Global Courant
Federal health officials have identified a number of mental illnesses linked to long-term COVID, prompting them to issue an advisory to help doctors treat patients with the syndrome.
Conditions can include depression, anxiety, psychosis, obsessive-compulsive disorder, and post-traumatic stress disorder. Other long-term COVID symptoms can include fatigue, trouble sleeping and cognitive impairment, the advisory of the Substance Abuse and Mental Health Services Administration – a division of the United States Department of Health and Human Services.
It can be challenging to determine whether mental illness is the result of long-term COVID or other factors. Whatever the reason, “treating symptoms is vital to recovery,” the advisory said.
“This long COVID epidemic is not over yet. We’re in the middle of it,” says Dr. Will Pittman, deputy director of the UCLA Health Long COVID Program. “Psychiatric symptoms are some of the most common symptoms we see with long-term COVID.”
The advice is, in part, an acknowledgment that many health care providers need more education about long-term COVID, which has been linked to a host of symptoms affecting virtually every part of the body. Even in the post-emergency phase of the pandemic, it can be difficult for patients with long-term illnesses to get the care they need, experts say.
While COVID clinics have been around for a long time, their capacity is limited.
“We know that people living with long COVID need help today, and healthcare providers need help understanding what long COVID is and how to treat it,” said Dr. Rachel Levine, assistant secretary of health for the U.S. Department of Health and Human Services, said in a statement.
Because a long COVID can be debilitating, the advice suggests that health care providers approach patients as if they’ve experienced a trauma. Suggested interventions include individual and group psychotherapy, peer support groups, physical therapy, neurorehabilitation, medication to treat anxiety and depression, speech therapy for people whose language skills are impaired, and treatment for those who suffer from substance abuse.
The advisory also urged healthcare providers to listen to their patients’ stories and not ignore them, manage symptoms while sharing the uncertainty of the prognosis and “offer hope while helping set realistic recovery goals”. Anyone with worsening anxiety or depression, or thoughts of self-harm warrants immediate action and referral to a mental health specialist.
Pittman said he’s seen patients who have had COVID for a long time but feel their other doctors haven’t listened to them — “they don’t feel like they’re being taken seriously.”
Other times, some GPs link symptoms such as anxiety or depression to a long COVID diagnosis, but then refer the patient to a specialist clinic instead of treating those mental health issues.
“Primary care really needs to take the reins to treat this. And they absolutely can, and I think they have tools at their disposal to treat this and make patients better,” Pittman said.
The advisory notes that healthcare providers unfamiliar with the wide range of long-term COVID symptoms may be misdiagnosing patients. This can be another barrier to care, as patients may feel embarrassed or discouraged from seeking treatment if a healthcare provider suggests that the symptoms are exaggerated or just “on their mind.”
The precise prevalence of long COVID is difficult to determine. But some scientists estimate that 10% of people who have had a coronavirus infection will develop long-term COVID. Among those hospitalized due to COVID-19, researchers estimate that 50% to 70% develop long-term COVID.
According to a report published in January in the journal Nature Reviews Microbiology, “Long COVID is associated with all ages and severity of the acute phase of the disease, with the highest rate of diagnosis between ages 36 and 50.”
Most of the long-term COVID cases, the report added, “concern non-hospitalized patients with mild acute illness, as this population represents the majority of total COVID-19 cases.”
Being unvaccinated increases the risk of long-term COVID.
There is likely a complicated relationship between a coronavirus infection and mental illness, the advisory said.
Those who already suffered from depression, anxiety, stress and loneliness before a coronavirus infection are at greater risk for long-term COVID, the advisory said. But it is also true that people with no prior mental illness are “at a greater risk of developing a first post-COVID-19 mental illness compared to people who were not infected.”
Officials identified nine mental illnesses and other symptoms associated with long-term COVID in the advisory. Authorities also indicated how often symptoms or conditions were reported:
Fatigue: Reported by 32% of COVID-19 survivors 12 or more weeks after diagnosis.Brain fog/cognitive disorder: Reported by 22% of COVID-19 survivors 12 or more weeks after diagnosis. Even two years after infection, there is an increased risk of cognitive impairment for people who had COVID-19 compared to people with any other respiratory disease.Tension: Symptoms reported in 35% of adults with long-term COVID-6 months after onset of COVID-19 symptoms.Depression: Reported in 41% of adults with long-term COVID six months after the onset of COVID-19 symptoms.Obsessive Compulsive Disorder: Symptoms reported by 20% of adults one month after hospitalization for COVID-19 infection. By comparison, about 2% of adults in the US will be diagnosed with OCD in their lifetime.Sleeping problems: Reported by 30% of adults with long-term COVID. Posttraumatic stress disorder: Diagnosis is reported in about 14% of adults with long-term COVID three months or more after a COVID-19 infection. Psychotic Disorder: There is evidence of a greater risk of a psychotic disorder six months after a COVID-19 diagnosis compared to people with any other type of respiratory infection. “While the risk of anxiety and mood disorders returned to baseline one to two months after a COVID-19 diagnosis, the risk of psychotic disorders remained elevated two years after follow-up, suggesting a different pathogenesis for this condition” said the health advisory. First onset of substance use disorder: Scientists say those who were infected, but not hospitalized, with COVID-19 are more likely to be diagnosed with their first addiction disorder six months after being diagnosed compared to people who recover from the flu.
“The symptoms of long-term COVID are extremely varied, can last for an extended period of time, and sometimes keep people from going about their daily activities — all things that can contribute to mental health problems,” said the LA County Department of Public Health. in a statement.
Long-distance sufferers who are female, Black, Latino, and Native American are at a higher risk of developing mental illness as well. Those who were hospitalized for their acute COVID-19 illness had a more severe initial illness or a longer duration of symptoms.
One reason black, Latino, and Native American people are at higher risk is because those groups have higher hospitalization rates for COVID-19 compared to white residents — a disparity that officials attribute in part to an increased risk of chronic disease and less access to health care among those populations.
“Insufficient access to safe housing, healthy food, transportation and health care can cause chronic stress for people in racial and ethnic minorities, people with disabilities and people who identify as LGBTQI+. This contributes to negative impacts on their mental health and poor COVID-19 outcomes,” the advisory said.
LA County residents who need more information about COVID-19 can contact the Department of Public Health at (833) 540-0473. Those without a health care provider can call 211 to get help finding a health care provider.
