Long-term effects of COVID-19 on mental health: A systematic review

In the paper

“Participants typically experienced no or mild symptoms of long-term anxiety (GAD-7, STAI-S, HADS) and depression (PHQ-9, BDI, PHQ-2, HADS).”

• Also stated in: § Discussion · plain

  “The included participants typically exhibited no worse than mild symptoms of anxiety and depression.”

In the paper

“Cohorts followed up for more than three months had half the prevalence of depression compared to those that were followed up for less than three months, reporting a prevalence of 10.36% and 20.84% respectively.”

In the paper

“One study reported no anxiety with an average score of 1.88 (95% CI = 0.68, 3.08; (Kang et al., 2021)”

In the paper

“This included 3431 patients 17.52% of whom were experiencing at least mildly severe anxiety symptoms.”

In the paper

“Depression prevalence in severe COVID-19 cases was 20.39% out of 309 patients, averaging none to mild symptoms of depression.”

In the paper

“An average MOS-SS score of 20.58 (95% CI = 19.95, 21.21) was reported representing mild symptoms of sleep disturbance (Mazza et al., 2020).”

In the paper

“Two studies used the ISI with an overall insomnia prevalence of 34.64% (Li et al., 2021, Morin et al., 2021).”

In the paper

“The prevalence of PTSD in severe cases of COVID-19 was 19% from 200 patients.”

In the paper

“Prevalence varied depending on the measurement tool.”

In the paper

“PTSD prevalence in cohorts followed up longer than three months was slightly higher than less than three months follow-up at 18.99% and 12.19% respectively (Supplement 8).”

In the paper

“Overall, there was inconsistency findings in anxiety prevalence between different diagnostic tools.”

In the paper

“Guo et al. (2020) and Hasan et al., 2021 reported an average mild depression severity, with a mean PHQ-9 score of 5.00 (95% CI = 4.71, 5.29) and 5.64 (95% CI = 4.98, 6.30).”

In the paper

“Taquet et al. (2021) reported a prevalence of anxiety disorder of 7.11% (95% CI = 6.82, 7.41).”

What the sources say

• Not checked yetcites Taquet et al. (2021) source

In the paper

“The two BDI studies, Mazza et al. (2021) and Ortelli et al. (2021) reported minimal depression, with average scores of 1.93 (95% CI = 1.34, 2.52) and 3.80 (95% CI = 2.16, 5.44) respectively.”

In the paper

“Sensitivity analysis showed a decrease in prevalence from 20.68% to 11.11% between one to three months follow-up and more than three months follow-up (Supplement 8).”

• Also stated in: § Discussion · plain

  “Finally, the sensitivity analysis revealed a decrease in anxiety with follow-up greater than three months.”

In the paper

“The overall prevalence of positive PTSD screen was 17.68% of 3405 participants.”

In the paper

“only two HADS studies reported mean scores, both indicating minimal depression with scores of 3.81 (95% CI = 3.227, 4.35) for Noviello et al., 2021 and 6.3 (95% CI = 5.79, 6.81) for Poyraz et al., (2021).”

In the paper

“PTSD prevalence was similar to anxiety and depression.”

In the paper

“All studies examined an adult sample from treatment centres or hospitals.”

In the paper

“The outcomes were assessed approximately one to six months after infection (see Supplement 4).”

In the paper

“An overall prevalence of sleep disturbances of 36.59% of 1454 participants was obtained.”

In the paper

“Similar to anxiety, depression mean scores for each study indicated levels from none to mild.”

In the paper

“Three studies used the PSQI with an overall prevalence of 41.97% (Poyraz et al., 2021, Tanriverdi et al., 2021, Wong et al., 2020).”

In the paper

“Sleep disturbances (primarily insomnia) were most commonly reported as mild.”

In the paper

“The only study using the STAI-S identified minor symptoms of anxiety with Mendez et al., 2021 reporting 33.66 (95% CI = 31.88, 35.44)”

In the paper

“Patients with a positive psychiatric history were more likely to display higher symptoms scores of depression, anxiety, and PTSD.”

In the paper

“It is important to note that there was heterogeneity related to the severity of COVID-19 within and between studies.”

In the paper

“Anxiety prevalence in severe COVID-19 cases was 19.03% of 309 patients that were experiencing at least mild anxiety symptoms”

In the paper

“From a total of 4935 participants, 18.85% exhibited at least mild symptoms of depression (Supplement 7).”

In the paper

“two HADS studies (Noviello et al., 2021, Poyraz et al., 2021) reported minimal anxiety with overall scores of 4.68 (95% CI = 4.07, 5.29) and 6.2 (95% CI = 5.65, 6.75) respectively.”

In the paper

“Two studies using GAD-7 (Guo et al., 2020, Hasan et al., 2021) reported on average mild anxiety with a mean score of 5.00 (95% CI = 4.14, 5.86) and 5.79 (95% CI = 5.16, 6.42).”

