Neuropsychiatric sequelae after severe COVID-19 was similar to the sequelae following other severe acute respiratory infections (SARIs), according to study findings published in JAMA Psychiatry.
Data from pre-pandemic SARIs have indicated that patients were at increased risk for subsequent neuropsychiatric illness and cognitive impairments. Patients who recovered from severe COVID-19 have been associated with neuropsychiatric sequelae, however, it remains unclear whether the trends in sequelae observed after SARS-CoV-2 are similar to or differ from previous SARI outbreaks.
Data for this study were sourced from the QReasearch primary care database which comprises of more than 30 million individuals who received care from over 1400 general practices in England since 1989. Patients with COVID-19 between January 2020 and July 2021 (n=32,525) were compared with historical cohorts of patients with SARIs (n=16,679) and the general population (n=8,330,986) between January 2015 and January 2020 for instances of new-onset diagnoses of neuropsychiatric conditions or first prescriptions of neuropsychiatric drugs.
The COVID-19, SARI, and reference populations were aged mean 65.40 (standard deviation [SD], 18.42), 69.34 (SD, 18.70), and 49.07 (SD, 18.40) years; 53.52%, 50.60%, and 50.14% were men; and 62.35%, 74.15%, and 64.22% were White, respectively.
Rates of new-onset diagnoses of anxiety (0.74% vs 1.04% vs 0.95%), dementia (0.50% vs 1.13% vs 0.18%), psychotic disorder (0.04% vs n<10 vs 0.02%), depression (0.05% vs 0.15% vs 0.06%), and bipolar affective disorder (0.04% vs 0.08% vs 0.05%) or new prescription of antidepressant (2.85% vs 4.12% vs 2.10%), hypnotic or anxiolytic (2.11% vs 3.44% vs 0.99%), and antipsychotic (1.64% vs 3.90% vs 0.34%) medications were observed among the COVID-19, SARI, and reference populations, respectively.
Compared with the reference population, COVID-19 and SARI were associated with increased risk for anxiety (COVID-19: hazard ratio [HR], 2.36; SARI: HR, 1.86), dementia (COVID-19: HR, 2.63; SARI: HR, 2.55), psychotic disorder (COVID-19: HR, 3.05; SARI: HR, 3.63), depression (COVID-19: HR, 1.95; SARI: HR, 3.46), bipolar disorder (COVID-19: HR, 2.26; SARI: HR, 2.26) and receipt of antidepressants (COVID-19: HR, 3.24; SARI: HR, 2.55), hypnotics or anxiolytics (COVID-19: HR, 3.79; SARI: HR, 3.10), and antipsychotics (COVID-19: HR, 4.78; SARI: HR, 4.64) at similar levels.
In the maximally adjusted analysis using a cohort of patients who survived admission after an acute myocardial infarction as a reference population (n=10,630), COVID-19 and SARI were associated with decreased risk for new-onset anxiety (COVID-19: HR, 0.62; SARI: HR, 0.66) and increased risk for new-onset dementia (COVID-19: HR, 1.92; SARI: HR, 2.24), receipt of antipsychotic prescription (COVID-19: HR, 2.00; SARI: HR, 2.48), and hypnotic or anxiolytic prescription (COVID-19: HR, 1.04; SARI: HR, 1.09).
A limitation of the study was that it relied on the assumption that all patients experiencing neurologic sequelae sought care for new-onset conditions.
“Risks of neuropsychiatric illnesses or commencement of related medications were similar for COVID-19 and non-COVID severe respiratory infections,” the researchers concluded.
Disclosure: An author declared affiliations with industry. Please refer to the original article for a full list of disclosures.
Clift AK, Ranger TA, Patone M, et al. Neuropsychiatric Ramifications of Severe COVID-19 and Other Severe Acute Respiratory Infections. JAMA Psychiatry. Published online May 11, 2022. doi:10.1001/jamapsychiatry.2022.1067