Bidirectional associations between COVID-19 and psychiatric disorder: a study of 62,354 COVID-19 cases

Taquet, M.; Luciano, S.; Geddes, J. R.; Harrison, P. J.

Background: Adverse mental health consequences of COVID-19, including anxiety and depression, have been widely predicted but not yet accurately measured. There are a range of physical health risk factors for COVID-19, but it is not known if there are also psychiatric risk factors. Methods: We addressed both questions using cohort studies derived from an electronic health records (EHR) network of 69 million patients including over 62,000 cases of COVID-19. Propensity score matching was used to control for confounding by risk factors for COVID-19 and for more severe illness. Findings: In patients with no prior psychiatric history, COVID-19 was associated with an increased incidence of psychiatric diagnoses in the three months after infection compared to 6 other health events (hazard ratio [95% CI] 2.1 [1.8-2.5] compared to influenza; 1.7 [1.5-1.9] compared to other respiratory tract infections; 1.6 [1.4-1.9] compared to skin infection; 1.6 [1.3.1-9] compared to cholelithiasis; 2.2 [1.9-2.6] compared to urolithiasis, and 2.1 [1.9-2.5] compared to fracture of a large bone; all p<0.0001). The increase was greatest for anxiety disorders but also present for depression, insomnia, and dementia. The results were robust to several sensitivity analyses. There was a ~30% reduction in psychiatric diagnoses in the total EHR population over the same period. A psychiatric diagnosis in the previous year was associated with a 65% higher incidence of COVID-19 (relative risk 1.65, 95% CI: 1.59-1.71, p<0.0001). This was independent of known physical health risk factors for COVID-19. Interpretation: COVID-19 infection has both psychiatric sequelae and psychiatric antecedents. Survivors have an increased rate of new onset psychiatric disorders, and prior psychiatric disorders are associated with a higher risk of COVID-19. The findings have implications for research into aetiology and highlight the need for clinical services to provide multidisciplinary follow-up, and prompt detection and treatment.