Risk of mental disorders enhanced in elderly hospitalized patients of COVID 19 infection: JAMA

Denmark: New research revealed that individuals who were tested for SARS-CoV-2 had a greater chance of developing new mental health issues than those who were never tested, and the likelihood of new-onset mental illnesses was elevated more among older individuals when compared to those with negative tests findings. The study results were published in the journal JAMA Psychiatry. 

The COVID-19 pandemic has had a significant influence on human health globally. COVID-19, in addition to being an infectious respiratory sickness, has the potential to damage several organ systems, including the brain with a high rate of persistent neuropsychiatric symptoms following initial SARS-CoV-2 infection. Due to lacking enough literature on this, researchers from Denmark conducted a nationwide cohort study to estimate the risk of mental disorders and use of psychotropic medication among individuals with COVID-19 compared with individuals not tested, individuals with SARS-CoV-2–negative test results, and those hospitalized for non–COVID-19 infections. 

Using the Danish registries, all individuals who were alive,18 years or older, and residing in Denmark between January 1 and March 1, 2020 (N = 4 152 792), excluding individuals with a mental disorder history were identified and followed up until December 31, 2021. The results of SARS-CoV-2 polymerase chain reaction (PCR) testing (negative, positive, and never tested) and COVID-19 hospitalization were targeted. The main outcome of measurement was the risk of new-onset mental disorders (International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, codes F00-F99) and redeemed psychotropic medication (Anatomical Therapeutic Chemical classification codes N05-N06). These were estimated through survival analysis using a Cox proportional hazards model, with a hierarchical time-varying exposure, reporting hazard rate ratios (HRR) with 95% CIs. All outcomes were adjusted for age, sex, parental history of mental illness, Charlson Comorbidity Index, educational level, income, and job status. 

Key findings: 

• Among the total participants, there were: 

• Follow-up time was 1.83 years for 93.4% of the population.
• As compared to those who were never tested, the risk of mental disorders was increased in individuals with positive and negative test results for SARS-CoV-2. 
• The risk of new-onset mental disorders in SARS-CoV-2–positive individuals was less in the age group of 18 to 29 years than the individuals who are 70 years or older. 
• A similar pattern of elevated risk was seen regarding psychotropic medication use among individuals 70 years or older than in the group aged 18 to 29 years. 
• The risk for new-onset mental disorders was substantially elevated in hospitalized patients with COVID-19 compared with the general population however, no significant difference in risk was seen when compared with hospitalization for non–COVID-19 respiratory tract infections. 

Thus, individuals who test positive for SARS-CoV-2 have a greater risk of incident mental illnesses than those who are never tested, but a lower risk than those who test negative; however, this is controlled by age as older individuals showed increased risk of mental health issues than young individuals. 

Further reading: Nersesjan V, Christensen RHB, Kondziella D, Benros ME. COVID-19 and Risk for Mental Disorders Among Adults in Denmark. JAMA Psychiatry. Published online May 24, 2023. doi: 10.1001/jamapsychiatry.2023.1265