Clinical Epidemiology Center, Research and Development Service, VA Saint Louis Health Care System, Saint Louis, MO 63106, USA.
Department of Epidemiology and Biostatistics, College for Public Health and Social Justice, Saint Louis University, Saint Louis, MO, USA.
BMJ. 2022 Feb 16;376:e068993. doi: 10.1136/bmj-2021-068993.
To estimate the risks of incident mental health disorders in survivors of the acute phase of covid-19.
Cohort study.
US Department of Veterans Affairs.
Cohort comprising 153 848 people who survived the first 30 days of SARS-CoV-2 infection, and two control groups: a contemporary group (n=5 637 840) with no evidence of SARS-CoV-2, and a historical control group (n=5 859 251) that predated the covid-19 pandemic.
Risks of prespecified incident mental health outcomes, calculated as hazard ratio and absolute risk difference per 1000 people at one year, with corresponding 95% confidence intervals. Predefined covariates and algorithmically selected high dimensional covariates were used to balance the covid-19 and control groups through inverse weighting.
The covid-19 group showed an increased risk of incident anxiety disorders (hazard ratio 1.35 (95% confidence interval 1.30 to 1.39); risk difference 11.06 (95% confidence interval 9.64 to 12.53) per 1000 people at one year), depressive disorders (1.39 (1.34 to 1.43); 15.12 (13.38 to 16.91) per 1000 people at one year), stress and adjustment disorders (1.38 (1.34 to 1.43); 13.29 (11.71 to 14.92) per 1000 people at one year), and use of antidepressants (1.55 (1.50 to 1.60); 21.59 (19.63 to 23.60) per 1000 people at one year) and benzodiazepines (1.65 (1.58 to 1.72); 10.46 (9.37 to 11.61) per 1000 people at one year). The risk of incident opioid prescriptions also increased (1.76 (1.71 to 1.81); 35.90 (33.61 to 38.25) per 1000 people at one year), opioid use disorders (1.34 (1.21 to 1.48); 0.96 (0.59 to 1.37) per 1000 people at one year), and other (non-opioid) substance use disorders (1.20 (1.15 to 1.26); 4.34 (3.22 to 5.51) per 1000 people at one year). The covid-19 group also showed an increased risk of incident neurocognitive decline (1.80 (1.72 to 1.89); 10.75 (9.65 to 11.91) per 1000 people at one year) and sleep disorders (1.41 (1.38 to 1.45); 23.80 (21.65 to 26.00) per 1000 people at one year). The risk of any incident mental health diagnosis or prescription was increased (1.60 (1.55 to 1.66); 64.38 (58.90 to 70.01) per 1000 people at one year). The risks of examined outcomes were increased even among people who were not admitted to hospital and were highest among those who were admitted to hospital during the acute phase of covid-19. Results were consistent with those in the historical control group. The risk of incident mental health disorders was consistently higher in the covid-19 group in comparisons of people with covid-19 not admitted to hospital versus those not admitted to hospital for seasonal influenza, admitted to hospital with covid-19 versus admitted to hospital with seasonal influenza, and admitted to hospital with covid-19 versus admitted to hospital for any other cause.
The findings suggest that people who survive the acute phase of covid-19 are at increased risk of an array of incident mental health disorders. Tackling mental health disorders among survivors of covid-19 should be a priority.
估计新冠病毒急性感染期幸存者新发心理健康障碍的风险。
队列研究。
美国退伍军人事务部。
队列由 153848 名在感染 SARS-CoV-2 后 30 天内存活下来的患者组成，以及两个对照组：无 SARS-CoV-2 证据的同期对照组（n=5637840）和新冠疫情前的历史对照组（n=5859251）。
在一年时，以每 1000 人计算的特定新发心理健康结局的风险，包括风险比和绝对风险差异，以及相应的 95%置信区间。使用预设协变量和通过反向加权算法选择的高维协变量来平衡新冠组和对照组。
新冠组新发焦虑障碍（风险比 1.35（95%置信区间 1.30 至 1.39）；风险差异 11.06（95%置信区间 9.64 至 12.53）每 1000 人年）、抑郁障碍（1.39（1.34 至 1.43）；风险差异 15.12（95%置信区间 13.38 至 16.91）每 1000 人年）、应激和适应障碍（1.38（1.34 至 1.43）；风险差异 13.29（95%置信区间 11.71 至 14.92）每 1000 人年）和抗抑郁药（1.55（1.50 至 1.60）；风险差异 21.59（95%置信区间 19.63 至 23.60）每 1000 人年）和苯二氮䓬类药物（1.65（1.58 至 1.72）；风险差异 10.46（9.37 至 11.61）每 1000 人年）的使用风险增加。新发阿片类药物处方的风险也增加（1.76（1.71 至 1.81）；风险差异 35.90（95%置信区间 33.61 至 38.25）每 1000 人年）、阿片类药物使用障碍（1.34（1.21 至 1.48）；风险差异 0.96（95%置信区间 0.59 至 1.37）每 1000 人年）和其他（非阿片类）物质使用障碍（1.20（1.15 至 1.26）；风险差异 4.34（95%置信区间 3.22 至 5.51）每 1000 人年）。新冠组新发神经认知障碍（1.80（1.72 至 1.89）；风险差异 10.75（95%置信区间 9.65 至 11.91）每 1000 人年）和睡眠障碍（1.41（1.38 至 1.45）；风险差异 23.80（95%置信区间 21.65 至 26.00）每 1000 人年）的风险也增加。任何新发心理健康诊断或处方的风险增加（1.60（1.55 至 1.66）；风险差异 64.38（95%置信区间 58.90 至 70.01）每 1000 人年）。即使在没有住院的人群中，检查结果的风险也增加了，在新冠病毒急性感染期间住院的人群中风险最高。结果与历史对照组一致。在新冠组与未因季节性流感住院的新冠组、因新冠住院与因季节性流感住院的新冠组、因新冠住院与因任何其他原因住院的新冠组相比，新发心理健康障碍的风险始终更高。
研究结果表明，新冠病毒急性感染期幸存者新发各种心理健康障碍的风险增加。解决新冠幸存者的心理健康障碍应成为优先事项。
