Bidirectional associations between COVID-19 and psychiatric disorder: retrospective cohort studies of 62 354 COVID-19 cases in the USA.
Open accessPublished version of a preprint
Abstract
BACKGROUND: Adverse mental health consequences of COVID-19, including anxiety and depression, have been widely predicted but not yet accurately measured. There are a range of physical health risk factors for COVID-19, but it is not known if there are also psychiatric risk factors. In this electronic health record network cohort study using data from 69 million individuals, 62 354 of whom had a diagnosis of COVID-19, we assessed whether a diagnosis of COVID-19 (compared with other health events) was associated with increased rates of subsequent psychiatric diagnoses, and whether patients with a history of psychiatric illness are at a higher risk of being diagnosed with COVID-19. METHODS: We used the TriNetX Analytics Network, a global federated network that captures anonymised data from electronic health records in 54 health-care organisations in the USA, totalling 69·8 million patients. TriNetX included 62 354 patients diagnosed with COVID-19 between Jan 20, and Aug 1, 2020. We created cohorts of patients who had been diagnosed with COVID-19 or a range of other health events. We used propensity score matching to control for confounding by risk factors for COVID-19 and for severity of illness. We measured the incidence of and hazard ratios (HRs) for psychiatric disorders, dementia, and insomnia, during the first 14 to 90 days after a diagnosis of COVID-19. FINDINGS: In patients with no previous psychiatric history, a diagnosis of COVID-19 was associated with increased incidence of a first psychiatric diagnosis in the following 14 to 90 days compared with six other health events (HR 2·1, 95% CI 1·8-2·5 vs influenza; 1·7, 1·5-1·9 vs other respiratory tract infections; 1·6, 1·4-1·9 vs skin infection; 1·6, 1·3-1·9 vs cholelithiasis; 2·2, 1·9-2·6 vs urolithiasis, and 2·1, 1·9-2·5 vs fracture of a large bone; all p<0·0001). The HR was greatest for anxiety disorders, insomnia, and dementia. We observed similar findings, although with smaller HRs, when relapses and new diagnoses were measured. The incidence of any psychiatric diagnosis in the 14 to 90 days after COVID-19 diagnosis was 18·1% (95% CI 17·6-18·6), including 5·8% (5·2-6·4) that were a first diagnosis. The incidence of a first diagnosis of dementia in the 14 to 90 days after COVID-19 diagnosis was 1·6% (95% CI 1·2-2·1) in people older than 65 years. A psychiatric diagnosis in the previous year was associated with a higher incidence of COVID-19 diagnosis (relative risk 1·65, 95% CI 1·59-1·71; p<0·0001). This risk was independent of known physical health risk factors for COVID-19, but we cannot exclude possible residual confounding by socioeconomic factors. INTERPRETATION: Survivors of COVID-19 appear to be at increased risk of psychiatric sequelae, and a psychiatric diagnosis might be an independent risk factor for COVID-19. Although preliminary, our findings have implications for clinical services, and prospective cohort studies are warranted. FUNDING: National Institute for Health Research.
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There are suggestions of increased risk in people who have been infected with COVID-19.
“There are suggestions of increased risk in people who have been infected with COVID-19, in line with findings from studies showing increased risk of mental health problems in survivors of COVID-19 ( Taquet et al., 2021).”
From The impact of the COVID-19 pandemic on self-harm and suicidal behaviour: update of living systematic review (2021) · cites this paper as Taquet et al., 2021
Long COVID-19 can involve chronic fatigue syndrome and psychiatric problems such as cognitive decline, depression, and neurodegeneration.
“These include chronic fatigue syndrome (Salisbury, 2020) and a spectrum of psychiatric disorders ranging from cognitive decline, depression, to even neurodegeneration (Taquet et al., 2021).”
From COVID-19 and the human innate immune system (2021) · cites this paper as Taquet et al., 2021
How people who recovered from COVID-19 will fare in the long term is uncertain.
“There are also uncertainties about the long-term prognosis of people who recovered from COVID-19,”
From Strengthening public mental health during and after the acute phase of the COVID-19 pandemic (2022) · cites this paper as [3]
Survivors of COVID-19 are at increased risk of mood and anxiety disorders in the 3 months after infection.
“Similar concerns have been raised regarding psychiatric sequelae of COVID-19,12, 13 with evidence showing that survivors are indeed at increased risk of mood and anxiety disorders in the 3 months after infection.14”
From 6-month neurological and psychiatric outcomes in 236 379 survivors of COVID-19: a retrospective cohort study using electronic health records (2021) · cites this paper as [14]
The findings regarding anxiety and mood disorders showed that the HR remained elevated, although decreasing, at the 6-month period.
“The findings regarding anxiety and mood disorders were broadly consistent with 3-month outcome data from a study done in a smaller number of cases than our cohort, using the same network,14 and showed that the HR remained elevated, although decreasing, at the 6-month period.”
From 6-month neurological and psychiatric outcomes in 236 379 survivors of COVID-19: a retrospective cohort study using electronic health records (2021) · cites this paper as [14]
The data in this study support an association between COVID-19 and dementia.
“Our previous study reported preliminary evidence for an association between COVID-19 and dementia.14 The data in this study support this association.”
From 6-month neurological and psychiatric outcomes in 236 379 survivors of COVID-19: a retrospective cohort study using electronic health records (2021) · cites this paper as [14]
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- Authors
- Taquet, M., Luciano, S., Geddes, J. R., & Harrison, P. J.
- Affiliations
- Oxford Health NHS Foundation Trust (GB)
- TriNetX (United States) (US)
- Corresponding author
- Harrison, Paul J
- Venue
- The Lancet Psychiatry
- Publisher
- Elsevier BV
- Published
- 2021-02
- Volume
- 8
- Issue
- 2
- Pages
- 130-140
- ISSN
- 2215-0366 (ISSN-L)
- PMC
- PMC7820108
- OpenAlex
- W3095092064
- Cited by
- 1,484
- References
- 30
- Citations by year
- 2026: 34 · 2025: 90 · 2024: 173 · 2023: 280 · 2022: 402 · 2021: 484 · 2020: 18 · 2019: 1
- FWCI
- 118.50
- Type
- journal article
- Language
- en
- Update notices
- erratum (2021-01-01)
- Open access
- hybrid
- doi.org
- Licence
- Locations
- The Lancet Psychiatry (publishedVersion, cc-by)
- medRxiv (acceptedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, other-oa)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Funders
- National Institute for Health Research
- Topics
- Social Sciences › Psychology › Clinical Psychology › COVID-19 and Mental Health
- Health Sciences › Medicine › Neurology › Long-Term Effects of COVID-19
- Health Sciences › Medicine › Infectious Diseases › COVID-19 Clinical Research Studies
- Keywords
- COVID-19 pandemic, mental illness, anxiety disorders, depression, dementia, insomnia, bidirectional relationship, psychiatric risk factors, COVID-19 risk factors, electronic health records, TriNetX, influenza, respiratory infections, urolithiasis, gallstones, fracture, relapse, hazard ratio, propensity score matching
- MeSH terms
- COVID-19, Adult, Aged, Mental Disorders, Female, Humans, Male, Middle Aged, Retrospective Studies, Risk Factors, United States, Comorbidity, Incidence, Electronic Health Records
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