Even patients who were never sick enough to be hospitalized for COVID were still 68% more likely than their non-infected counterparts to be diagnosed with a sleep disorder, 69% more likely to have an anxiety disorder, and 77% more likely to have a depressive disorder. The relative risk of developing the conditions was significantly higher still in patients hospitalized for COVID, and translates into dozens of additional mental health conditions for every 1,000 coronavirus cases.

The findings, based on an analysis of the U.S. Department of Veterans Affairs’ electronic health-care databases, were published Wednesday in the journal BMJ. They indicate that the burden of neurological disorders — estimated to afflict more than 200 million Americans in 2017 — will balloon as a consequence of the pandemic and have wider medical and social complications, including more substance abuse and suicides.

The COVID virus “is actually now capable of producing long-term consequences on a scale that we have never seen before,” said study co-author Ziyad Al-Aly, chief of research and development at the VA St. Louis Health Care System and clinical epidemiologist at Washington University in Missouri, in an interview. “It really produces a myriad of abnormalities that will stick with people for a lifetime and have really long-term ramifications on their ability to rejoin the workforce.”

Al-Aly and colleagues followed for about a year almost 154,000 users of the largest integrated health-care system in the U.S. who survived the first 30 days of a SARS-CoV-2 infection to assess their likelihood of having a new mental-health condition. The group was compared with 5.6 million people who weren’t reported to have been infected during the same period, along with data predating the pandemic from a historical control group of 5.9 million people.

“While we all suffered mental distress in this pandemic, people with COVID-19 had it much worse and are experiencing mental-health problems up to a year after their initial diagnosis,” Al-Aly said. “We see across-the-board anxiety, depression, sleep problems, neurocognitive decline, opioid use disorders.”

Drug Abuse, Suicidal Thoughts

The authors found a 2.4 times higher likelihood of being prescribed opioids and sleep medication among non-hospitalized COVID survivors and a fourfold increased risk among those needing hospitalization. The risk of a substance abuse disorder was about twice as high among COVID survivors, and the risk of having suicidal thoughts was 3-to-4 times higher than uninfected people.

“The diseases that we’re talking about as a result of COVID-19 in the long term are chronic diseases that really will scar people for a lifetime,” Al-Aly said. “Anxiety is not something that just goes away all of a sudden; it requires care and attention. Public health authorities, governments and health systems around the world should really start paying attention, before it’s too late, to the aftermath of the pandemic.”

In a separate analysis, the authors found COVID was associated with a significantly higher risk of mental-health problems than seasonal influenza.

Users of the VA health system are predominantly older white males, which may limit how generalizable the study’s findings are to other groups, said Nilu Ahmed, a behavioral psychologist at the University of Bristol. “We need more research on marginalized groups where indications are there will be higher levels of unmet mental health needs due to the intersecting of systemic racism and access to health care,” she said.

Studies representing larger populations have produced similar findings, said Max Taquet, a senior research fellow studying psychiatric disorders at the University of Oxford. 

“The fact that patients appear to still be at an increased risk 12 months after their COVID-19 diagnosis is concerning,” Taquet said. “But whether this represents delayed diagnoses or new onset of mental illness remains to be determined.”

It’s possible other factors may have influenced the findings, said Paul Harrison, professor of psychiatry at the University of Oxford. 

“People recovering from COVID-19 might have a lower threshold for presenting for health care, or their doctors might be more likely to make a diagnosis,” he said. “Nevertheless, the findings strengthen the case for adequate resourcing of mental health care in COVID-19 survivors, and for research into the causes and treatment of the disorders.”