COVID-19 Infection and Subsequent Psychiatric Morbidity, Sleep Problems and Fatigue: Analysis of an English Primary Care Cohort of 226,521 Positive Patients

Background: While some people who have had COVID-19 experience fatigue and sleep problems long after the acute phase of the illness, the proportion affected and the length of time symptoms persist remains uncertain. There are also concerns of an increase in psychiatric illness following COVID-19 infection; however evidence of a direct effect is inconclusive. Methods: This was a retrospective cohort study using a UK primary care registry. Adults with a positive PCR COVID-19 test between 1st February and 8th December 2020 were matched to controls based on gender, general practice and year of birth. Separate matched cohorts were assembled for those with and without prior recorded mental illness, fatigue and sleep problems. Cox proportional hazard models estimated the association between a COVID-19 positive test and subsequent psychiatric morbidity (depression, anxiety, psychosis, or self-harm), sleep problems, fatigue or psychotropic prescribing, adjusted for comorbidities, ethnicity, smoking status and BMI. Interaction with age and area-level deprivation were tested for. Additional cohorts examined those with a negative COVID-19 test and those with influenza symptoms (and a negative COVID-19 test). Results: After adjusting for observed confounders, there was an association between testing positive for COVID-19 (n=232,780) and almost all markers of psychiatric morbidity, psychotropic prescribing, fatigue and sleep problems. The adjusted hazard ratio for any indicator of incident psychiatric morbidity was 1.75 (95% CI: 1.56-1.96) and for new psychotropic prescribing 2.17 (95% CI: 2.00-2.35). However, there was an increased risk of incident psychiatric morbidity for those with a negative COVID-19 test of similar magnitude and a larger increase associated with having influenza. Interpretation: Whilst COVID-19 infection appears to be causing sleep problems and fatigue, there is less clear evidence of an effect on subsequent psychiatric morbidity. Funding Information: This work was funded by the NIHR Greater Manchester Patient Safety Translational Research Centre. Declaration of Interests: TC received ad hoc payments for conducting workshops on evidence-based treatments for persistent physical symptoms. TC has received grants from NIHR programme grants, HTA, RfPB, Guy’s and St Thomas Charity, King’s Challenge Fund. Personal financial interests: TC is the author of several self-help books on chronic fatigue and received royalties in the past. TC received expenses for workshops on evidence-based treatments for persistent physical symptoms for BABCP and IAPT services (travel and accommodation). None of the other authors have any conflicts of interest. Ethics Approval Statement: This study was conducted using data from the CPRD obtained under licence from the UK Medicines and Healthcare products Regulatory Agency (MHRA). The data are provided by patients and collected by the NHS as part of their care and support. The study was approved by the Independent Scientific Advisory Committee for CPRD research (20_094R2).