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The psychological sequelae are also lasting in the event of covid-19

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Among the many sequelae of the covid-19 pandemic, the mental health impacts, both for survivors and for those who have not been infected, are among the most documented. Now, for the first time, a study in six countries has assessed the long-term incidence of depression and anxiety in former patients. The research, published in The Lancet Public Health, shows that the duration of symptoms reaches 16 months after diagnosis.

The scientists also compared the sleep quality and mental health impacts of people who did not have covid and those who were mildly, moderately or severely infected. Survivors who were hospitalized for more than seven days had the highest rates of disorder.

According to the authors, previous studies that assessed the mental impacts of the pandemic followed participants for up to 12 months after diagnosis. However, the intention now was to study whether, in addition to the physical sequelae that characterize the long covid, these also persist long after the infection has healed. For this, the researchers used population cohort data from Denmark, Estonia, Iceland, Norway, Sweden and the United Kingdom for 16 months.

Of the 247,249 participants included, 9,979 (4%) were diagnosed with covid between February 2020 and August 2021. Overall, survivors had a higher prevalence of depression and poorer sleep quality compared to survivors. people who have never been infected — 20.2% versus 11.3% (depression) and 29.4% versus 23.8% (poor quality of sleep). After adjusting for other factors such as age, sex, body mass index and psychiatric history, the prevalence of symptoms was 18% and 13% higher, respectively, in Sars-CoV-2 victims. .

Interestingly, those diagnosed but not hospitalized were less likely to show symptoms of depression and anxiety than those who had never been infected. In the article, the authors explain that “the return to normal life is a relief for these individuals, while those who were not infected were still anxious about the risk of infection and burdened by social isolation”.

The researchers found that the longer the patient was bedridden, the higher the prevalence of mental health impacts. Over 16 months, patients who remained in this state for seven days or more were 50-60% more likely to suffer from depression and anxiety, compared to people who were never infected during the study period. .

“Our research is among the first to explore mental health symptoms after severe COVID in the general population up to 16 months after diagnosis,” said lead author Unnur Anna Valdimarsdóttir, from the University of Iceland, in a note. “This suggests that mental health effects are not the same for all Covid patients and that time spent in bed is a key factor in determining the severity of impacts in this regard. As we enter the third year of the pandemic, increased clinical monitoring of adverse psychiatric effects among the proportion of patients with severe acute illnesses and long-term follow-up studies are essential to ensure access to needed care.

multifactorial
Co-author Ingibjörg Magnúsdóttir, also from the University of Iceland, explained that the higher frequency of depression and anxiety in patients with severe covid who stayed longer than seven days in hospital could be due to a combination of factors. “In addition to concerns about long-term health effects, limiting social contact can lead to feelings of helplessness. Similarly, inflammatory responses in severely diagnosed patients can contribute to more persistent mental health symptoms. In contrast, the fact that people with mild Covid infection can return to normal life sooner and only experience mild infection likely helps reduce the risk of negative mental health effects that we observed.

“We now have a clearer picture of the mental health impacts of the Covid-19 pandemic,” says Scott Weich, a professor of mental health at the University of Sheffield in England who was not involved in the study. He recently wrote an op-ed in the British Medical Journal on the relationship between Covid infection and the increased incidence of depression and anxiety. “Based on findings from previous studies, for the general population, Covid and lockdowns caused transient threat-related suffering. Those who contracted covid had an increased risk of anxiety and depression,” says Weich , saying that, now, we need to focus on understanding the causes of the long-term mental impacts on those with the infectious disease.

Royce Lee, a psychiatrist and researcher at the University of Chicago, says some survivors even suffer from what he calls “covid psychosis,” a condition that may even be linked to brain changes. “In some cases, we can be sure that Covid is directly playing a role because patients may show neurological symptoms such as confusion, delirium and loss of taste and smell, which actually prove that the virus is affecting the brain,” says -he. “In other cases, we don’t see strong neurological symptoms, we only notice psychiatric symptoms, including suicidal thoughts.” The doctor also advocates greater attention to the mental health of survivors of the infection.

Inflammation persists after mild covid
A new study from the Karolinska Institute in Sweden and the Technical University of Munich in Germany demonstrates that a certain type of immune cells called macrophages have altered inflammatory and metabolic expression three to five months after mild covid. Long-term symptoms are relatively common after severe Sars-CoV-2 infection, but they can also affect people with mild disease. Further research is needed to understand long-term immune aberrations in patients who suffered from the mild form of the disease, the study authors warn.

For this, the researchers analyzed blood samples from 68 people cured of a mild infection and from a control group of 36 volunteers who did not have covid. They then isolated the macrophages in the lab and stimulated them with spike proteins, steroids and lipopolysaccharides (LPS), a molecule that triggers the immune system. Cells were sequenced with RNA to measure active genes. The scientists also looked at the presence of eicosanoid signaling molecules, which are a key hallmark of inflammation.

“It is not surprising to find large numbers of eicosanoid molecules in people with covid-19, as the disease causes inflammation, but it was surprising that they were still produced in large quantities several months after the outbreak. ‘infection,” says Craig Wheelock of the Karolinska. Institute and one of the authors of the study.

Asthma
Research has also shown a higher concentration of leukotrienes, which are a type of pro-inflammatory molecule known to cause asthma. “Although most of these people did not have persistent symptoms, their immune systems were more sensitive than those of their healthy counterparts,” says Wheelock.

“It is very impressive that the concentration of leukotrienes remains elevated in macrophages in people who have had mild covid,” comments the study’s corresponding author, Julia Esser-von Bieren, head of the research group at the Technical University of Munich. “Leukotrienes are key mediators of asthma, but they are also involved in the host’s antiviral defense against influenza. A sustained increase after infection with Sars-CoV-2 may result in greater susceptibility to respiratory inflammation, but may also enhance antiviral immunity to Sars-CoV-2 or other viruses.

The researchers note that post-covid diagnosis was not specifically examined in the study, and as such, further research is needed to determine whether these findings can be directly linked to the long form of the disease.

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