Hospital Programs Tackle Mental Health Effects of Long COVID


Editor’s note: Find the latest news and guidance about COVID-19 at the Medscape Coronavirus Resource Center.

Few doubt that prolonged COVID is real. As doctors and federal agencies struggle to identify the syndrome, hospitals and health systems are opening lengthy, specialized COVID treatment programs. Today, almost every state has at least one long-term COVID center — 48 out of 50, according to patient advocacy group Survivor Corps.

Among the biggest challenges will be treating the mental health effects of prolonged COVID. After people recover from an acute COVID infection, they can still have a wide range of lingering symptoms, including depression, anxiety, confusion, and post-traumatic stress disorder.


Specialized centers will address these issues even as the US struggles to cope with mental health needs.

One study of COVID patients found that more than a third of them had symptoms of depression, anxiety, or post-traumatic stress disorder 3 to 6 months after the initial infection. Another analysis of 30 previous studies of long-term COVID patients found that about one in eight of them had major depression, and that the risk was the same regardless of whether people were hospitalized with COVID-19.

“Many of these symptoms can appear several months after a long illness with COVID,” says Jordan Anderson, MD, a neuropsychiatrist who sees patients in the Long COVID-19 program at the Oregon Health and Science University in Portland. Psychological symptoms are often exacerbated by physical setbacks, such as extreme fatigue, as well as difficulties at work, caring for children, and performing daily activities, he says.


“This impact is not only severe but also chronic for many,” he says.

Like dozens of hospitals across the country, Oregon Health and Science opened its long-term COVID center as it became clear that more patients would need help to manage their lingering physical and mental health symptoms. Today, every state except Kansas and South Dakota has at least one long-term COVID center — sometimes called post-COVID centers or clinics — according to Survivor Corps.

According to Tracey Vannorsdall, Ph.D., a neuropsychologist working with Johns Hopkins University’s Post-Acute COVID-19 Team, many COVID-19 care centers aim to address both physical and mental health symptoms. One of Hopkins’ goals, she says, is to identify patients with psychological problems that might otherwise go unnoticed.


A significant minority of patients at Johns Hopkins — up to about 35% — report mental health issues they didn’t have until they contracted COVID-19, Vannorsdall said. The most common mental health issues faced by health care providers are depression, anxiety, and trauma-related distress, she says.

“Regular evaluation is key,” says Vannorsdall. “If patients are not asked about their mental health symptoms, they may spontaneously not report them to their doctor for fear of stigma or simply not realizing that there are effective treatments for these problems.”

Fears that doctors won’t take symptoms seriously are common, says Heather Murray, MD, senior lecturer in psychiatry at the University of Colorado School of Medicine.


“Many patients worry that their doctors, loved ones and the public will not believe them or minimize their symptoms and suffering,” says Murray, who treats patients at the UCHealth Post-COVID clinic.

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Diagnostic tests in long-term COVID patients are often inconclusive, she said, which can lead doctors and patients themselves to question whether the symptoms are truly “physical or psychosomatic.” “It’s important that healthcare professionals trust their patients and treat their symptoms, even if diagnostic tests fail.”

Patients often end up in academic treatment centers after experiencing a severe COVID-19 infection. But these centers are seeing more patients with long-term COVID after milder cases. These patients have never been hospitalized with COVID-19, but they still have persistent symptoms such as fatigue, thinking problems, and mood disorders.


Among the main challenges is the lack of mental health providers to meet the growing need for care since the start of the pandemic. Globally, levels of anxiety and depression rose by 25% during the first year of the pandemic, according to the World Health Organization.

According to a March 2022 White House statement, in the US, 40% of adults report feelings of anxiety and depression, and one in three high school students experience feelings of sadness and hopelessness.

Despite the growing need for care, almost half of Americans live in areas with a severe shortage of mental health providers, according to the Health Resources and Services Administration. As of 2019, about 6,790 mental health providers were missing in the U.S., according to the agency. Since then, the deficit has worsened; now it is about 7500 providers.

