- This internet survey compared symptoms of major depressive disorder in 5,945 people with a prior COVID-19 clinician diagnosis or test result and 85,846 people without prior COVID-19
- 28,617 respondents (31%) reported moderate or severe depressive symptoms (score ≥10 on the Patient Health Questionnaire–9)
- In respondents who had prior COVID-19, moderate/severe depression was significantly associated with sex, locale, race and income; the risk increased over time after acute illness (9% greater odds for each additional month)
- Among the nine individual symptoms assessed, suicidality and motor symptoms were particularly likely to be more prevalent in respondents who had prior COVID-19 than in those who did not
- These results indirectly suggest that apparent major depressive episodes after COVID-19 illness may be distinct from those typically observed in adults
Several epidemiologic studies suggest that the risk of major depressive disorder (MDD) is increased after SARS-CoV-2 infection. For example, researchers at Massachusetts General Hospital reported in JAMA Network Open that 52% of 3,900 individuals surveyed after acute COVID-19 had moderate or greater symptoms of MDD, with symptoms being more likely in those who had greater COVID-19 severity.
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A key question is whether depressive symptoms are a general consequence of the stress associated with acute illness or result from COVID-19 itself. Building on their prior results, Roy Perlis, MD, MSc, director of the Center for Quantitative Health in the Department of Psychiatry at Mass General, and colleagues present evidence for the latter conclusion in a research letter also published in JAMA Network Open.
The researchers conducted 12 waves of an internet survey, posted approximately every month between May 2020 and February 2021 for individuals 18 years and older. Along with answering questions about COVID-19 and sociodemographics, participants completed the Patient Health Questionnaire (PHQ)-9, rating nine depressive symptoms on a scale of 0 (not at all) to 3 (nearly every day). Scores ≥10 were considered moderate to severe depression.
91,791 respondents completed the PHQ-9 (67% female, median age 42). 5,945 individuals (6.5%) reported a prior COVID-19 clinician diagnosis or test result, and 28,617 (31%) reported moderate or severe depressive symptoms.
Depression and COVID-19
In the group with prior COVID-19, moderate/severe depression was significantly associated with:
- Sex—34% lower odds of depressive symptoms for women vs. men
- Locale—31% greater odds for urban vs. rural respondents
- Race—9% greater odds for Black vs. white respondents
- Income—2% greater odds per $20,000
The risk of depressive symptoms increased over time after acute illness (9% greater odds for each additional month).
When the nine symptoms were assessed individually, respondents with versus without prior COVID-19 differed most regarding suicidality and motor symptoms—both were significantly more likely after COVID-19. The difference in motor symptoms might be related to delirium, which is common among hospitalized patients with COVID-19 and is often associated with subsequent motor symptoms.
Interpreting the Findings
It's noteworthy that the risk of depressive symptoms increased with greater duration after acute COVID-19 illness. If the symptoms were related to illness-associated stressors, the risk would be expected to decline gradually.
These results indirectly suggest that apparent major depressive episodes after COVID-19 illness may be distinct from those typically observed in adults. For a definite conclusion to be drawn, research is needed that examines a wider array of depressive symptoms and obtains information about each patient's psychiatric history and course of COVID-19.
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