London—While most people with severe coronavirus infections appear to recover from their initial bout without experiencing mental illness, pharmacists and other healthcare professionals should expect to see significant long-term effects such as depression, anxiety, fatigue, and PTSD in patients who were hospitalized for COVID-19, according to a new report.

That would be the case in patients admitted to the hospital with severe COVID-19 if it follows a course similar to the coronavirus epidemics of severe acute respiratory syndrome (SARS) in 2002 and Middle East respiratory syndrome (MERS) in 2012, according to a meta-analysis published in The Lancet.

To reach those conclusions, researchers in the United Kingdom looked at 66 studies on severe acute respiratory syndrome in 2002 and Middle East respiratory syndrome in 2012, as well as COVID-19. The systematic review was the first to look at the psychiatric consequences of coronavirus infections in more than 3,550 patients hospitalized with SARS, MERS, and COVID-19.

The authors caution that the analysis was based on only 12 low-to-moderate quality COVID-19 studies, including 7 nonpeer-reviewed preprints. They also suggest that, while past coronavirus outbreaks are useful, they may not perfectly predict prevalence of psychiatric complications from the current pandemic.

The study also said that not all severe COVID-19 patients escaped mental health problems. In the acute stages of SARS, MERS, and COVID-19 illness, the review found that some patients suffered delirium; it focused on severe cases and did not look at milder or asymptomatic cases.

“Our analysis of more than 3,550 coronavirus cases suggests that most people will not suffer from mental health problems following coronavirus infection,” says Jonathan Rogers, MA, MB, from University College London, UK, a coleader of the research. “While there is little evidence to suggest that common mental illnesses beyond short-term delirium are a feature of COVID-19 infection, clinicians should monitor for the possibility that common mental disorders such as depression, anxiety, fatigue, and PTSD could arise in the weeks and months following recovery from severe infection, as has been seen with SARS and MERS.”

The authors suggest several reasons why severe coronavirus infections might have psychiatric consequences, including:
• Possible direct effects of viral infection on the central nervous system
• The degree of physiological compromise, such as low blood oxygen
• The immune response, and
• Medical interventions

Other issues such as wider social impact, including social isolation, the psychological impact of a novel, severe, and potentially fatal illness, concerns about infecting others, and stigma also could play a role, according to the researchers.

Six studies looking at SARS and MERS patients after recovery from initial infection found frequent reports of low mood (35/332 patients, 11%), insomnia (34/208, 12%), anxiety (21/171, 12%), irritability (28/218, 13%), memory impairment (44/233, 19%), fatigue (61/316, 19%), and frequent recall of traumatic memories (55/181, 30%) over a follow-up period ranging from 6 weeks to 39 months.

Prevalence of PTSD among SARS and MERS survivors was 33% at an average of 34 months after the acute stage of illness (121/402 cases in four studies), with rates of depression and anxiety disorders at about 15% at an average of 23 months (77/517 cases from five studies) and 1 year (42/284 cases from three studies) after the acute stage, respectively.

“With few data yet for COVID-19, high quality, peer-reviewed research into psychiatric symptoms of patients infected with SARS-CoV-2 as well as investigations to mitigate these outcomes is needed. Monitoring for the development of symptoms should be a routine part of the care we provide,” Rogers added.

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