Lancet: Acute COVID-19 severity and mental health morbidity trajectories in patient populations of six nations: an observational study, 2022

The Lancet: Acute COVID-19 severity and mental health morbidity trajectories in patient populations of six nations: an observational study Magnúsdóttir et al

Summary

Background
Long-term mental and physical health consequences of COVID-19 (long COVID) are a persistent public health concern. Little is still known about the long-term mental health of non-hospitalised patients with COVID-19 with varying illness severities. Our aim was to assess the prevalence of adverse mental health symptoms among individuals diagnosed with COVID-19 in the general population by acute infection severity up to 16 months after diagnosis.

Methods
This observational follow-up study included seven prospectively planned cohorts across six countries (Denmark, Estonia, Iceland, Norway, Sweden, and the UK). Participants were recruited from March 27, 2020, to Aug 13, 2021. Individuals aged 18 years or older were eligible to participate. In a cross-sectional analysis, we contrasted symptom prevalence of depression, anxiety, COVID-19-related distress, and poor sleep quality (screened with validated mental health instruments) among individuals with and without a diagnosis of COVID-19 at entry, 0–16 months from diagnosis. In a cohort analysis, we further used repeated measures to estimate the change in mental health symptoms before and after COVID-19 diagnosis.

Findings
The analytical cohort consisted of 247 249 individuals, 9979 (4·0%) of whom were diagnosed with COVID-19 during the study period. Mean follow-up was 5·65 months (SD 4·26). Participants diagnosed with COVID-19 presented overall with a higher prevalence of symptoms of depression (prevalence ratio [PR] 1·18 [95% CI 1·03–1·36]) and poorer sleep quality (1·13 [1·03–1·24]) but not symptoms of anxiety (0·97 [0·91–1·03]) or COVID-19-related distress (1·05 [0·93–1·20]) compared with individuals without a COVID-19 diagnosis. Although the prevalence of depression and COVID-19-related distress attenuated with time, individuals diagnosed with COVID-19 but never bedridden due to their illness were consistently at lower risk of depression (PR 0·83 [95% CI 0·75–0·91]) and anxiety (0·77 [0·63–0·94]) than those not diagnosed with COVID-19, whereas patients who were bedridden for more than 7 days were persistently at higher risk of symptoms of depression (PR 1·61 [95% CI 1·27–2·05]) and anxiety (1·43 [1·26–1·63]) than those not diagnosed throughout the study period.

Interpretation
Severe acute COVID-19 illness—indicated by extended time bedridden—is associated with long-term mental morbidity among recovering individuals in the general population. These findings call for increased vigilance of adverse mental health development among patients with a severe acute disease phase of COVID-19.

 

I haven't read the study, but the news site Forskning.no had an article about it today including an interview with two of the Norwegian researchers (one who works at the Norwegian Institute for Public Health).

In the news article there are so many speculations from two of the researchers that I wonder if this study has been able at all to distinguish between psychological problems and post viral disease, or taken into account that depression and anxiety can develop as a consequence of post viral disease.

Forskning.no De som fikk korona hardest, blir dobbelt så ofte deprimerte og sliter lenger
google translation: Those who were hardest hit with Corona, are twice as often depressed and struggle for longer

Quotes:

- It may be that those who have been very ill, have physical symptoms that linger for a long time. But we should expect those symptoms to diminish over time. Therefore, it is unexpected that the proportion who have a high level of anxiety and depression symptoms, stays at the same level for so long and that it does not look like it goes down at all even after 16 months

....

The researchers will now look further at what happens after longer than 16 months and at the connection between mental and physical symptoms.

...

UiO professor Ole A. Andreassen believes that the high anxiety and depression rates are due to several things:

- It may be a combination of them worrying about long-term health effects and that they continue to struggle with long covid symptoms long after the disease. This in turn limits social contact and can lead to a feeling of helplessness, he says in a press release.

 

It's like long Covid just doesn't exist here. During the news yesterday there was a segment about a lot of children suddenly being absent from school after the pandemic. The explanation from experts was school refusal. The explanation for the school refusal was psychological problems due to restrictions and closed schools under the pandemic. I don't think post viral illness has even occurred to them as an alternative explanation, at least for some, and feel so sorry for the children where that might be the reason they can't go to school. I dread to think of how people around them will be trying to "fix" this.

 

Yes, I just read that. Chilling.

 

They used the PHQ-9, which was developed for screening healthy populations but which awards points for core ME/CFS & long covid symptoms including sleep problems, fatigue and problems concentrating. The PHQ-9 is inappropriate for measuring depression in this population - the authors might well be just picking up physical symptoms.

 

In a sane world, this would be a good case study for how the BPS model of illness is flawed and unfit for purpose. It encourages asking the wrong questions, making baseless wild assumptions (symptoms "should" diminish and have no impact; says who?) and concluding whatever the researchers want. Asking sick people questions that should not be asked of sick people because the answers overlap with the intent of the questionnaire is just beneath amateurism, it borders on sabotage. It is, at the very least, massively incompetent. But it is an accepted norm, making circular reasoning normal.

 

vested interest wanting to create evidence for refusal of insurance claims and benefits by creating a mental health get out clause .