Psychiatrists from Oxford University have found that several patients who recovered from COVID-19 were at a risk of being diagnosed with a mental illness within three months since the onset of the disease. The study published in British journal Lancet highlights that about 20 per cent (one in five) COVID-19 survivors were diagnosed with depression, anxiety disorders. Notably, 25 per cent of these patients never had a psychiatric disorder before battling COVID-19.
People who had pre-existing anxiety, depression, or insomnia issues are also at a 65 per cent higher risk of developing COVID-19, the study found. This finding prompted the researchers to ask mental health disorders to be introduced in the list of COVID-19 risk factors. According to Dr. Max Taquet, Department of Psychiatry, Oxford, who conducted the study, this finding was unexpected and needed further research.
BOOM spoke to Dr. Rajesh Parikh, Director of Medical Research and Neuropsychiatrist, Jaslok Hospital and the author of 'The Coronavirus: What You Need To Know About The Global Pandemic", who highlighted four different relationships between COVID-19 and mental health.
What Did The Study Find
As patients experiencing anxiety and depression associated with COVID-19 was being discussed but not measured, the psychiatrists from Oxford decided to use electronic health records to identify psychiatric risk factors for COVID-19.
The scientists accessed over 69 million electronic health records of patients from the United States to assess whether COVID-19 (compared with other health events) was associated with an increase in the rate of subsequent psychiatric diagnoses. The study also intended to find whether patients with a history of psychiatric illness are at a higher risk of testing positive for COVID-19.
From this database, over 62,354 patients were diagnosed with COVID-19 between January and August. The researchers maintained a window of 14-90 days to check for incidences of mental illness disorders and whether patients with COVID-19 were more likely to develop mental illnesses in comparison to patients with other illnesses.
While comparing a specific cohort of patients who did not have any mental health illnesses and were diagnosed with COVID-19, around one in five developed anxiety, depression, or insomnia with three months for the first time. In comparison to patients with other health disorders, patients with COVID-19 were twice as likely to develop these disorders. Patients over 65 years of age were also at risk of developing dementia, the study found.
Furthermore, the study found that people with pre-existing mental health disorders were at 65 per cent higher risk of being diagnosed with COVID-19.
Different Relationships Between Mental Health And COVID-19
Paul Harrison who led the study at Oxford highlighted that their study should form a basis for further niche research highlighting each area.
"People have been worried that COVID-19 survivors will be at greater risk of mental health problems, and our findings in a large and detailed study show this to be likely. Services need to be ready to provide care, especially since our results are likely to be underestimates of the actual number of cases. We urgently need research to investigate the causes and identify new treatments," Harrisson stated.
The psychiatrists did not anticipate pre-existing mental illnesses to exacerbate the likelihood of developing COVID-19.
Dr. Parikh concurred with this finding. "Stress has an inverse relationship with immunity. As their immunity is compromised due to the psychiatric disorders, people leave themselves vulnerable to COVID-19 if they stop following the necessary precautions."
Highlighting that psychiatric illness leaves people with no attention to focus on the perils of COVID-19, Dr. Parikh also added that people with psychiatric illnesses develop a "nihilistic attitude towards life."
The researchers also insisted that mental illnesses should be accounted for as an independent risk factor and symptom for COVID-19. Dr. Parikh said this was the second association between mental health and COVID-19. "Before the respiratory symptoms, psychiatric illnesses manifest as symptoms of COVID-19. The loss of smell is associated with an inflammation of the olfactory nerves deeper into the brain. There is a body of literature showing that pre-existing illness could contribute as an initial symptom." Delirium and confusion could be presentations of the virus which needs to be further researched.
Along with this, Dr. Parikh added two other associations of development of psychiatric illnesses as reactions to the disease. Fatigue, Post Intensive Care Syndrome (PICS) in the patient and their family are one reaction. Survivor guilt, the continuous questions of "Why me" are also reactions to COVID-19.
The fourth association is anticipatory anxiety disorder due to the social isolation wherein people anticipate a recurrence of COVID-19, worsening of symptoms or infecting their family members with the virus.
COVID-19 Patients With Mental Illnesses In Mumbai
Dr. Parikh stated that he has treated patients with all the four associations discussed above. He suggested that families need to be particular to create an area of less stress while following precautionary measures and not giving into COVID-19 fatigue. "Families need to be extra careful with people who are experiencing survivors guilt wherein they recovered but know someone who passed away due to COVID-19," Dr. Parikh added.
BOOM also spoke to Dr. Sagar Mundada, a privately practicing psychiatrist from Mumbai who shared his observations of families of patients developing anxiety disorders due to the fear of being diagnosed with COVID-19. "Families are anxious about their partners and elders and are worrying about the probability of situations", Dr. Mundada added.
Adding that depression is more common among a significant number of recovered patients, Dr. Mundada said that patients who were not admitted or were not severely affected by COVID-19 are showing signs of clinical depression. "Patients who have recovered are landing into depressive states as they still want to be confined within their rooms, do not enjoy anything."
Discussing Post Traumatic Stress Disorder, both Dr. Parikh and Dr. Mundada agreed that patients who were severely affected or were on ventilators were exhibiting signs of hypersensitivity, hyper-agitation, waking up in the middle of the night due to nightmares, and reliving their upsetting experiences.
Also Read:Explained: How COVID-19 Is Affecting Mental Health