The COVID-19 Pandemic: Even Mild Disease Impacts Mental Health

A significant level of symptoms of depression, anxiety and post-traumatic stress may follow COVID-19 independent of any previous psychiatric diagnoses, according to new research by Columbia University Mailman School of Public Health with colleagues at Universidade Municipal de São Caetano do Sul in Brazil. Exposure to increased symptomatic levels of COVID-19 may be associated with psychiatric symptoms after the acute phase of the disease.  This is the largest study to evaluate depressive, anxiety, and post-traumatic stress symptoms in tandem among patients who had mild COVID-19 disease. The findings published online in the journal Progress in Neuro-Psychopharmacology and Biological Psychiatry shed light on a significant subpopulation at risk for mental symptoms.
 
“These results are important because the vast majority of COVID-19 patients are classified as mild cases, facing long periods of at-home isolation,” said João Mauricio Castaldelli-Maia, MD, PhD, NIDA-INVEST Postdoctoral Fellow in the Department of Epidemiology at Columbia Mailman School. “It is probable that the increased prevalence of psychiatric symptoms post-COVID-19 is a consequence of the psychological context of the disease, and patients should be closely monitored for the development of psychiatric symptoms after COVID-19 treatment discharge.”
 
Nasal swabs were collected from residents within a section of Sao Paulo, Brazil, 18 years of age or older with suspected COVID-19 symptoms. Patients were tested at their homes under the supervision of trained healthcare personnel. Those who tested positive for COVID-19 -- with at least two of the following symptoms: fever, cough, sore throat, change in/loss of smell -- and were classified as mild cases -- were further assessed for the presence of psychiatric symptoms approximately two months later.
 
Significant levels of depressive, anxiety and post-traumatic stress symptoms were reported by 26 percent, 22 percent, and 17 percent, respectively. For comparison purposes, previous estimates of post-traumatic stress levels within Brazil were 8.5% demonstrating that the prevalence within individuals presenting with mild COVID-19 increased versus past estimates.
 
In general, survivors of critical illnesses have a high level of mental symptoms after the condition improves. Depression, anxiety and post-traumatic stress disorder are among the most reported psychiatric events in patients with these conditions, according to the researchers.  The ongoing COVID-19 pandemic has disrupted the lives of many across the globe, resulting in an increased burden of physical and mental health consequences. Brazil, to date, is one of the most affected countries, reaching around 412,000 deaths by early May 2021.
 
“These findings echo warnings from the previous SARS outbreak, when survivors of SARS infections experienced increased psychological distress, persisting one year or more subsequent to the outbreak, and similar findings were observed following the occurrence of the Middle East Respiratory Syndrome Coronavirus (MERS-CoV) in 2015,” observed Silvia Martins, MD, PhD, associate professor of Epidemiology at Columbia Mailman School.
 
“Early mental health intervention such as psychotherapy and supportive groups could play an important role in preventing incident mental health problems for post-COVID sufferers,” said Castaldelli-Maia. “While further investigations for the possible neurobiological mechanisms linking COVID-19 and mental health conditions are warranted, healthcare systems must prepare for an influx of individuals experiencing psychological distress as a result of the COVID-19 pandemic.”
 
Co-authors are Flavia Ismael, João C.S.Bizario, Tatiane Battagin, Beatriz Zaramella, and Fabio Leal from Universidade Municipal de São Caetano do Sul; Julio Torales, National University of Asuncion; Antonio Ventriglio, University of Foggia; and Megan Marziali, Columbia Mailman School of Public Health.