Published in the British Medical Journal (BMJ), a study has raised concerns that biological and nonbiological influences may be triggering the development of mental health conditions, such as depression, anxiety, sleep disorders, and substance misuse disorders.

Data extracted from the US Department of Veterans Affairs (VA) national healthcare database has estimated the risk of mental health symptoms post-acute Covid-19 infection. The conclusions of the VA study came from a comparison of cohorts from the VA’s database of over 150,000 veterans who had been infected with Covid-19 and a control group of 560,000 veterans who have had no history of infection.

The down-the-road risks to mental health of Covid-19

Compared to those who have not had the virus, those in the Covid-19 group had a 60% higher risk of having any mental health condition.

Findings by the type of mental health issue were:

  • Anxiety: 35% risk in the Covid-19 group
  • Depression: 39% higher risk
  • Sleep disorder: 41% higher risk
  • Opioid use: 76% higher risk
  • Opioid use disorder: 34% higher risk
  • Non-opioid substance use disorders: 20% higher risk.

For the vast majority of people, Covid-19 infection comes only with mild or moderate symptoms – especially if the person is vaccinated – although a minority of people develop a chronic illness. While those who manifested a chronic reaction to the virus were most at risk of developing a mental health condition post-recovery, it was also found this was also true for those that only experienced mild or moderate symptoms.

Researchers hypothesised that one potential cause of this elevated risk might be a ‘bidirectional connection’, theorising that having an underlying mental health disorder may, in turn, situationally predispose someone to catching the virus and then lead to a more adverse mental health manifestation.

Alternatively, researchers on the study also suggested that there may be biological factors involved, such as T cell infiltration of the brain, which is known to cause impaired cognition, depression, and other neuropsychiatric disorders. Also, nonbiological factors were considered, such as changes in employment, financial distress, social isolation, trauma, grief, and changes to diet and physical activity.

The best defence against post-recovery illness is vaccination and high-quality masks

It is worth noting that previous coronavirus epidemics – such as SARS and MERS – have also had enduring mental health consequences. A comparative study analysis of the SARS and MERS epidemics concluded that depression, anxiety, fatigue, and PTSD were long term post-illness features. However, the presentation of mental health symptoms post-recovery for those epidemics is seemingly connected to acute infection, hospitalisation, and ICU treatment.

The VA researchers linked the post-recovery development of mental health conditions in the veterans to long-Covid, the prolonged, primarily physiological, aftermath of an acute Covid-19 infection experienced by many for up to 6-months. Other studies conducted by the principal investigator on the VA study, Dr Ziyad Al-Aly, have shown that long-Covid can affect nearly every organ system.

Dr Al-Aly said: “People return to their doctor with fatigue, brain fog, amnesia, strokes, new-onset diabetes, kidney disease, heart disease, and more… We've all suffered some sort of distress from this pandemic—may be a measure of anxiety or difficulty sleeping. But these challenges are magnified, especially in those who were admitted to the hospital during the acute part of their Covid battle but also in many who experienced only mild or moderate symptoms.”

“Those who go on to experience serious chronic consequences—effects that commonly last a lifetime—are the ones who will bear the scars of this pandemic… By generating more awareness of the spectrum of health complications long-hauliers face, we can work to nip this long-Covid crisis in the bud and keep it from ballooning into a larger public health plight.”