Having Covid-19 puts people at a significantly increased chance of developing new mental health conditions, potentially adding to existing crises of suicide and overdoses, according to new research looking at millions of health records in the US over the course of a year.

The long-term effects of having Covid are still being discovered, and among them is an increased chance of being diagnosed with mental health disorders. They include depression, anxiety, stress and an increased risk of substance use disorders, cognitive decline, and sleep problems – a marked difference from others who also endured the stress of the pandemic but weren’t diagnosed with the virus.

“This is basically telling us that millions and millions of people in the US infected with Covid are developing mental health problems,” said Ziyad Al-Aly, chief of research and development at the VA St Louis Healthcare System and senior author of the paper. “That makes us a nation in distress.”

The higher risk of mental health disorders, including suicidal ideation and opioid use, is particularly concerning, he said.

“This is really almost a perfect storm that is brewing in front of our eyes – for another opioid epidemic two or three years down the road, for another suicide crisis two or three years down the road,” Al-Aly added.

These unfolding crises are “quite a big concern”, said James Jackson, director of behavioral health at Vanderbilt University’s ICU Recovery Center, who was not involved with this study. He is also seeing patients whose previous conditions, including anxiety, depression and opioid use disorder, worsened during the pandemic.

Research like this shows the clear need to follow patients in the weeks and months after even mild Covid diagnoses and to seek quick treatment for any emerging disorders, the experts said. “If we apply attention to it now and nip it in the bud, we could literally save lives,” Al-Aly said.

More than 18% of Covid patients developed mental health problems, compared with 12% of those who did not have Covid, according to the study published on Wednesday.

The study followed more than 153,000 patients who tested positive for Covid in the Veterans Affairs health system between March 2020 and January 2021, and compared them with other health records: to 5.8 million people who did not test positive in that time, but lived through the same stresses of the pandemic, and with 5.6 million patients seen before the pandemic.

Among all patients who developed new mental health problems during the pandemic, the Covid patients were significantly more likely to develop cognitive problems (80%), sleep disorders (41%), depression (39%), stress (38%), anxiety (35%) and opioid use disorder (34%), compared with those who didn’t have Covid.

The study looked only at patients with no history of mental health diagnoses in the past two years. It compared those hospitalized for Covid versus other illnesses, and compared outcomes to thousands of flu cases. The study also adjusted for factors like demographics, other health conditions and other factors.

The results were all clear: Covid has a marked effect on mental health.

Those with more severe cases of Covid, especially those who need to be hospitalized, tend to be at higher risk. But even those with mild or asymptomatic cases were more likely to receive mental health diagnoses.

“People who were hospitalized had it worse, but the risk in non-hospitalized [patients] is significant and absolutely not trivial – and that represents the majority of people in the US and the world,” Al-Aly said.

The study did have some limitations: most of those analyzed were older white men. But controlling for race, gender and age found no changes in risk.

The coronavirus can be found in the brain, other studies have shown. “We can actually see the virus in the amygdala, in the hippocampus – the very centers responsible for regulating our moods, regulating our emotions,” Al-Aly said.

The study adds to other research showing that “mental health issues are a huge concern” after Covid, Jackson said. And the results line up with what he sees among patients.

“We’re learning that Covid may be even more problematic and more impactful than we thought,” Jackson said.

Early treatment of patients facing new or additional mental health challenges after Covid can make a crucial difference, the experts said.

“The idea here is to identify patients’ data early to hopefully reduce this from becoming a much larger problem down the road,” Al-Aly said. “If you leave a disease unattended, it only gets worse.”

But the longer the virus continues circulating, the more long-term problems it may create – adding even greater pressure to health systems.

“The wave of people with mental health disorders is going to be hitting the clinics in the next year or two or three, as a result of Covid and as a result of the pandemic,” Al-Aly said.

And many mental health practitioners don’t accept insurance, creating a large stumbling block for patients, while others have long waiting lists.

“This is a gigantic problem, and I’m not really sure what we’re going to do about it,” Jackson said. “The needs are vastly greater than the resources.”

Jackson has set up peer support groups to offer counseling to patients dealing with long Covid – brain fog, cognitive impairment, memory problems, feelings of inadequacy. The groups are held on Zoom, so patients can join from all over the country.

“We need to pay attention to the long-term consequences of Covid,” Al-Aly said. “If we only pay attention to the short-term consequences, the first 30 days or the first 90 days, we really, really are missing the larger picture.

“The pandemic itself caught the US unprepared, and we’re going to be caught unprepared again for long Covid,” Al-Aly said. “The reality is that Covid is producing long-term consequences, and we cannot just wish it away or sweep it under the rug or not deal with it.”

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