases ranged from 0.86% in the NSHD to 46.1% in the NS study.

Social isolation, unknown pandemics

COVID-19 was associated with psychological distress (standardized difference between those with and without COVID-19, 0.10), depression (0.08), anxiety (0.08), and lower life satisfaction (-0.06 ). There was no association between COVID-19 and gender, educational attainment, race, or pre-pandemic mental health.

“The observed effects (6-10% standard deviation change for continuous-scale outcomes and 9-15% increased risk of clinical cases) have substantial implications when considered at the population level, especially given the high rates of infection,” the researchers wrote.

Compared to never-infected people, those who reported having COVID-19 but no antibodies to SARS-CoV-2 reported more deterioration in mental health, while there was no such relationship for those who did not report having COVID-19 , but they have antibodies.

“These findings raise the possibility that the observed effects are not specific to SARS-CoV-2 infection, but could still reflect the illness experienced during this period or be explained by other factors,” the authors wrote.

The associations did not decrease significantly from less than 4 weeks post-infection, 4 to 12 weeks, or more than 12 weeks, and were observed in all age groups, although the effects appeared to be stronger in participants aged 50 years and older.

The researchers said that infection with COVID-19 may affect the mental health of middle-aged and older people more because they are at higher risk of severe infections, may worry more about their physical condition and is more likely to experience vascular or neurological changes after infection.

The authors say that the negative impact of COVID-19 on mental health may be caused by social isolation, loss of pay, worry about spreading the virus and the unpredictable course of the pandemic. The results, they said, “highlight the need for greater provision of post-infection mental health services, given the significant spread of COVID-19 in the UK and globally”.

“These findings suggest that there were lingering mental health consequences of COVID-19 infection for some people early in this pandemic,” first author Dr. Ellen Thompson said in a King’s College London press release. “Understanding why this is so will be key to finding strategies to treat those affected, as well as prevent similar effects in future pandemic waves.”

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