People living with long COVID are at significant risk of experiencing depression and post-traumatic stress disorder (PTSD), according to research published in the European Respiratory Journal.
The research is one of the first long-term follow-up studies of people who presented at hospital with COVID-19. Researchers found that a significant proportion of patients who attended hospital, whether admitted or discharged from the emergency department and regardless of disease severity, experienced an ongoing mental health burden – 14% showed signs of depression and 11% experienced PTSD. The researchers say that COVID-19 patients should be routinely monitored for psychological distress in post-COVID care to ensure that they recover both physically and mentally.
Dr Swapna Mandal, Consultant Respiratory Physician at the Royal Free London NHS Foundation Trust, UK, was a lead researcher on the study. She said: “Whilst caring for COVID patients we could see the mental health effects; patients were terrified by what was happening to them and what they were seeing around them. Many people who have had COVID-19 report adverse mental health after the infection has cleared, but up to now, there have been very few long-term studies focused on this issue.
“Based on these concerns, when we set up our post-COVID follow-up clinics we sought to monitor the psychological consequences among patients. We screened for depression and PTSD so that we could support our patients to get the right help and to gain insight in to how prevalent these long-term effects are.”
Researchers conducted virtual follow-up care with 760 patients who presented at the Royal Free London NHS Foundation Trust, UK, with COVID-19 including those who were treated in the emergency department (112 patients), inpatient wards (558) and intensive care unit (90). The respondents’ average age was 60 years and the cohort comprised 60% male and 48% of black or minority ethnic background.
Patients were followed-up at nine weeks and screened for psychological distress using the Patient Health Questionnaire 2-item scale, which assesses depression by asking about the frequency of depressed mood in the past two weeks, as well as the Trauma Screening Questionnaire, another self-report tool that is designed to identify those experiencing PTSD.
The questionnaire data showed that at approximately nine weeks after discharge, a significant proportion of patients who had attended the hospital experienced varying levels of ongoing mental health burden. Around 105 patients (14%) of those receiving follow-up care showed signs of depression and 80 patients (11%) experienced symptoms of PTSD.
The data also showed that patients who experienced depression or PTSD were more likely to have ongoing physical symptoms, such as breathlessness and muscle pain, and they were less likely to have returned to work at nine weeks’ follow-up.
Dr Mandal said: “Our results show very clearly that among those who we provided post-COVID care for, many have experienced some level of poor mental health during their recovery. All health professionals who are involved in the care of those with long COVID must be aware of this and should actively screen patients for symptoms, even in those with pre-existing mental health issues. It is vital that multidisciplinary clinics are established to manage all aspects of long COVID symptoms in a holistic manner, so that patients are able to fully recover.”
When the researchers accounted for others factors that can impact mental health – such as the patients’ age, sex, socioeconomic status, and ethnicity; whether they had any existing illness and related symptoms; or if they presented with worse COVID-19 symptoms – they found that the increased prevalence of depression or PTSD among long COVID patients remained.
Dr Mandal explained: “Interestingly, our data suggests there were no significant differences in the levels of depression or PTSD between ethnic groups, nor among those admitted to the ICU when compared with patients admitted to inpatient wards or those who presented at the emergency department, suggesting that disease severity does not impact the likelihood of experiencing ongoing mental health issues.
“However, as our respondents included only those who had attended the emergency department or stayed in the hospital, the analysis of the relationship between mental health and disease severity is somewhat limited. Future studies should investigate this further by looking at patients who were treated in primary care settings, such as GP clinics and those who self-treated at home following doctors’ or official advice.”
Professor Anita Simonds, President of the European Respiratory Society and Consultant in Respiratory and Sleep Medicine at Royal Brompton Hospital, UK, was not involved in the research. She said: “The results of this long-term study support that individuals who have had COVID-19 are at-risk of worsening mental health. Research on other long-term lung conditions like asthma and COPD suggests that addressing patients’ anxiety or mental ill health can improve their quality of life and ability to keep physically active, which may help with symptom management and recovery in the long run. Health professionals who are caring for those with long COVID should monitor mental health and ensure patients can access local psychological services alongside respiratory rehabilitation.
“Long COVID treatment is likely to become a large burden on health systems around the world, so is it vitally important that clinics equally address the physical and mental health symptoms of long COVID and that policymakers ensure clinics have the resources to offer this multidisciplinary care.”
The researchers say they were not able to screen patients for depression or PTSD on admission to hospital, so it is not clear if some patients had pre-existing mental health issues or were undiagnosed.