Researchers have observed that COVID patients who are bed-ridden (but not hospitalised) from the effects of the virus for more than seven days experience a higher risk of depression and sleep disturbance.
The University of Iceland study observed 250,000 Europeans over 16 months, 10,000 of whom had COVID-19 at the commencement of the assessment.
While higher incidences of depressive symptoms and poor sleep were reported among those who had contracted the virus and were stuck in bed for more than a week, they were no more prone to anxiety or a form of poor mental health that the researchers referred to as ‘COVID-19 related distress’.
In another surprising outcome, people who experienced milder effects of COVID (defined by spending under a week in bed after contracting the respiratory virus) reported consistently lower depression and anxiety. The researchers attributed this to possibly being relieved that they got away relatively unscathed while people who had so far avoided the virus were still fearful of the unknown.
The study is the first to look at long-term mental health implications for patients using data from seven cohorts across Denmark, Estonia, Iceland, Norway, Sweden, and the UK. Most of the comparison group responded between April and June 2020.
Many other similar studies only followed patients who had contracted COVID-19 six months after their positive diagnosis.
“The pandemic upended many aspects of daily life and the toll of social distancing requirements, coupled with a general uncertainty has taken on many people’s mental health is well-documented.
“Much less is known about the long-term mental health impacts beyond that period, particularly for non-hospitalised patients with varying degrees of illness severity,” a statement from the research group said.
Over 16 months, patients who were bedridden for seven days or more continued to be 50-60% more likely to experience higher depression and anxiety compared to people never infected during the study period.
Crucially, the study found a clear improvement in some mental health symptoms –specifically for depression and COVID-19 related distress over time.
The researchers said the mental health of patients who enjoyed a faster recovery from the physical symptoms of COVID-19 may have declined and rebounded at a similar rate. However, patients with severe COVID-19 were also reported to have experienced inflammation that has been linked to chronic mental health effects, particularly depression.
One of the paper co-authors, Professor Unnur Anna Valdimarsdóttir, said as society grappled with the pandemic for a third year it was important that more clinical studies examining the adverse mental health impacts for people who experienced acute disease of COVID-19.
“[Our study] suggests that mental health effects aren’t equal for all COVID-19 patients and that time spent bedridden is a key factor in determining the severity of the impacts on mental health,” Valdimarsdóttir said.
Ingibjörg Magnúsdóttir, another co-author from the University of Iceland, said the higher rates of depression for those who spent more time recovery from COVID-19 in bed could boil down to helplessness.
“[It] could be due to a combination of worrying about long-term health effects as well as the persistence of physical long COVID symptoms well beyond the illness that limit social contact,” Magnúsdóttir said.
The peer-reviewed findings were published in The Lancet Public Health journal on Monday.
Limitations noted in the study included the fact that individuals who were diagnosed with COVID-19 were slightly more likely to have past diagnoses of psychiatric disorders than individuals without a COVID-19 diagnosis (the absolute differences however did not exceed 4% in any of the cohorts whose data was analysed); and that the COVID-19 diagnosis and mental health symptoms (the coexistence of two or more symptoms) were self-reported.