People who were bedridden for a week or more with COVID-19 remain at increased risk for anxiety and depression more than a year later, according to a new study.
But those who had milder infections are actually at lower risk for mental health problems than the general public.
“The good news is that the patient group as a whole is not at higher risk of developing long-term (mental health) symptoms,” said Unnur Anna Valdimarsdóttir, a psychiatric epidemiologist at the University of Iceland, who helped lead the research.
A mild infection could even boost mental health.
“There might be a relief associated with having gone through the infection,” she said.
Nearly 80% of those who had COVID-19 are not at higher risk for persistent mental health symptoms, she said.
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The study is the first to look at large numbers of people who were infected but not sick enough to go the hospital and to follow them for such a long time, said Dr. Stephanie Collier, a geriatric psychiatrist at McLean Hospital in Belmont, Massachusetts.
Doctors have assumed that sicker patients were at higher risk for depression and anxiety, but the risk wasn’t clear for those who didn’t need hospital care, she said.
It’s also good news for people who weren’t severely ill.
“This study helps share that not every mild infection is going to end up with lingering symptoms,” she said.
The cause of longer-term depression or anxiety after infection remains unclear. But a mental health challenge triggered by an infection might eventually be treated differently than one that arose without an obvious start date, said Collier, who now asks all of her patients whether they’ve been infected with COVID-19.
Most of her patients who complain of new depression or anxiety also suffer other symptoms of so-called long COVID-19, including severe fatigue or the inability to concentrate long enough to read a book or pursue work or a hobby, she said.
“Time will tell,” she said, whether depression that starts after a COVID-19 infection is any different from other forms of depression.
The new study began before the pandemic, when a group of scientists from six countries, including the U.K., Denmark, Sweden and Iceland, came together to study mental health. In the early days of COVID-19, they decided to shift gears and track nearly 300,000 volunteers as they endured the pandemic.
Roughly 10,000 fell ill between late March 2020 and mid-August 2021, with about 2,200 sick enough to stay in bed for a week or more and 300 ending up in the hospital.
Valdimarsdóttir and her colleagues showed that those who spent seven or more days lying in bed were at 50% to 60% increased risk of suffering from depression or anxiety 16 months later.
“The symptoms in this group seemed persistent,” Valdimarsdóttir said, not improving with time, “which is worrying.”
People who were quite ill originally and are still suffering should not feel like they are the only ones, and their doctors should target them for follow-up and extra assistance, Valdimarsdóttir said.
During infection, many people suffered acute stress, concerned about how severe their illness would become. They often developed nightmares and anxiety, but these decreased over time in all groups, the study showed.
Meanwhile, people who came through infections relatively unscathed felt like they no longer had to worry about the virus or potential long-term consequences.
The study could not explain why people have lingering symptoms, but the fact that they were quite sick initially suggests that excessive inflammation during the infection could lead to these longer-term problems.
“We need to explore these mechanisms in further detail,” Valdimarsdóttir said.
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