Neuropsychiatric Symptoms Worsen 2 to 3 Years After COVID-19 Hospitalization

Psychiatric and cognitive symptoms increase in the 2 to 3 years after COVID-19 hospitalization, due to both the worsening of pre-existing symptoms and the emergence of new symptoms. These study results were published in The Lancet Psychiatry.

Although ample evidence has demonstrated that acute SARS‑CoV‑2 infection is associated with adverse neuropsychiatric symptoms, there is relatively little long-term data on cognitive and psychiatric symptoms that emerge or persist more than 1 year after an initial COVID-19 hospitalization.

To address this knowledge gap, investigators conducted a prospective cohort study to characterize neuropsychiatric symptom trajectories in the 2 to 3 years following hospital admission for COVID-19. The investigators used data from the post-hospitalization COVID-19 study (PHOSP-COVID), conducted at 83 participating National Health Service hospitals across the United Kingdom. Eligible participants included adults at least 18 years of age who were hospitalized with acute COVID-19 and subsequently discharged between February 2020 and March 2021. Participants who consented to participate completed clinical scales and cognitive assessments 2 to 3 years following hospital admission. The assessments included tasks and questionnaires that evaluated cognitive change and decline, depression, anxiety, and chronic illness therapy fatigue.

A total of 475 participants had complete data and were included in the analysis. The participants had a mean (SD) age of 58.26 (11.13) years, 40.2% were women, and 87.8% were White. The most common comorbidities included cardiovascular conditions (45.2%), respiratory conditions (33.3%), and psychiatric or neurological conditions (24.5%).  

Most participants reported anxiety (53.5%), fatigue (62.3%), and mild depression (74.5%), or subjective cognitive decline (52.1%). Additionally, a significant number of participants reported severe depression (22.4%), fatigue (24.6%), or subjective cognitive decline (24.9%).

Relative to scores at 6 months post-hospitalization, the investigators observed significant increases in mean depression scores (1.77; 95% CI, 0.95-2.59; P <.0001), anxiety scores (0.82; 95% CI, 0.15-1.48; P =.017), and fatigue (3.90; 95% CI, 1.97-5.84; P =.0001) in the 2 to 3 years following COVID-19 hospitalization. Further, 7.7% (95% CI, 2.6%-18.8%) of those who reported no subjective cognitive impairment at 6 months post-COVID reported at some least cognitive decline at 2 to 3 years.

The investigators found evidence that pre-existing depressive symptoms increased from 6 months to 2 to 3 years (mean increase, 1.74; 95% CI, 0.50-2.99; P =.0068) and identified newly emerging depressive (mean increase, 1.79; 0.68–2.91; P =.0021) and anxiety (mean increase, 0.82; 95% CI, 0.058–1.58; P =.035) symptoms among individuals who had no evidence of psychiatric symptoms at 6 months following COVID-19 hospitalization.

The severity of acute COVID-19 did not predict symptoms at 2 to 3 years. However, the degree of recovery at 6 months did explain 35.0% to 48.8% of the variance in anxiety, depression, fatigue, and subjective cognitive decline.

“Psychiatric and cognitive symptoms appear to increase over the first 2–3 years post-hospitalization due to both worsening of symptoms already present at 6 months and emergence of new symptoms,” the investigators concluded. “Interventions to promote cognitive recovery or to prevent cognitive decline are therefore needed to limit the functional and economic impacts of COVID-19.”

These study findings may be limited, as the low response rate of participants may have contributed to selection bias, the results may not be generalizable to patients who were not hospitalized due to COVID-19, and the investigators did not account for different COVID-19 variants or vaccination status.

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.

This article originally appeared on Psychiatry Advisor