Survey: Major Depression Affects Most Patients After Serious COVID-19 Infection

With all of the discussion of so-called long haul symptoms after COVID-19 infection, a new survey reminds pharmacists and other healthcare professionals not to forget how common major depressive symptoms can be after severe cases. Find out what percentage of patients reported the symptoms and which subgroups were more likely to suffer from major depression.

BOSTON – More than half of recovered COVID-19 patients had symptoms of major depression, and those with more severe cases also had more evidence of depression, according to a new survey.

That could help explain at least some of the symptoms involving mood, sleep, anxiety and fatigue which plague a subset of patients after acute infection with SARS-CoV-2, according to researchers from Massachusetts General Hospital, Harvard Medical School and colleagues. Their results were published in JAMA Network Open.

The survey study included data from U.S. adult participants in 8 waves of an internet-based nonprobability survey conducted by Qualtrics with multiple panels of respondents (PureSpectrum). Surveys were conducted approximately monthly between June 2020 and January 2021.

The Patient health Questionnaire-9 (PHQ-9) was completed by 82,319 respondents, of which 3,904 nonoverlapping individuals reported prior COVID-19 illness. Participants were 44.3% women; 10.7% Hispanic, 11.2%, Black and 3.6% Asian individuals with a mean age of 38.1. Their mean (SD) time since initial COVID-19 symptoms was reported as 4.2 months.

The survey included standard sociodemographic questions, including self-identified race and ethnicity in 5 prespecified categories based on the U.S. Census and also asked participants whether they had been diagnosed with COVID-19 illness by a clinician or received a positive test result and in which month(s) they had been ill.

Participants were asked to indicate the presence or absence of specific symptoms and overall perceived severity of COVID-19 illness (i.e., not at all, not too, somewhat, or very). At the same time, respondents completed the PHQ-9, a screen for symptoms of depression, with each of the 9 items scored from 0 to 3, yielding a score between 0 and 27; a score of 10 or greater is considered moderate depression.

Results indicate that 52.4% of participants met the criteria for symptoms of major depressive disorder. Researchers note that, in fully adjusted models, presence of headache was associated with greater probability of moderate or greater depression symptoms (adjusted odds ratio [OR], 1.33; 95% CI, 1.10-1.62), as was greater overall severity (somewhat vs not at all severe: adjusted OR, 2.59; 95% CI, 2.04-3.30; very vs not at all severe: OR, 5.08; 95% CI, 3.93-6.59).

The study also found that women were less likely to have symptoms than men (adjusted OR, 0.72; 95% CI, 0.61-0.84), and the likelihood of symptoms decreased with increasing age (adjusted OR by decade, 0.76; 95% CI, 0.72-0.81).

“Among more than 3,900 individuals with prior COVID-19 illness surveyed between May 2020 and January 2021, 52.4% met criteria for moderate or greater symptoms of major depression,” the authors conclude. “In regression models, these symptoms were more likely among younger respondents compared with older respondents and among men compared with women as well as among those with greater self-reported overall COVID-19 severity compared with those with lower severity.”

While the survey had some limitations, the authors add, “Nevertheless, our results add to a growing body of evidence suggesting the importance of considering potential neuropsychiatric sequelae of COVID-19 infection. Our results also suggest the importance of considering strategies that might mitigate the elevated risk of depressive symptoms following acute infection.”

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