Workers' Compensation: Survivors of COVID-19 appear to be at increased risk of psychiatric sequelae

A recent study concludes that survivors of COVID-19 appear to be at increased risk of psychiatric sequelae. This reports reflects the potential for an increased surge of workers’ compensation claims attributed to exposure to coronavirus in the workplace.

The study published in The Lancet indicates:

In patients with no previous psychiatric history, a diagnosis of COVID-19 was associated with increased incidence of a first psychiatric diagnosis in the following 14 to 90 days compared with six other health events, hazard ratios [HR] (HR 2⋅1, 95% CI 1⋅8–2⋅5 vs influenza; 1⋅7, 1⋅5–1⋅9 vs other respiratory tract infections; 1⋅6, 1⋅4–1⋅9 vs skin infection; 1⋅6, 1⋅3–1⋅9 vs cholelithiasis; 2⋅2, 1⋅9–2⋅6 vs urolithiasis, and 2⋅1, 1⋅9–2⋅5 vs fracture of a large bone; all p<0⋅0001).

The HR was greatest for anxiety disorders, insomnia, and dementia. We observed similar findings, although with smaller HRs, when relapses and new diagnoses were measured. The incidence of any psychiatric diagnosis in the 14 to 90 days after COVID-19 diagnosis was 18⋅1% (95% CI 17⋅6–18⋅6), including 5⋅8% (5⋅2–6⋅4) that were a first diagnosis.

The incidence of a first diagnosis of dementia in the 14 to 90 days after COVID-19 diagnosis was 1⋅6% (95% CI 1⋅2–2⋅1) in people older than 65 years.

A psychiatric diagnosis in the previous year was associated with a higher incidence of COVID-19 diagnosis (relative risk 1⋅65, 95% CI 1⋅59–1⋅71; p<0⋅0001). This risk was independent of known physical health risk factors for COVID-19, but we cannot exclude possible residual confounding by socioeconomic factors.

“The psychiatric effects of COVID-19 were broad but not uniform. The HR was greater for anxiety disorders than for mood disorders. The impact of COVID-19 on anxiety is in line with expectations and highlights the need for effective and accessible interventions. Our data show increased diagnoses in all major anxiety disorder categories, and it remains unclear whether post-COVID-19 anxiety will have a particular post-traumatic stress disorder-like picture. Rates of insomnia diagnosis were also markedly elevated, in agreement with predictions that circadian disturbances will follow COVID-19 infection.

“By contrast, we did not find a clear signal for newly diagnosed psychotic disorders, despite case reports suggesting that this might occur.11,25 The two to three times increased risk of dementia after COVID-19 infection extends findings from previous case series11,26 and is concerning. Some of the excess might reflect misdiagnosed cases of delirium, or transient cognitive impairments due to reversible cerebral events. However, our exclusion of the first 14 days after COVID-19 diagnosis reduces this likelihood, and the incidence of dementia was not higher among inpatients (who are more prone to having delirium) than outpatients (appendix p 45), further suggesting that delirium misdiagnosis does not explain this finding. Detailed follow-up and investigation of this group should be a research priority, as should evaluation of other severe neuropsychiatric phenotypes that become apparent.”

Maxime Taquet, Sierra Luciano, John R Geddes, Paul J Harrison, Bidirectional associations between COVID-19 and psychiatric disorder: retrospective cohort studies of 62 354 COVID-19 cases in the USA, Lancet Psychiatry 2020,

Published Online November 9, 2020.

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