VA research explains future mental health risks of COVID
The most threatening consequences of COVID-19 often show themselves only after the initial "acute" infection passes. A team of VA researchers has been bringing to light several dangerous and long-lasting consequences that can arise after the initial attack of COVID. These COVID complications include mental health disorders.
In one of two studies they conducted on the chronic effects of COVID that were published in February 2022, researchers at the VA St. Louis Healthcare System focused on mental health disorders after COVID-19 infection. The group’s findings appeared in the British Medical Journal (BMJ).
Researchers found that even in people who do not need hospitalization while infected with COVID-19, serious health problems related to mental health can persist or appear in the weeks and months after the acute stage. They say the reasons for increased mental health risks after COVID are not completely clear.
Biological changes can occur in the body that affect the brain, and non-biological changes such as social isolation and trauma may also be at play.
Led by principal investigator Dr. Ziyad Al-Aly, who directs both the Center for Clinical Epidemiology and the Research and Development Service at the VA St. Louis Health Care System, the researchers found increased risks for conditions such as depression, anxiety, sleep disorders and substance use disorders.
For many people, COVID-19 infection presents with only mild or moderate symptoms, such as a bothersome cough and shortness of breath that last a few days. But this first phase may be the “tip of the iceberg,” according to Al-Aly. “Those who experience severe chronic consequences, effects that commonly last a lifetime, are the ones who will bear the scars of this pandemic,” he says.
Al-Aly is a nephrologist, a doctor specializing in kidney diseases, as well as a clinical epidemiologist with expertise in big data. His team analyzes huge data sets too complex for conventional computer software. As a researcher, Al-Aly specializes in the chronic effects of COVID, which are technically known as "post-acute sequelae of SARS-CoV-2" and informally as "long COVID" or "long-haul COVID."
Studies by Al-Aly and others have shown that long COVID can affect almost all organ systems. “People return to their doctor with fatigue, brain fog, amnesia, strokes, new-onset diabetes, kidney disease, heart disease and more,” says the physician-researcher.
Of the wide range of chronic consequences of COVID, one area that Al-Aly and his team decided to focus on was mental health. They selected this area because of its serious ramifications for individual and public health, explains study co-author Dr. Yan Xie, a clinical epidemiologist at the VA St. Louis Epidemiology Center.
The research group compared the mental health risks of those who had COVID-19 and survived the first 30 days of infection with the same health outcomes among those who were not infected. Over a study period of about a year, researchers identified elevated risks for problems such as anxiety, depression, stress disorders, opioid use, substance use disorders and sleep conditions.
“We have all suffered some form of distress from this pandemic, perhaps a measure of anxiety or difficulty sleeping,” says lead researcher Al-Aly. “But these challenges are magnified, especially in those who were admitted to the hospital during the acute part of their battle with COVID, but also in many who experienced only mild or moderate symptoms.”
Compared to those without COVID, those in the COVID group had a 60 percent higher risk of having any mental health disorder or mental health-related prescriptions.
The findings by type of mental health problem were:
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Given the large number of people with COVID-19, these findings could translate into a large impact in the United States and around the world, the authors note.
In the study published in the BMJ, researchers analyzed medical records in a database within the VA, which operates the largest integrated health care system in the United States. The analysis included nearly 154,000 patients who had tested positive for COVID-19 in a defined time period from March 2020 to January 2021. (The time period predates the delta and omicron variants, as well as the widespread availability of vaccines).
Using sophisticated statistical methods, the researchers compared the health information of these patients with data from more than 11 million people who had not had COVID-19 infection, about half of them in the same time period and the other half in a period of time prior to the pandemic.
“A strength of our research was the large number of patients and the ability to leverage the breadth and depth of the VA electronic health records system,” Al-Aly notes. As a pioneer in the use of electronic health records, VA “can offer answers to questions about areas, including the pandemic, that would be difficult for others to address.”
Al-Aly also credits his multidisciplinary research team for making the rigorous analysis possible. “We brought together public health experts from all disciplines, successfully combining medical and research perspectives,” says Al-Aly. The team hopes its research and that of other groups will encourage people, health care systems and policymakers to remain vigilant about the virus.
The best defense against long COVID, according to researchers: Avoid getting COVID in the first place. That means taking measures such as getting vaccinated and vaccinated, wearing high-quality masks and washing your hands regularly, Xie specifies. For those who become infected and develop mental health disorders, Xie says, "We hope our results will make it easier for them and their healthcare providers to identify these conditions and initiate treatment."
From a broader public policy perspective, Al-Aly urges a rapid and robust response to support the millions of people who could face serious mental health problems as a result of COVID. “The VA will certainly take care of our patients, and health care systems, as well as governments in this country and around the world, must prepare as well. “It is very important to address these issues now, before they become much bigger crises in the future.”
Al-Aly says he and his colleagues will continue studying long-distance COVID. “As a clinician and researcher, working with a group of full-time researchers, we will continue to leverage our expertise to answer questions that concern the public, including veterans and veterans organizations.”
Al-Aly’s ongoing research includes an examination of the link between long COVID and diabetes. “By raising more awareness about the spectrum of health complications long-haulers face,” she says, “we can work to nip this long COVID crisis in the bud and prevent it from becoming a larger public health problem.” .
Conclusions Using a large national cohort of people with Covid-19 and contemporary and historical controls, we find that the risks of incident mental health disorders are substantial in people with Covid-19 and span several categories of disorders, including anxiety, depression, stress and adjustment disorders, opioid and other substance use disorders, cognitive impairment, and sleep disorders. The risks were evident even among those with Covid-19 who did not require hospital admission. Addressing mental health disorders among Covid-19 survivors must be a priority. What is already known on this topic
What this study adds
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