COVID-19 could cause delirium in 1 in 4 patients during hospitalization as well as the possibility of depression, anxiety, and post-traumatic stress disorder (PTSD) afterward, according to a systematic review and meta-analysis published online in The Lancet Psychiatry.
“Most people with COVID-19 will not develop any mental health problems, even among those with severe cases requiring hospitalization, but given the huge numbers of people getting sick, the global impact on mental health could be considerable,” said co-lead author Jonathan Rogers, MRCPsych, of University College London.
Researchers analyzed 65 peer-reviewed studies and 7 recent preprints awaiting peer review that focused on people with severe acute respiratory syndrome (SARS) between 2002 and 2004, Middle East respiratory syndrome (MERS) in 2012, and COVID-19 this year. The analysis included data for more than 3500 patients hospitalized with the viruses. People with mild cases were not included.
Nearly one-third of patients hospitalized with SARS or MERS developed PTSD over an average 3-year follow-up. The prevalence of depression and anxiety disorders was nearly 15% for each a year or longer after illness. Another 15% of patients had depression and anxiety symptoms without a clinical diagnosis, researchers reported. Chronic fatigue, mood swings, sleep disorders, or impaired concentration and memory also affected more than 15% of patients.
During hospitalization, a significant minority of patients experienced confusion, agitation, altered consciousness, and other symptoms of delirium, the study found. Confusion affected almost 28% of patients hospitalized with SARS and MERS, and researchers said early evidence is signaling similar rates of delirium with COVID-19 hospitalization.
The meta-analysis also identified two risk factors associated with poorer mental health outcomes over the long run: worrying a lot about the illness and employment as a healthcare worker. On the other hand, making a good physical recovery predicted better long-term mental health.
“To avoid a large-scale mental health crisis, we hope that people who have been hospitalized with COVID-19 will be offered support and monitored after they recover to ensure they do not develop mental illnesses,” said senior author Anthony David, FMedSci, a professor at University College London, “and are able to access treatment if needed.”
Rogers JP, Chesney E, Oliver D, et al. Psychiatric and neuropsychiatric presentations associated with severe coronavirus infections: a systematic review and meta-analysis with comparison to the COVID-19 pandemic. The Lancet Psychiatry. 2020 May 18;[Epub ahead of print].