COVID-19 Infection Associated with More Depression Symptoms among Veterans at 18 months Post-Infection
BACKGROUND:
Past studies have found some associations between COVID-19 infection and depression symptoms. However, these studies had limited ability to account for potential confounding (e.g., comorbid conditions). This survey-based, cohort study robustly matched COVID-19 infected patients with contemporaneous, uninfected controls (n=186 per group) to assess the effects of COVID-19 on depression symptoms. Investigators also explored associations between COVID-19 infection and depression symptom subdomains (i.e., physical, psychological) to differentiate symptoms commonly associated with long-term symptoms of COVID-19 infection (e.g., low energy) from mood disturbance (e.g., negative self-worth). Participating Veterans completed the Patient Health Questionnaire-9 (PHQ-9) by phone between May and December 2022. In addition, investigators explored the role of past depression diagnosis to assess the impact of new onset versus exacerbation of existing depression.
FINDINGS:
- COVID-19 infection was associated with more depression symptoms among Veterans at 18 months post-infection, with a significantly higher prevalence of positive depression screening among Veterans with COVID compared to those without (49% vs 12%).
- COVID-19 infection was associated with significantly elevated psychological depression symptoms, but not physical depression symptoms. History of depression diagnosis did not appear to affect the risk of depression symptoms after COVID-19 infection.
IMPLICATIONS:
- Primary care and Primary Care-Mental Health Integration providers may consider monitoring depression symptoms among Veterans after being infected with COVID-19, as they may exceed what is expected for normal adjustment to illness. In addition, providers should be aware that such symptoms may be present long after infection (up to 18 months post-infection).
- Significant increases in psychological symptoms (e.g., low self-worth) but not physical symptoms of depression (e.g., sleep disturbance) challenge the broader narrative that such mental health symptoms following COVID are predominantly due to the impact of physical illness.
LIMITATIONS:
- The study measured depression symptoms at one time point (18 months post-infection), and thus was unable to determine how depression symptoms may have changed both prior to or directly following infection, as well as whether such symptoms were secondary to Long COVID.
- The study did not differentiate potentially overlapping physical and mental health symptoms (e.g., PHQ-9 question on feeling tired)
AUTHOR/FUNDING INFORMATION:
Drs. Chen and Bui are part of HSR’s Center to Improve Veteran Involvement in Care (CIVIC), and Dr. Iwashyna is with HSR’s Center for Clinical Management Research (CCMR). This study was funded by HSR; Dr. Chen is supported by an HSR Career Development Award (CDA).
Chen J, Bui D, Iwashyna T, et al., for the VA/HSR SARS-CoV-2 Observational Research Collaboratory (CORC). Impact of SARS-CoV-2 Infection on Long-Term Depression Symptoms among Veterans. Journal of General Internal Medicine. April 16, 2024;online ahead of print.
