Bidirectional associations between COVID-19 and psychiatric disorder

Written by:
Maxime Taquet, Sierra Luciano, John R Geddes, Paul J Harrison * Lancet Psychiatry, 2020

The findings in a nutshell

This paper provides an analysis of a large dataset to determine whether being diagnosed with COVID-19 has a relationship with future and past diagnoses of a psychiatric (or mental health) disorder.

There are two main findings from this data analysis:

  1. A COVID-19 diagnosis is a risk factor for developing a mental health disorder, with an anxiety disorder the most likely followed by mood disorder
  2. Individuals who have a history of a psychiatric disorder are at greater risk of being diagnosed with COVID-19

This paper also recognises the growing need for mental health services and support from the perspective of disease comorbidity.

The authors are from the Department of Psychiatry at University of Oxford in the United Kingdom.

Implications for Australian workplaces

Health providers should be equipped to provide mental health services to any members who have had a COVID-19 diagnosis; and also to educate those individuals with a psychiatric illness diagnosis on recommended risk reduction

Employers should be aware of the relationship between COVID-19 and mental illness and ensure they are equipped to provide appropriate support and referral to services.

Overview of paper

The authors used anonymous, de-identified data from over 50 different healthcare organisations across the USA.  The data captured information from the electronic health records of over 62,000 Americans with a diagnosis of COVID-19 between 20 January 2020 and 1 August 2020.

The paper provides considerable detail of the analyses of a bi-directional / two-way relationship between a COVID-19 diagnosis and a psychiatric diagnosis. These are i) the risk of developing a psychiatric disorder (psychotic disorder, mood disorder and anxiety disorder) after being diagnosed with COVID-19, and ii) the instances of previous psychiatric diagnoses with individuals before being diagnosed with COVID-19.  The risk of developing/or having a previous psychiatric disorder for individuals diagnosed with COVID-19 was compared with individuals diagnosed with other health conditions that have similar acute health events, including influenza, other respiratory tract infections, gallstones, urinary tract stones, skin infections, large bone fractures. The analysis reviews data up to 90 days post diagnosis with COVID-19 and previous history was considered from the previous year. Risk factors of individuals (e.g. age, sex, obesity, heart disease, diabetes, asthma etc.) were matched between groups.

Individuals diagnosed with COVID-19 were more than twice as likely to have a first psychiatric diagnosis (psychotic disorder, mood disorder and anxiety disorder) than individuals who had experienced influenza, urinary tract stones or large bone fractures.  Individuals diagnosed with COVID-19 were also more than one and half times (or 50%) more likely to have a first psychiatric diagnosis than other respiratory tract infections, skin infections or gallstones. The overall probability of being diagnosed with a psychiatric illness after a COVID-19 diagnosis within 90 days was 18%, compared to other health conditions (12.7-15.1%).

First diagnoses of psychiatric illness were also greater amongst individuals with COVID-19 diagnoses when compared to the other health conditions (5.8% verses 2.5-3.4%). Hence COVID-19 produced almost double the risk of a first psychiatric diagnosis.  The most common psychiatric disorder reported from individuals with COVID-19 was anxiety disorder with a probability outcome of 12.8%, followed by mood disorder at 9.9%.

The findings were explored further to help ensure that the COVID-19-psychiatric illness relationship was not likely to be due to other reasons i) the differences in the level of severity of the COVID-19 presentations compared to other health condition/events, and ii) The contextual COVID-19 pandemic factors (stress experienced in the health system during the COVID pandemic). The relationships remained similar after adjusting for these potential causes.

Individuals with a history of psychiatric illness (psychotic disorder, mood disorder and anxiety disorder) were also analysed to identify any relationships with COVID-19.  A previous diagnosis of psychiatric disorder was associated with a 65% increased risk of a COVID-19 diagnosis than individuals without a previous psychiatric illness diagnosis.  Further analyses adjusted for other factors such as other illnesses, socioeconomic status and race, and the odds still indicated an increased risk of a COVID-19 diagnosis by around 50% for individuals with a previous psychiatric diagnosis. However, the researchers interpret this with caution as elsewhere (Korea) no relationship was found, but behavioural factors suggested as a possible reason (e.g. social distancing).

Authors also note that it is plausible that the likelihood of psychiatric diagnoses may have been increased by health practitioners after a COVID-19 diagnosis due to nature and extent of assessments.

To find out more read the full article here.

Date published: 12 November 2020

Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK

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