“One of the biggest challenges for hospitals and clinics in treating psychiatric disorders in long-term COVID is limited resources and long waiting times to get checked out and treated,” says Nyaz Didehbani, Ph.D., a neuropsychologist who treats patients with long-term COVID. in the hospital. COVID Recover program at the University of Texas Southwestern Medical Center at Dallas.

These delays could lead to worse outcomes, Didehbani says. “Furthermore, patients don’t feel like they are being heard, as many health care providers are unaware of the mental health impact and links to physical and cognitive symptoms,” she says.

Even when doctors acknowledge that psychological problems are common with long-term COVID, they still have to think creatively to find treatments that meet the unique needs of these patients, says Thida Tan, MD, assistant professor of psychiatry at the School of the University of Colorado. MD who treats patients at the UCHealth Post-COVID clinic.

“There are at least two main factors that make it difficult to treat psychological problems in long-term COVID: the fact that the pandemic is still ongoing and still divisive in society, and the fact that we do not know a single best way to treat everyone. symptoms of protracted COVID,” she says.

Some common treatments for anxiety and depression, such as psychotherapy and medication, may be used for long-term COVID patients with these conditions. But another intervention that can work wonders for many people with mood disorders — exercise — doesn’t always help long-term COVID patients. This is because many of them struggle with physical problems such as chronic fatigue and what is known as post-exercise malaise, or worsening of symptoms even after limited physical effort.

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“While we generally encourage patients to be active, maintain a daily routine, and engage in physical activity as part of their mental health treatment, some long-term COVID patients find their symptoms worsen after increased activity,” says Vannorsdall.

Physicians working in many programs around the country agree that patients who may be in long-term COVID-19 treatment centers are much more likely to be diagnosed and treated for mental health problems. But many of the patients hardest hit by the pandemic — low-income, racial and ethnic minorities — are also less likely to have easy access to hospitals that offer these programs, says Anderson of Oregon Health and Science.

“Wealthy, predominantly white people are showing up at these clinics when we know non-whites have a disproportionate rate of acute infections, hospitalizations and virus-related deaths,” he says.

Clinics are also concentrated in academic medical centers and in urban areas, Anderson said, limiting options for rural residents who may have to drive for hours to get help.

“We already knew long before COVID that many people live in areas that simply lack affordable mental health services,” says John Zulueta, MD, assistant professor of clinical psychiatry at the University of Illinois at Chicago, who provides mental health care. . health assessments at the UI Health Post-COVID clinic.

“As more patients develop mental health issues associated with prolonged COVID, this will put more strain on an already stressed system,” he says.


JMIR Mental Health: “Impact of long-term COVID-19 on mental health: An observational 6-month follow-up study.” Journal of Psychiatric Research: “Onset and frequency of depression in post-COVID-19 syndrome: a systematic review.”

Jordan Anderson, DO, Neuropsychiatrist, Longitudinal COVID-19 Program, Oregon Health & Science University, Portland.

Survivor Corps: “Post-COVID Care Centers (PCCC)”.

Tracey Vannorsdall, Ph.D., neuropsychologist, Johns Hopkins University Acute COVID-19 Team, Baltimore.

Heather Murray, MD, is senior lecturer in psychiatry at the University of Colorado School of Medicine.

World Health Organization: “The COVID-19 pandemic is causing a 25 percent increase in the prevalence of anxiety and depression worldwide.”

White House: “Fact Sheet: President Biden to Announce Strategy to Address Our National Mental Health Crisis Through Unity Program in His First State of the Union.”

Health Resources and Services Administration: “Lack of areas.”

Niyaz Didehbani, PhD, Neuropsychologist, COVID Recover Program, UT Southwestern Medical Center, Dallas.

Thida Tan, MD, Associate Professor of Psychiatry, University of Colorado School of Medicine, UCHealth Post-COVID Clinic.

CDC: Post-exercise malaise management (PEM) in ME/CFS.

John Zulueta, MD, Associate Professor of Clinical Psychiatry, University of Illinois at Chicago, UI Health Post-COVID Clinic.


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