Study spotlights psychiatric, cognitive problems years after severe COVID-19

Psychiatric and cognitive symptoms appear to increase over the first 2 to 3 years post-hospitalization for COVID-19, due to both worsening of symptoms already present at 6 months and the emergence of new symptoms, according to a study yesterday in The Lancet Psychiatry.

The study offers new evidence suggesting long COVID can worsen psychiatric prognosis: Overall, psychiatric symptoms at 2 to 3 years post-infection were linked not to COVID-19 severity, but to persistence of COVID-19 symptoms at 6 months post-infection.

“Objective cognitive deficits at 2–3 years were not predicted by any of the factors tested, except for cognitive deficits at 6 months, explaining 10.6% of their variance,” the authors wrote. 

Objective cognitive deficits at 2–3 years were not predicted by any of the factors tested, except for cognitive deficits at 6 months

The findings come from the Post-hospitalization COVID-19 study (PHOSP-COVID), a longitudinal study in the United Kingdom. A subset of the study assessed participants for up to 3 years and had them complete eight cognitive tasks, covering eight cognitive domains, and take several depression and anxiety scales.

Cognitive deficits can lead to occupation changes 

“We evaluated how the absolute risks of symptoms evolved between follow-ups at 6 months, 12 months, and 2–3 years, and whether symptoms at 2–3 years were predicted by earlier aspects of COVID-19 illness,” the authors wrote. 

A total of 353 participants were analyzed in the 2 to 3 year follow up. Most (74.5%) reported at least mild depression, 53.5% reported anxiety, 62.3% reported fatigue, and 52.1% reported subjective cognitive decline. Almost a fourth (22.4%) reported severe depression.

Notably, 95 of 353 participants (26.9%) reported occupational change, with poor health being the most common reason for this change, the authors said.  Occupation change was significantly associated with objective cognitive deficits (odds ratio [OR], 1.51; 95% confidence interval [CI], 1.04 to 2.22) for every standard deviation decrease in overall cognitive score.

The impact on job performance and occupation change adds more evidence to understanding long COVID has a significant factor in job loss. 

“Long term consequences, especially for thinking skills, have been noted in several reports and of course by the Covid-19 survivors themselves. This paper quantifies their concerns and points out that we need better interventions to prevent or treat these long term issues,” said Dame Til Wykes, PhD, of King’s College London, in an expert reaction on the Science Media Centre site. 

“We know cognitive problems are associated with loss of employment in general and these Covid-19 patients also report changing jobs due to thinking difficulties not their mental health symptoms.”

She concluded, “These results are important, but they refer to those who were the most affected by Covid-19.  New treatments that have been introduced, as well as vaccinations, will reduce the numbers of people needing admission and should decrease these after-effects. But we do need to know how prevalent these problems are in those not admitted but were treated at home, as they too might need further support and intervention.”

David Curtis, MBBS, an honorary professor at University College London, said, “I think it’s very difficult to decide what this study tells us about the prevalence of problems after infection with COVID, because 2,469 volunteers were invited to participate in the study but only 475 actually did so, fewer than 1 in 5.”

He added, “It may well be that some people do experience long-term problems as a result of COVD infection. But these symptoms are generally common and non-specific so elucidating any precise relationship remains very challenging.”