Covid-19 leaves trail of questions about effects on mental health

Our mental health is strongly influenced by what’s going on in the world, as well as by our personal commitments and constraints. It’s no surprise to see the psychological fallout of the Covid-19 pandemic over the past 15 months as so many of our personal support structures have been taken away.

The pandemic has contributed to a rise in depression, anxiety and suicidal thoughts over the last 15 months: physical and social isolation, loss of work, fear of spreading the virus and loss of loved ones are major stressors that are hard to cope with.

GPs, psychologists and psychiatrists have been hearing a wave of distressed voices throughout the pandemic. As mental-health expert Dr Harry Barry told the Today with Claire Byrne show on RTÉ Radio One recently: "We're feeling maybe hopeless, demotivated and lots of others are having these Covid days where we just feel: what's the point in going on?"

Those with existing mental-health issues face a Covid double whammy. As well as experiencing the same distressed thoughts as the rest of the population, they have had less access to their usual support services. And patients with a recent diagnosis of a mental illness have a sevenfold increased risk of Covid-19 infection. US research published in the journal World Psychiatry found that patients with both a recent diagnosis of a mental disorder and Covid-19 infection had a death rate of 8.5 per cent, almost double the rate among Covid-19 patients with no mental disorder. In addition the study found a hospitalisation rate of 27.4 per cent for patients with Covid-19 as against a rate of 18.6 per cent among Covid-19 patients with no psychological illness.

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Another study showed that even those with mild Covid-19 may experience psychiatric symptoms independent of previous psychiatric diagnoses. Some 26 per cent of the sample of almost 900 patients reported depression, 22 per cent reported anxiety and 17 per cent reported symptoms of post-traumatic stress two months after testing positive for the virus.

A key emerging question is whether lingering psychiatric problems that occur after Covid are linked to the psychosocial impact of the disease or to pathologic processes such as inflammation, affecting the brain.

Neuropsychiatric symptoms

In a recent review of the literature, an international multidisciplinary team set out to analyse the effects of Covid-19 on the brain. Published in the journal Neurology, Neurosurgery and Psychiatry, the authors’ stated aim was to cut through a lot of the speculation surrounding Covid-19’s neurological and psychiatric effects. They found the most common neuropsychiatric symptoms were loss of smell, weakness, fatigue and a change in taste – all of which appeared in more than 30 per cent of patients. Anxiety and depression occurred in between 16 per cent and 23 per cent of cases.

But probably the most important conclusion reached by the authors was to pose a question: how can we be sure that Covid-19 is actually causing any of these problems? The data available to the reviewers did not include a comparison group of people without Covid-19, making it impossible to answer this key question.

Looking ahead, an online editorial just published in the Irish Journal of Psychological Medicine highlighted several features particular to this pandemic that will result in an increased mental-health burden in the medium to longer term.

“These features include the morbidity and mortality associated with Covid-19, the relentless media coverage, the social-distancing measures, the altered pathways to access care, the changes to the care that is available, the suspension of development plans in mental-health services and the economic impact on all populations in society,” it notes.

No more than intensive-care units at the beginning of Covid-19, psychiatric services now face a tsunami of mental-health need. A combination of urgent investment, capacity-building and innovation is essential.

mhouston@irishtimes.com, muirishouston.com