Psychiatric and Cognitive Morbidity Following Moderate and Severe SARS-CoV-2 Infection: A Cohort Study

Background: Recent studies indicate that psychiatric and neurocognitive symptoms are frequent after Coronavirus Disease-2019 (COVID-19). The present study aims to investigate the occurrence of psychiatric and cognitive impairments in a cohort of survivors from moderate or severe forms of COVID-19. Methods: 425 adults (mean age 55.7 years) were assessed 6 to 9 months after hospital discharge with a structured psychiatric interview (Clinical Interview Schedule, CIS-R) and a combination of psychometric tests. Cognitive state was examined with a subjective memory complaint scale and screening tests. A large, multidisciplinary, set of clinical data depicting the acute phase of the disease, along with relevant psychosocial variables, were used to predict psychiatric and cognitive outcomes using the ‘Least Absolute Shrinkage and Selection Operator’ (LASSO) method. Outcomes: CIS-R diagnoses of ‘depression’, ‘generalized anxiety disorder’ and ‘post-traumatic stress disorder’ were established respectively in 8%, 15.5% and 13.6% of the sample. Memory decline was reported by 51.1% of the patients. Psychiatric or cognitive outcomes were not predicted by any clinical variables related to the severity of acute-phase disease, nor by disease-related psychosocial stressors. Rather, depression and anxiety were only predicted by current frailty and worse general health status. Interpretation: Using a structured psychiatric interview and an objective assessment of cognitive state, we found high rates of psychiatric and cognitive morbidity in the long-term outcome after moderate or severe COVID-19. The lack of associations of previous medical or psychosocial factors with these diagnoses suggests a direct, disease-related, mechanism in the pathophysiology of COVID-19 related psychiatric and cognitive impairments. Funding: This work was partially supported by donations from the general public under the HC-COMVIDA crowdfunding scheme (https://viralcure.org/c/hc) and the Fundacao Faculdade de Medicina (ALA). ARB receives scholarships and support from FAPESP, the Brazilian National Council of Scientific Development (CNPq-1B), University of Sao Paulo Medical School (FMUSP), the UK Academy of Medical Sciences (Newton Advanced Fellowship), and the International Health Cohort Consortium (IHCC). Conflict of Interest: Authors Declare no Conflict of Interest. Ethical Approval: This research protocol has been approved by the Ethics Committee at HCFMUSP (CAPPesq HC), and registered at the Brazilian Registry of Clinical Trials (ReBEC) under the registration number 4.270.242 (RBR-8z7v5wc) and will be reported according to The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement.