Acute COVID-19 severity and mental health morbidity trajectories in patient populations of six nations: an observational study

, Ingibjörg Magnúsdóttir, Anikó Lovik, Anna Bára Unnarsdóttir, Daniel McCartney, Helga Ask, Kadri Kõiv, Lea Arregui Nordahl Christoffersen, Sverre Urnes Johnson, Arna Hauksdóttir, Chloe Fawns-Ritchie, Dorte Helenius, Juan González-Hijón, Li Lu, Omid V. Ebrahimi, Asle Hoffart, David J. Porteous, Fang Fang, Jóhanna Jakobsdóttir, Kelli LehtoOle A. Andreassen, Ole B.V. Pedersen, Thor Aspelund, Unnur Anna Valdimarsdóttir

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Background: Long-term mental and physical health consequences of COVID-19 (long COVID) are a persistent public health concern. Little is still known about the long-term mental health of non-hospitalised patients with COVID-19 with varying illness severities. Our aim was to assess the prevalence of adverse mental health symptoms among individuals diagnosed with COVID-19 in the general population by acute infection severity up to 16 months after diagnosis. 

Methods: This observational follow-up study included seven prospectively planned cohorts across six countries (Denmark, Estonia, Iceland, Norway, Sweden, and the UK). Participants were recruited from March 27, 2020, to Aug 13, 2021. Individuals aged 18 years or older were eligible to participate. In a cross-sectional analysis, we contrasted symptom prevalence of depression, anxiety, COVID-19-related distress, and poor sleep quality (screened with validated mental health instruments) among individuals with and without a diagnosis of COVID-19 at entry, 0-16 months from diagnosis. In a cohort analysis, we further used repeated measures to estimate the change in mental health symptoms before and after COVID-19 diagnosis. 

Findings: The analytical cohort consisted of 247 249 individuals, 9979 (4·0%) of whom were diagnosed with COVID-19 during the study period. Mean follow-up was 5·65 months (SD 4·26). Participants diagnosed with COVID-19 presented overall with a higher prevalence of symptoms of depression (prevalence ratio [PR] 1·18 [95% CI 1·03-1·36]) and poorer sleep quality (1·13 [1·03-1·24]) but not symptoms of anxiety (0·97 [0·91-1·03]) or COVID-19-related distress (1·05 [0·93-1·20]) compared with individuals without a COVID-19 diagnosis. Although the prevalence of depression and COVID-19-related distress attenuated with time, individuals diagnosed with COVID-19 but never bedridden due to their illness were consistently at lower risk of depression (PR 0·83 [95% CI 0·75-0·91]) and anxiety (0·77 [0·63-0·94]) than those not diagnosed with COVID-19, whereas patients who were bedridden for more than 7 days were persistently at higher risk of symptoms of depression (PR 1·61 [95% CI 1·27-2·05]) and anxiety (1·43 [1·26-1·63]) than those not diagnosed throughout the study period. 

Interpretation: Severe acute COVID-19 illness-indicated by extended time bedridden-is associated with long-term mental morbidity among recovering individuals in the general population. These findings call for increased vigilance of adverse mental health development among patients with a severe acute disease phase of COVID-19. 

Funding: Nordforsk, Horizon2020, Wellcome Trust, and Estonian Research Council.

Original languageEnglish
Pages (from-to)e406-e416
Number of pages11
JournalLancet Public Health
Issue number5
Early online date26 Apr 2022
Publication statusPublished - May 2022

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health


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