In the paper

“The prevalence of insomnia reported using the ISI was lower than that in patients with acute COVID-19, and comparable to the general population during the early stages of the pandemic in China, when measured using the same instrument (Deng et al., 2020; Yu et al., 2020).”

What the sources say

• Not checked yetcites Deng et al., 2020
• Not checked yetcites Yu et al., 2020

In the paper

“Taquet et al. (2021) reported a low prevalence of mood disorders, with other studies stating that long-term anxiety and depression in COVID-19 patients are similar to pre-pandemic levels (Klaser et al., 2021).”

What the sources say

• Not checked yetcites Taquet et al., 2021 source

In the paper

“Finally, the sensitivity analysis revealed a decrease in PTSD prevalence with longer follow-up.”

In the paper

“PSQI prevalence was also comparable to that in the general population during the outbreak determined using the same tool (Jahrami et al., 2021).”

What the sources say

• Not checked yetcites Jahrami et al., 2021 source

In the paper

“Sensitivity analysis showed a halving of depression prevalence in studies with a longer follow-up.”

In the paper

“Overall, although sleep disturbance prevalence is higher than the other outcomes, this is not pertaining to disorders and does not appear substantially different from general population estimates.”

In the paper

“As for PTSD, overall PCL-5 and TSQ scores were lower compared to DTS and IES-R scores.”

In the paper

“The pooled prevalence was also lower compared to rates reported in the MERS (Park et al., 2020a) and SARS epidemics (Mak et al., 2009).”

What the sources say

• Not checked yetcites Park et al., 2020a
• Not checked yetcites Mak et al., 2009 source

In the paper

“In the case of sleep disturbances, evidence of minor levels of sleep disturbances was presented by Mazza et al. (2020).”

What the sources say

• Not checked yetcites Mazza et al., 2020 source

In the paper

“When pooled, the combined prevalence of all studies reporting depression was no higher than would be expected in the general public during the COVID-19 pandemic (Salari et al., 2020; Zhang et al., 2020; Krishnamoorthy et al., 2020).”

What the sources say

• Not checked yetcites Salari et al., 2020
• Not checked yetcites Zhang et al., 2020
• Not checked yetcites Krishnamoorthy et al., 2020 source

In the paper

“Most studies reported anxiety, depression and sleep disturbances in the short term following COVID-19.”

In the paper

“The prevalence of insomnia reported using the ISI was lower than that in patients with acute COVID-19, and comparable to the general population during the early stages of the pandemic in China, when measured using the same instrument (Deng et al., 2020; Yu et al., 2020).”

In the paper

“Taquet et al. (2021) reported a low prevalence of mood disorders, with other studies stating that long-term anxiety and depression in COVID-19 patients are similar to pre-pandemic levels (Klaser et al., 2021).”

What the sources say

• Not checked yetcites Klaser et al., 2021 source

In the paper

“The studies’ risk of bias were typically fair quality.”

• Also stated in: § Quality assessment · plain

  “The risk of bias, assessed using the NOS, indicated seven studies were rated as good quality, eighteen rated as fair quality, and eight rated as poor quality (Supplement 3).”

In the paper

“These have demonstrated sustained long-term psychiatric illness in people who have recovered from the acute infection (Park et al., 2020a).”

What the sources say

• Not checked yetcites Park et al., 2020a

In the paper

“As with anxiety, the clinical interview implemented by Xiong et al. (2021) yielded a much lower depression prevalence compared to the questionnaires.”

What the sources say

• Not checked yetcites Xiong et al. (2021) source

In the paper

“Studies with up to 12-year follow-up have shown sustained mental health effects including anxiety, depression, trauma, and sleep disturbance (Tzeng et al., 2020).”

What the sources say

• Not checked yetcites Tzeng et al., 2020 source

In the paper

“However, the long-term effect from direct COVID-19 infection has been associated with no or mild symptoms.”

In the paper

“Overall, the evidence presented does not suggest any increase in anxiety after COVID-19 infection.”

In the paper

“All except PHQ-9 and HRSD reported lower than expected prevalence compared to other studies that examined the general population and healthcare workers during the COVID-19 pandemic using a mild disease severity threshold (Salari et al., 2020; Zhang et al., 2020; Krishnamoorthy et al., 2020).”

What the sources say

• Not checked yetcites Salari et al., 2020
• Not checked yetcites Zhang et al., 2020
• Not checked yetcites Krishnamoorthy et al., 2020 source

In the paper

“However, one year on from the (Rogers et al., 2020)systematic review of May 2020, the predicted mild trajectory of psychiatric illness would seem to have been borne out.”

What the sources say

• Not checked yetcites Rogers et al., 2020 source

In the paper

“This was also found within Klaser et al. (2021) who recruited a large cohort of SARS-CoV-2 positive individuals and found a slightly higher prevalence of anxiety and depression disorders at three months compared to pre-pandemic levels.”

