Mental health effects common among mild and severe cases of COVID-19

By James DuckerReviewed by Emily Henderson, B.Sc.Jun 4 2021

Findings on mental health outcomes of COVID-19 infection show frequent symptoms associated with lasting neurological symptoms.

SARS-CoV-2. Image Credit: Kateryna Kon/Shutterstock.com

Impacts of COVID-19 infection on mental health – a norm rather than an exception

In a study published in the Journal of Neurology, Neurosurgery, and Psychiatry, authors led by Dr. Jonathan Rogers have reported that neurological and psychiatric symptoms are common among people with COVID-19 and maybe just as likely in people with mild cases.

Recent evidence has shown that COVID-19 infection can induce both physical symptoms, affecting respiratory processes most frequently, but also affects mental health. And yet, conclusive data on the psychiatric and neurobiological outcomes of COVID-19 remained to be synthesized.

An international collaboration of scientists from UCL, the University of Edinburgh, King's College London, and the Queen Mary University of London, along with co-authors in the UK, Bulgaria, Canada, India, and Germany, has now collected the existing evidence that COVID-19 infection impacts mental health.

The researchers conducted a meta-analysis of 215 COVID-19-related studies using data up to July 2020 from 30 countries and encompassing 105,638 people with acute symptoms of COVID-19. From the data collected, the team pooled the types of neurological and psychiatric symptoms together to track the frequency of each type.

Across the whole dataset, the most common neurological and psychiatric symptoms were a loss of smell; reported by 43% of patients with COVID-19, weakness (40%), fatigue (38%), loss of taste; (37%), myalgia (muscle pain; 25%), depression (23%), headache (21%) and anxiety (16%).

Further, more severe, disorders were also identified including ischemic strokes (1.9% of cases in the dataset), hemorrhagic strokes (0.4%), and seizures (0.06%).

Common symptoms in both mild and severe cases of COVID-19 infection

By further investigating the treatment associated across individuals with different symptoms, scientists also showed that neurological and psychiatric symptoms were still common even when patients were not hospitalized. Of those who were not hospitalized, 5% reported fatigue, 52% loss of smell, 47% muscle pain, 45% loss of taste, and 44% reported headaches. This suggests that there is considerable overlap in symptom types across symptomatic acute and chronic cases of COVID-19 infection.

Such a result is potentially very important as studies frequently overrepresent patients with severe COVID-19 who are often hospitalized. This pattern was found among the dataset, with studies focusing primarily on hospitalized patients, and even the studies of people outside of hospital included few people with very mild or no symptoms.

Nevertheless, the extensive data collected provided alternative solutions to consider more mild symptoms, avoiding the over-representation of severe infection.

This review did not examine the causal mechanisms underlying the reason why mild and severe cases show such overlap, but the authors suggest it may be due to levels of inflammation found in the brain, which may explain some of the symptoms.

Additionally. psychosocial factors relating to the context of the global pandemic may play a role, as isolated individuals may experience increased levels of depression and anxiety. This result was found to be more common than in other viral illnesses as Dr. Rogers explains: "Many factors could contribute to neurological and psychiatric symptoms in the early stages of infection with COVID-19, including inflammation, impaired oxygen delivery to the brain, and psychological factors. More studies are needed to understand these links better."

A warning sign for better mental health awareness and treatment

Such findings indicate that the mental health repercussions of even mild COVID-19 infection can be damaging for physical and mental processes beyond infection.

Neurological and psychiatric symptoms are very common in people with COVID-19. With millions of people infected globally even the rarer symptoms could affect substantially more people than in usual times. Mental health services and neurological rehabilitation services should be resourced for an increase in referrals."

Dr. Alasdair Rooney

Researchers also found that many symptom types were often neglected, like depression, anxiety, and post-traumatic stress disorder (PTSD), as well as stroke and seizures, were often not considered potentially due to uncertain diagnoses or limited awareness. By reducing the diagnostic range of outcomes, studies drastically reduce the perceived impact of infection, thereby preventing a more comprehensive understanding of infection outcomes.  

Further research into the causal links of brain inflammation as well as the indirect effects of COVID-19 infection, such as social isolation, could contribute to a more refined understanding of how the global pandemic is affecting populations physically and mentally.