Centre de Recherche en Epidémiologie et Santé des Populations, Institut National de la Santé et de la Recherche Médicale, Université Paris-Saclay, Université de Versailles Saint-Quentin-en-Yvelines, Paris, France.
Epidemiology and Public Health Department, Assistance Publique-Hôpitaux de Paris Université Paris-Saclay, Le Kremlin-Bicêtre, France.
JAMA Netw Open. 2023 May 1;6(5):e2312892. doi: 10.1001/jamanetworkopen.2023.12892.
The long-term consequences of COVID-19 on mental health are a critical issue given the number of people infected with SARS-CoV-2 worldwide since the beginning of the pandemic.
To investigate the associations between self-reported COVID-19-like symptoms or SARS-CoV-2 seropositivity and subsequent depression or anxiety.
DESIGN, SETTING, AND PARTICIPANTS: This propensity score-matched cohort study began in May 2020, with follow-ups in November 2020 and July 2021. The study used data from a large, randomly selected, national population-based cohort from France, the EpiCoV (Epidémiologie et Conditions de Vie) study. Of 85 074 individuals 15 years or older who completed the questionnaires at the 3 collection times, 28 568 were excluded because they did not return a blood sample for serologic testing, 1994 because of missing data on outcomes or exposures, and 9252 to respect the temporal sequence (exposure must precede the outcome).
Propensity scores based on various socioeconomic, lifestyle, and health variables were computed to match participants who experienced COVID-19-like symptoms between February and November 2020 or showed SARS-CoV-2 seropositivity in November 2020.
Logistic regression models were used to estimate associations between these occurrences and depression or anxiety assessed in July 2021 using the Patient Health Questionnaire 9-item and Generalized Anxiety Disorder 7-item scales, respectively.
Among the 45 260 included participants (mean [SD] age, 51.1 [18.9] years; 52.4% women; 8.0% with depression and 5.3% with anxiety in July 2021), COVID-19-like symptoms were associated with subsequent depression (adjusted odds ratio, 1.70; 95% CI, 1.45-1.99) and anxiety (adjusted OR, 1.57; 95% CI, 1.29-1.92), whereas SARS-CoV-2 seropositivity was not. Furthermore, COVID-19-like symptoms, but not anosmia or dysgeusia alone, were associated with subsequent depression and anxiety in both the seropositive and seronegative subgroups.
In this cohort study of more than 45 000 individuals drawn from the French general population, SARS-CoV-2 infection was not found as a risk factor of subsequent depression or anxiety. Moreover, self-reported COVID-19-like symptoms were associated with depression and anxiety assessed at least 8 months later in both seropositive and seronegative subgroups, suggesting that factors other than SARS-CoV-2 infection are implied in this association.
自大流行开始以来，全球范围内感染 SARS-CoV-2 的人数众多，因此 COVID-19 对心理健康的长期影响是一个关键问题。
调查自我报告的 COVID-19 样症状或 SARS-CoV-2 血清阳性与随后的抑郁或焦虑之间的关联。
设计、设置和参与者：这项倾向评分匹配的队列研究于 2020 年 5 月开始，随后于 2020 年 11 月和 2021 年 7 月进行了随访。该研究使用了来自法国一项大型、随机选择的全国人群队列研究（EpiCoV[流行病学和生活条件]研究）的数据。在完成了三次问卷调查的 85474 名 15 岁及以上的个体中，有 28568 人因未返回血液样本进行血清学检测而被排除，有 1994 人因结局或暴露的缺失数据而被排除，有 9252 人因尊重时间顺序（暴露必须先于结局）而被排除。
基于各种社会经济、生活方式和健康变量计算了倾向评分，以匹配 2020 年 2 月至 11 月期间出现 COVID-19 样症状或 2020 年 11 月 SARS-CoV-2 血清阳性的参与者。
使用逻辑回归模型估计这些事件与 2021 年 7 月使用患者健康问卷 9 项和广泛性焦虑症 7 项量表评估的抑郁或焦虑之间的关联。
在包括的 45260 名参与者（平均[标准差]年龄，51.1[18.9]岁；52.4%为女性；2021 年 7 月抑郁的发生率为 8.0%，焦虑的发生率为 5.3%）中，COVID-19 样症状与随后的抑郁（调整后的优势比，1.70；95%置信区间，1.45-1.99）和焦虑（调整后的 OR，1.57；95%置信区间，1.29-1.92）有关，而 SARS-CoV-2 血清阳性则没有。此外，COVID-19 样症状，而不仅仅是嗅觉丧失或味觉障碍，与血清阳性和血清阴性亚组中随后发生的抑郁和焦虑有关。
在这项针对来自法国普通人群的 45000 多名个体的队列研究中，未发现 SARS-CoV-2 感染是随后抑郁或焦虑的危险因素。此外，自我报告的 COVID-19 样症状与至少 8 个月后在血清阳性和血清阴性亚组中评估的抑郁和焦虑有关，这表明在这种关联中涉及到 SARS-CoV-2 感染以外的因素。
