Severity of SARS-CoV-2 infection increases the risk of generalized anxiety disorder, major depressive disorder, and post-traumatic stress disorder in COVID-19 survivors: a prospective longitudinal cohort study.

BACKGROUND

The COVID-19 pandemic has significantly impacted global mental health. However, individuals with confirmed SARS-CoV-2 infection, diagnosed either clinically or through serological testing, appear to be at higher risk for developing mental health outcomes (MHOs) such as generalized anxiety disorder (GAD), major depressive disorder (MDD), and post-traumatic stress disorder (PTSD). Despite this, the relationship between the severity of acute SARS-CoV-2 infection and the onset of MHOs remains underexplored.

METHODS

This observational, longitudinal cohort study included 1,565 COVID-19 individuals with confirmed COVID-19 who were discharged from emergency departments, inpatient wards, and ICUs in Colombia. Participants were assessed at baseline, 3-, 6-, and 12-months post-infection using validated scales for anxiety, depressive and PTSD symptoms and structured interviews. COVID-19 severity was categorized as mild, moderate, severe, or critical. Propensity-score-based marginal mean weighting through stratification (MMWS) was used to adjust for baseline differences. Multilevel robust Poisson regression weighted by MMWS estimated the risk of MHOs.

RESULTS

High prevalence rates of GAD (23%), MDD (10%), and PTSD (10%) were observed three months post-infection, especially among those with severe or critical COVID-19. The prevalence of anxiety, depressive and PTSD symptoms declined over time across all groups. Multivariate analysis identified COVID-19 severity and early post-discharge onset of disease as significant risk factors for MHOs. Critical cases were associated with an increased risk of GAD (aRR = 1.58; 95% CI [1.07-2.32]) and MDD (aRR = 1.46; 95% CI [1.00-2.16]).

DISCUSSION: The findings highlight the temporal and severity-related dimensions of MHOs post-COVID-19. The observed peak in the onset of GAD, MDD, and PTSD at three months post-infection suggests a critical window for early intervention and targeted mental health support. Declining prevalence trends underscore the potential for recovery, albeit influenced by initial infection severity.

CONCLUSION

This study underscores the need for targeted mental health interventions during early recovery, particularly for severe and critical COVID-19 cases, to mitigate the long-term psychiatric burden.