Post-COVID syndrome and suicide risk.
Article in review: Sher,L. (2021). Post-COVID syndrome and suicide risk. QJM: An International Journal of Medicine. doi: 10.1093/qjmed/hcab007
An increasing number of people who have had a COVID-19 infection continue to experience symptoms and illness following the acute phase of the disease, in a condition known as a post-COVID syndrome. Urgent research is needed to help determine if people with this form of COVID are at an increased risk of suicide. Research is also required to determine if people who have had a COVID-19 infection without post syndrome symptoms may also be at an increased risk. Appropriate management of psychiatric, neurological and medical conditions may reduce suicide risk for people who have had COVID-19.
We are hearing more and more about the post-COVID syndrome, (also known as long COVID or post-acute COVID-19 syndrome) in which various symptoms of the virus persist. Though definitions do vary in the literature, it is generally proposed that post-COVID syndrome is where symptoms extend beyond 12 weeks. According to one study, around 10% of patients continue to be unwell beyond three weeks, and a smaller percentage continues to be sick for months.
Physical symptoms cough, fatigue, dyspnea and pain persist. There can also be continued COVID-19 related neurological symptoms include anosmia, ageusia, dizziness, headache and seizures. Psychiatric symptoms including depression, anxiety, post-traumatic symptoms, and cognitive impairment have been reported to be attributed to psychological factors and neurological injury.
One UK study found that among people who had a COVID-19 infection in the previous 2-3 months, there was a higher rate of reported moderate and severe anxiety when compared to controls.
It can be difficult to separate neurological injury from psychological factors. One study performed after between 36 and 50 months after a SARS infection identified psychiatric illnesses at a much higher rate than general prevalence (3%). Rates were:
• Post-traumatic stress disorder – 54.5%
• Depression – 39%
• Panic disorder – 32.5%
• Obsessive compulsive disorder – 15.6%
A further consideration relates to the fact that some people with COVID-19 require admission to an Intensive care unit (ICU). It has already been demonstrated that people who have had an ICU admission have frequent rates of depression (43%) and PTSD (33%) along with anxiety, sleep abnormalities and cognitive impairments.
Receiving a positive diagnosis of COVID-19 evokes emotional stress for many people, and cause distress, inducing or aggravating an existing mental illness. Being diagnosed with a disease that is both potentially lethal and untreatable can understandably cause a person to feel distressed. There are also worries associated with social stigma, social isolation, concerns about loss of income and fear of an inability to work, these may all cause emotional distress, which can be lasting and significant.
The combination of systemic inflammation, hypoxia from respiratory failure and neuroinflammation may precipitate or worsen psychiatric disorders including:
• Alcohol and drug abuse
• Sleep disorders
• Neurodegenerative disorders
A recent study found that 84% of COVID-19 patients who had been hospitalized in Italy still had physical symptoms 60 days after the onset of symptoms, and 55% had three or more symptoms, most commonly fatigue, dyspnea and chest pain. The list of physical ailments that can present in cases of the post-COVID syndrome include:
• Weight loss
• Chest pain
• Digestive disorders
As health care professionals frequently experience COVID-19 infection, there is also a sustained risk of decreased ability to provide care and a shortage of available medical professionals. And in most cases, medical practitioners are most concerned with taking care of the immediate physical concerns of the patient with COVID-19. Very little consideration is given to long term effects.
From January to July 2020, there were a total of 635,000 deaths from COVID-19. The number of suicides over the period was not much lower at 462,000. If governments invested even a fraction of what they spend on COVID-19 research, service and treatments, significant numbers of lives could be saved.
Elevated Suicide risk among people with the post-COVID syndrome
With the presence of all of these psychiatric, neurological and physical symptoms among people with the post-COVID syndrome, there is a high probability we will see an increase in the number of people with suicidal ideation and behaviours.
Now is the time to assess how these factors might contribute to an increase in the number of people considered to be at risk of suicide. This will help us to understand better what risk factors may increase risk among survivors of COVID-19, regardless of if they experienced symptoms post the primary infection.