VA research spells out COVID’s down-the-road risks for mental health

The most menacing fallout from COVID-19 often shows itself only after the initial “acute” infection passes. A team of VA researches has been shining a light on various dangerous and enduring consequences that can arise following the initial COVID bout. These COVID complications include mental health disorders.

In one of two studies they conducted on COVID’s chronic effects that were published in February 2022, researchers with the VA St. Louis Health Care System focused on mental health disorders following COVID-19 infection. The group’s findings appeared Feb. 16, 2022, in the British Medical Journal (BMJ).

The researchers found that, even in people not needing hospitalization while infected with COVID-19, serious health issues related to mental health could persist, or pop up, in the weeks and months following the acute stage. They say the reasons for the increased mental health risks after COVID are not completely clear. Biologic changes may occur in the body that affect the brain, and nonbiologic changes such as social isolation and trauma may also be at play.

Led by principal investigator Dr. Ziyad Al-Aly, who heads up both the Clinical Epidemiology Center and the Research and Development Service at the VA St. Louis Health Care System, the researchers found increased risks of conditions such as depression, anxiety, sleep disorders, and substance use disorders.

For many people, COVID-19 infection comes with only mild or moderate symptoms, such as an irksome cough and shortness of breath that last for a few days. But this first phase can be the “tip of the iceberg,” according to Al-Aly. “Those who go on to experience serious chronic consequences—effects that commonly last a lifetime—are the ones who will bear the scars of this pandemic,” he says.  

Al-Aly is a nephrologist—a doctor specializing in kidney disease—as well as a clinical epidemiologist with expertise in big data. His team analyzes huge data sets too complex for conventional computer software. As a researcher, Al-Aly specializes in COVID’s chronic effects, which are known technically as “post-acute sequelae of SARS-CoV-2” and informally as “long COVID” or “long-haul COVID.”

Studies by Al-Aly and others have shown that long COVID can affect nearly every organ system. “People return to their doctor with fatigue, brain fog, amnesia, strokes, new-onset diabetes, kidney disease, heart disease, and more,” the physician-researcher says.

From the wide range of chronic consequences of COVID, one area that Al-Aly and his team decided to zero in on was mental health. They selected this area because of its serious ramifications for individual and public health, explains study coauthor Dr. Yan Xie, a clinical epidemiologist with the VA St. Louis Epidemiology Center.

The research group compared the mental health risks for those who had COVID-19 and survived the first 30 days of infection with the same health outcomes among those who were not infected. Over a study period of about a year, the researchers identified elevated risks for issues such as anxiety, depression, stress disorders, opioid use, substance use disorders, and sleep conditions. 

“We’ve all suffered some sort of distress from this pandemic—maybe a measure of anxiety or difficulty sleeping,” says lead investigator Al-Aly. “But these challenges are magnified, especially in those who were admitted to the hospital during the acute part of their COVID battle but also in many who experienced only mild or moderate symptoms.”

Compared to those who did not have COVID, those in the COVID group had a 60 percent higher risk of having any mental health disorder or mental health-related prescriptions.

Findings by the type of mental health issue were:

• Anxiety: 35 percent higher risk in the COVID-19 group
• Depression: 39 percent higher risk
• Sleep disorder: 41 percent higher risk
• Opioid use: 76 percent higher risk
• Opioid use disorder: 34 percent higher risk
• Non-opioid substance use disorders: 20 percent higher risk.

Given the large number of people with COVID-19, these findings could translate into a huge impact in the United States and around the world, the authors point out.

In the study published in BMJ, the researchers analyzed medical records in a database within VA, which operates the largest integrated health care system in the United States. The analysis included nearly 154,000 patients who had tested positive for COVID-19 in a defined time frame from March 2020 into January 2021. (The time frame predated the delta and omicron variants, as well as wide availability of vaccines.)

Using sophisticated statistical methods, the researchers compared these patients’ health information with data from more than 11 million people who had not had COVID-19 infection—about half of them from the same time frame and the other half from a pre-pandemic timespan.

“A strength of our research was the large number of patients and the ability to leverage the breadth and depth of the VA’s electronic health records system,” highlights Al-Aly. As a pioneer in the use of electronic health records, VA “can offer answers to questions about areas including the pandemic that would be hard for others to address.”

Al-Aly also credits his multidisciplinary research team for making the rigorous analysis possible. “We brought together public health experts from across disciplines, successfully marrying the medical and research perspectives,” Al-Aly says. Evan Xu, with VA St. Louis, co-authored the BMJ article with Al-Aly and Xie.

The team hopes their research and that of other groups will encourage individuals, health care systems, and policymakers to remain vigilant concerning the virus. 

The best defense against long COVID, according to the researchers: Avoid getting COVID in the first place. That means taking steps such as getting vaccinated and boosted, wearing high-quality masks, and washing hands regularly, Xie specifies. For those who become infected and develop mental health disorders, Xie says, “We hope our results will make it easier for them and their health care providers to identify these conditions and initiate treatment.”

From a broader, public-policy perspective, Al-Aly urges a prompt and robust response to support the millions of people who could face serious mental health challenges resulting from COVID. “No doubt, the VA will take care of our patients, and health care systems as well as governments across this country and around the world must also prepare. It is very important to address these issues now, before they become much larger crises down the road.”

Al-Aly says he and his colleagues will continue studying long-haul COVID. “As a physician and a researcher myself, working with a group of full-time researchers, we will continue to leverage our expertise to answer questions that the public, including Veterans and Veterans’ organizations, care about.”

Al-Aly’s ongoing research includes an examination of the link between long COVID and diabetes. “By generating more awareness of the spectrum of health complications long-haulers face,” he says, “we can work to nip this long-COVID crisis in the bud and keep it from ballooning into a larger public health plight.”