Risk of Sleep, Mental Disorders Lingers After Acute COVID-19

A new study sheds light on the nature of the “long covid.” Researchers say SARS-CoV-2 needs to be viewed not as a respiratory virus but as one with systematic effects.

Many people have experienced stress and lost sleep over the disruption and uncertainty brought about by COVID-19 pandemic, but a new report suggests that the infection itself could be associated with a long-term risk of sleep disorders and mental health problems.

The study, published in the BMJ, offers a broad look at the ways in which COVID-19 could continue to impact public health in the coming years.

Ziyad Al-Aly, M.D., who directs the Clinical Epidemiology Center at Veterans Affairs St. Louis Health Care System, explained that most of the existing research into the mental health impacts of the pandemic has focused on the acute phase of the disease and few first few months after.

“A comprehensive assessment of the mental health manifestations in people with COVID-19 at one year has not been undertaken,” Al-Aly and colleagues wrote. “Improving our understanding of the long-term risk of mental health disorders in people with COVID-19 can help guide strategies for care during the post-acute phase.”

Related:No Giving It Short Shrift: COVID-19 Can Be a Long Haul

The investigators organized data from the Veterans Health Administration into three cohorts: a group of 153,848 veterans who had been infected with the SARS-CoV-2 virus and survived at least 30 days, a control group made up of more than 5 million veterans with no evidence of SARS-CoV-2 infection, and a historical control group based on 5 million patients who used the healthcare system prior to the pandemic (in this case, the year 2017). The objective was to find out whether patients in the COVID-19 group had higher rates of a wide range of mental and sleep disorders.

Answer: yes.

Across multiple categories, from anxiety and depressive disorders to sleep and stress disorders patients in the COVID-19 group were more likely to be included.

The same was true for drug use associated with those disorders, as well as for substance abuse, such as opioid use.

In the case of sleep, after one year, people in the COVID-19 group were 41% more to have been diagnosed with a sleep disorder and 61% more likely to be taking a sleep medication to the contemporary control group.

Notably, the risk of sleep and mental disorders did not appear to be limited to those with severe COVID-19. The risk of such disorders was elevated even in patients who did not require hospitalization during the acute phase of COVID-19, although. in most cases, patients with hospitalizations had higher risks of mental and sleep disorders.

“Altogether, the findings suggest that people with COVID-19 are experiencing increased rates of mental health outcomes, which could have far-reaching consequences,” Al-Aly wrote in an accompanying opinion article. Al-Aly warned against using these mental health data to dismiss long COVID as merely psychosomatic manifestations associated with sleep and mental disorders: Some may use our findings to gaslight or dismiss long covid as a psychosomatic condition or explain the myriad manifestations of long covid as the result of mental illness.”

Instead, he said, the findings from his new study should be seen as examining one facet of a multifaceted disease.

“The body of evidence on long COVID — from our work and others — suggests the need to reframe our thinking about SARS-CoV-2,” he wrote. “It is not only a respiratory virus; it is a systemic virus that may provoke damage and clinical consequences in nearly every organ system—including mental health disorders and neurocognitive decline.”

Al-Aly said it is incumbent upon government and public health officials to recognize the potential for long-term effects of infection by the virus.

“Failure to attend to the risks of long covid risks amplifying the profound losses we have experienced in this global pandemic,” he wrote in BMJ.