Mental illness as well as dementia are alarming potential outcomes of recovering from coronavirus infection.

By Claire Gillespie
November 11, 2020
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COVID-19 is an infectious disease that causes respiratory illness, but its effects can go way beyond that. A large study from Oxford University in the UK found that survivors are at a higher risk of developing mental illness, such as anxiety and depression. They are also more likely to develop dementia, according to the research, which was published in The Lancet Psychiatry on November 9.

The researchers analyzed electronic health records of 69 million people in the US, including more than 62,000 people who had COVID-19. They found that 20% of those infected with the coronavirus were diagnosed with a psychiatric disorder within 90 days—about twice as likely as for other groups of patients with other illnesses in the same time frame.

"People have been worried that COVID-19 survivors will be at greater risk of mental health problems, and our findings... show this to be likely," said Paul Harrison, a professor of psychiatry at Oxford University, per Reuters. He urged doctors and scientists around the world to investigate the causes and identify new treatments for post-COVID-19 mental illness. "[Health] services need to be ready to provide care, especially since our results are likely to be underestimates [of the number of psychiatric patients]," he said.

While the findings add to a growing body of evidence that COVID-19 can have an impact on mental health as well as physical health, it's not known why the virus appears to increase the risk of psychiatric illness—and there could be several potential reasons, says psychiatrist Margaret Seide, MD.

"It is well known that after survival of a traumatic event there may be an increase of conditions such as insomnia, anxiety, and depression," Dr. Seide, who is based in New York City, tells Health. "This is precisely what is observed in the post-COVID-19 period."

Although most people who will be infected with the coronavirus will survive, the media coverage emphasizes the death rate—and rightly so, as it's an important measure to track. But this means COVID-19 patients are well aware of the fact that death is a very real possibility.

"Confronting the possibility of not surviving a condition is terrifying," explains Dr. Seide. "Most of us have the luxury of not thinking about our mortality very often. It makes sense that such an event would be triggering for a mental health condition—particularly for those who had a difficult course of the illness which included hospitalization or periods of respiratory distress."

A significant factor could be the isolation aspect of COVID-19. "If you're diagnosed with the illness, you're advised to quarantine," psychiatrist Julian Lagoy, MD, who is based in San Jose, California, tells Health. "But humans are social creatures, and being around friends and family is good for our mental (and physical) well-being." Being in quarantine and isolation has the opposite effect, Dr. Lagoy adds—"it can be very detrimental to your mental health." And if you have a severe case of COVID-19, the stress and worry concerning your physical health will naturally take its toll on your mental health.

Another theory: inflammation. "Scientists are still learning about what COVID-19 is, but there does seem to be the possibility of widespread inflammation in the body during the disease, including within the brain," says Dr. Seide. "Things such as good memory, stable mood, and sleep are products of a healthy brain, which may be affected by the inflammatory effects of the coronavirus."

The Oxford University study also found that people with a preexisting mental illness were 65% more likely to be diagnosed with COVID-19 than those without. "This is very interesting," Dr. Lagoy says. "I suspect this may be because people with mental illness are more likely to exhibit risky behaviors, which put them at risk of COVID-19. For instance, if they're less likely to isolate and quarantine because it can make their mental illness worse, they are more likely to go out and be with people in order to keep the mental illness stable. However, their risk of getting COVID-19 is then higher." People who suffer from mental illness may also be less likely to effectively manage chronic conditions such as diabetes, which can increase their risk of COVID-19.

While it has been established that there are some preexisting conditions that increase the likelihood of infection with COVID-19, such as diabetes, hypertension, respiratory conditions, and obesity, researchers have also found that those with a history of psychiatric conditions like bipolar disorder, depression, and schizophrenia, are also at increased risk of infection.

"Potential reasons for this include the fact that there is a downward drift on the socioeconomic ladder for those who struggle with mental illness," Dr. Seide says. "Missed days from work, interrupted education, and less social support can all be a result of psychological conditions and can lead to lower income. And lower socioeconomic status means an individual may be less likely to have a finance or tech job that can be effectively performed on a laptop from home." And thus be less likely to contract the virus than someone who has to go into the community to work every day.

Of course, you don't have to have a positive COVID-19 diagnosis to feel the mental health impact of the pandemic. In August, the Centers for Disease Control and Prevention (CDC) published a report showing that 40% of US adults—in particular younger adults, racial and ethnic minorities, essential workers, and unpaid caregivers—"reported considerably elevated adverse mental health conditions associated with COVID-19" during late June 2020. Those mental health conditions included anxiety and depression, substance abuse, trauma or stressor-related disorder, and suicidal ideation.

The information in this story is accurate as of press time. However, as the situation surrounding COVID-19 continues to evolve, it's possible that some data have changed since publication. While Health is trying to keep our stories as up-to-date as possible, we also encourage readers to stay informed on news and recommendations for their own communities by using the CDCWHO, and their local public health department as resources.

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