thelancet.comPosted Aug 19, 2022, 9:59 PM UTC
We identified 1 487 712 patients with a recorded diagnosis of COVID-19 during the study period, of whom 1 284 437 (185 748 children, 856 588 adults, and 242 101 older adults; overall mean age 42·5 years [SD 21·9]; 741 806 [57·8%] were female and 542 192 [42·2%] were male) were adequately matched with an equal number of patients with another respiratory infection.
So there was approx 2.5m people in this study (1284437 + their matched partner)
The risk trajectories of outcomes after SARS-CoV-2 infection in the whole cohort differed substantially. While most outcomes had HRs significantly greater than 1 after 6 months (with the exception of encephalitis; Guillain-Barré syndrome; nerve, nerve root, and plexus disorder; and parkinsonism), their risk horizons and time to equal incidence varied greatly.
Risks of the common psychiatric disorders returned to baseline after 1–2 months (mood disorders at 43 days, anxiety disorders at 58 days) and subsequently reached an equal overall incidence to the matched comparison group (mood disorders at 457 days, anxiety disorders at 417 days).
By contrast, risks of cognitive deficit (known as brain fog), dementia, psychotic disorders, and epilepsy or seizures were still increased at the end of the 2-year follow-up period.
That would make sense given we know covid affects the brain, since it affects taste and smell.
Post-COVID-19 risk trajectories differed in children compared with adults: in the 6 months after SARS-CoV-2 infection, children were not at an increased risk of mood (HR 1·02 [95% CI 0·94–1·10) or anxiety (1·00 [0·94–1·06]) disorders, but did have an increased risk of cognitive deficit, insomnia, intracranial haemorrhage, ischaemic stroke, nerve, nerve root, and plexus disorders, psychotic disorders, and epilepsy or seizures (HRs ranging from 1·20 [1·09–1·33] to 2·16 [1·46–3·19]). Unlike adults, cognitive deficit in children had a finite risk horizon (75 days) and a finite time to equal incidence (491 days).
A sizeable proportion of older adults who received a neurological or psychiatric diagnosis, in either cohort, subsequently died, especially those diagnosed with dementia or epilepsy or seizures.
Risk profiles were similar just before versus just after the emergence of the alpha variant (n=47 675 in each cohort). Just after (vs just before) the emergence of the delta variant (n=44 835 in each cohort), increased risks of ischaemic stroke, epilepsy or seizures, cognitive deficit, insomnia, and anxiety disorders were observed, compounded by an increased death rate.
Probably a good thing australia chose to mostly skip delta then.
With omicron (n=39 845 in each cohort), there was a lower death rate than just before emergence of the variant, but the risks of neurological and psychiatric outcomes remained similar.
Thank you for posting this my ex/girlfriend has long covid and amongst her symptoms (the most difficult for me) has been severe depression and psychological changes (along with the classic "brain fog" and gastrointestinal problems), this has been the cause of her ending our relationship and then resuming it several times before cutting off all communication with me. Her family have told me that the problem is with her and to just hope that her long covid gets better and see what happens. This study indicates that the depression etc is normally resolved in a year or 18 months. Even if other symptoms aren't, I now have hope that life for us may improve in the near future.
Good luck to you both
Narrator: Of the 1.2m patients, 95% were unvaccinated.
So incredibly relevant for Australia.
This is a good study, thanks for posting.
Think overall the results are pretty reassuring, most impairment associated with infection is transient, no long term increase in anxiety/mood disorders.
Important to keep in mind that as this is a massive study they were able to find differences that may be statistically significant but aren't really clinically meaningful.
For example the risk of psychotic disorders was higher by 0.06% in the COVID group compared to the control group (0.57% vs 0.51%). Social isolation, trauma, drug use and poverty have been found to be much much higher risk factors than this in many studies.
Think overall the results are pretty reassuring
Not the assessment of the authors
The fact that neurological and psychiatric outcomes were similar during the delta and omicron waves indicates that the burden on the health-care system might continue even with variants that are less severe in other respects. >Our findings are relevant to understanding individual-level and population-level risks of neurological and psychiatric disorders after SARS-CoV-2 infection and can help inform our responses to them.
Did you read what you posted? I agree with who you replied to, it shows that compared to other respiratory infections to covid this is reassuring.
You just post a quote talking about burden of health care which is obviously not what is 'reassuring' or what he was talking about.
You just post a quote talking about burden of health care which is obviously not what is 'reassuring' or what he was talking about.
I am genuinely curious to understand what part of the study you consider to be reassuring. I think I am missing the context that allows me to follow.
it shows that compared to other respiratory infections to covid this is reassuring
The study was done as a comparison study - you also have a much larger population of being being hospitalised with Covid than other respiratory conditions.
was identified and propensity-score matched (1:1) to a contemporaneous cohort of patients with any other respiratory infection.
The reassuring vs not reassuring depends on your priors I guess. For example some research has indicated that anxiety and mood disorders are increased after covid infection. This is a major concern given how common these diagnoses are and the findings re returning to baseline here is good news.
Haha yeah was thinking that myself!
Yep agree it's still potentially concerning, will be interesting to see if there are long term increases in psychotic disorders in the general population reflecting these results.
You don’t think 2.5m people is reflective of the general population??
I don't know. These sort of control matched studies are always difficult. They controlled for a bunch of variables but you can't control for everything.
What’s their vaccination status, done a search in study but can’t see it
It will also be interesting to see what impact treatments have and anything that reduces the length and severity of the initial symptoms.
Eh, that's a more than 10% increase in risk of psychotic disorders. You need to learn what words and numbers mean.
yeah sure, it's a 10% risk increase for something that is very low risk. As I said, other found risk factors for psychiatric disorders are generally much larger if you are worried about psychosis.
If you add one to one it more than DOUBLES!!
JFC dude, no it doesn't. And you actually think you're equipped to read these studies/papers?
risk of psychotic disorders was higher by 0.06% in the COVID group compared to the control group (0.57% vs 0.51%).
That's not correct. You've got the numbers backwards and there was no significant difference between the two groups in adults.
Shit you are right. Sorry was half asleep when I read this, will look at it again.
Shit you are right. Sorry was half asleep when I read this, will look at it again.
This is a big study but the big limitation of course is that its an observational study and only includes data collected from electronic health records. Infections that aren't reported or tested will not be included.
Another limitation is that there is no separation of disease severity. They do make some comment about patterns been similar during the Omicron period but this might come undone a bit because of the likelihood of far more unreported infections during Omicron.
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Thank you for posting. Interesting read, especially as I was actually not aware many of these neurological / psychiatric risks were so increased with Covid exposure. Four months after Covid infection I feel the “brain fog” aspect has diminished entirely for myself, so surprised to read many were still experiencing this problem over such a longer term. I also wonder how the overall stress of the Covid situation (lockdowns, border closures, restrictions etc.) has contributed to some these disorders too, seeing as most of us have never been through anything so concerning before.
All I can think of when reading this article is that the contention of the authors is to alarm and divide the public.
You'd rather just guess?
That’s a good read, thanks for posting.
The hazard ratio profiles by age group in figure 2, and by variant in figure 4 stand out.
There’s a lot of very good reasons to avoid this thing.