What the sources say

• Not checked yetcites Klaser et al. (2021) source

In the paper

“The PHQ-9 prevalence percentages may be over-sensitive in the included studies due to the low cut-off scores employed (Hasan et al., 2021).”

What the sources say

• Not checked yetcites Hasan et al., 2021

In the paper

“Compared to clinical diagnoses reported by Taquet et al. (2021), self-reported anxiety prevalence was significantly higher, further indicating the disparities between clinical diagnosis and patient-reported screening questionnaires.”

What the sources say

• Not checked yetcites Taquet et al. (2021) source

In the paper

“Anxiety findings (mean GAD-7, STAI-S and HADS scores) were comparable to the general population.”

In the paper

“It is possible that indirect psychosocial factors may be the overriding mechanism for any increased level of anxiety and depression(Brooks et al., 2020, Yu et al., 2020).”

What the sources say

• Not checked yetcites Brooks et al., 2020 source
• Not checked yetcites Yu et al., 2020

In the paper

“In addition, psychological, social, and job-related factors have also been shown to be associated with poor mental health outcomes (Vindegaard and Benros, 2020).”

What the sources say

• Not checked yetcites Vindegaard and Benros, 2020 source

In the paper

“While this is not a fair comparison due to the different follow-up timeframes, the low prevalence does not support an association between COVID-19 and long-term PTSD.”

In the paper

“From the results of our study, current data seem to indicate limited association between long-term follow-up after COVID-19 infection and psychiatric disorders.”

In the paper

“These have been linked to mood disorders (Dantzer, 2018; Miller and Raison, 2016) and sleep disturbances (Cespuglio et al., 2021) providing some indications of neurological mechanisms through which viral infection may have causal effects on psychiatric disorder onset.”

In the paper

“The appearance of some mental health symptoms following COVID-19 may be resultant of infection.”

In the paper

“However, symptoms at longer term were consistent with the general population suggesting deterioration could be attributed to indirect effects of COVID-19 psychosocial factors.”

In the paper

“This renders the mechanism for psychiatric effects complex and not easily disentangled with these included studies.”

In the paper

“These have been linked to mood disorders (Dantzer, 2018; Miller and Raison, 2016) and sleep disturbances (Cespuglio et al., 2021) providing some indications of neurological mechanisms through which viral infection may have causal effects on psychiatric disorder onset.”

What the sources say

• Not checked yetcites Dantzer, 2018
• Not checked yetcites Miller and Raison, 2016 source

In the paper

“Overall, although sleep disturbance prevalence is higher than the other outcomes, this is not pertaining to disorders and does not appear substantially different from general population estimates.”

In the paper

“These have been linked to mood disorders (Dantzer, 2018; Miller and Raison, 2016) and sleep disturbances (Cespuglio et al., 2021) providing some indications of neurological mechanisms through which viral infection may have causal effects on psychiatric disorder onset.”

What the sources say

• Not checked yetcites Cespuglio et al., 2021 source

In the paper

“Only seven of thirty-three studies were rated as good in the RoB assessment.”

In the paper

“This suggests that the global increase in mental health sequelae reported by Santomauro et al. (2021) is more likely due to psychosocial factors rather than a direct long-term effect of the virus.”

What the sources say

• Not checked yetcites Santomauro et al., 2021 source

In the paper

“However, symptoms at longer term were consistent with the general population suggesting deterioration could be attributed to indirect effects of COVID-19 psychosocial factors.”

In the paper

“Once in the brain, the virus can trigger an immune response resulting in the secretion of interleukins, tumour necrosis factor and nitric oxide (Cespuglio et al., 2021).”

What the sources say

• Not checked yetcites Cespuglio et al., 2021 source

In the paper

“External environmental factors such as quarantine and lockdown measures introduced during the onset of the pandemic have been shown to act as risk factors for psychiatric disorders.”

What the sources say

• Not checked yetcites Brooks et al., 2020 source

In the paper

“Studies of previous coronaviruses (Netland et al., 2008), animal models (Burks et al., 2021), and brain analysis at post-mortem of COVID-19 patients (Paniz-Mondolfi et al., 2020) provide evidence that SARS-CoV-2 can penetrate the blood-brain barrier.”

What the sources say

• Not checked yetcites Netland et al., 2008 source
• Not checked yetcites Burks et al., 2021 source
• Not checked yetcites Paniz-Mondolfi et al., 2020 source

In the paper

“This confirms results from Mazza et al. (2021) where PTSD reported using PCL-5 decreased with longer follow-up in COVID-19 patients.”

What the sources say

• Not checked yetcites Mazza et al., 2021 source

In the paper

“Overall, although sleep disturbance prevalence is higher than the other outcomes, this is not pertaining to disorders and does not appear substantially different from general population estimates.”