Depression After COVID-19 May Differ From Typical Major Depression

Self-reported major depressive symptoms in adults with prior COVID-19 illness differed in several ways from those in adults without SARS-CoV-2 infection, according to a study published online in JAMA Network Open.

“These differences in phenomenology and risk factors both indirectly suggest that apparent major depressive episodes following COVID-19 illness may be distinct from those typically observed in adults,” wrote first author Roy H. Perlis, MD, MSc, of Massachusetts General Hospital and Harvard Medical School in Boston, and colleagues.

To investigate whether major depressive symptoms may be a consequence of stress associated with acute illness or reflect a more specific sequelae associated with COVID-19 itself, researchers surveyed 91,791 adults between May 2020 and February 2021. Among them, 6.5% reported a prior COVID-19 diagnosis or positive SARS-CoV-2 test result, and 31.2% reported moderate or greater depressive symptoms on the Patient Health Questionnaire (PHQ)-9.

In participants with and without prior COVID-19, the greatest differences in PHQ-9 scores involved suicidality (on average, 2.50 in participants with prior COVID-19 vs 1.99 in participants without prior COVID-19) and motor symptoms (2.58 vs 2.11), according to the study.

“The difference in symptom profile is notable in light of the markedly elevated rates of delirium observed in patients with COVID-19,” researchers suggest, “given that delirium is also often associated with both motoric and cognitive symptoms.”

Of note, the risk for depressive symptoms increased with a greater interval of time after acute COVID-19 illness, analysis showed, rather than decreased. If depressive symptoms were a consequence of stress associated with acute illness, a gradual decrease would be expected, researchers wrote.

The study also identified significant associations with prior COVID-19 status and depressive symptoms for sex, income, Black vs White race, and urban vs rural locale.

“Broadly, our results may suggest a different disease process at least in a subset of individuals,” researchers wrote. “At minimum, these distinctions suggest a need to better understand differences and similarities between depressive symptoms following COVID-19 and those associated with typical major depressive disorder.”

—Jolynn Tumolo

Reference

Perlis RH, Santillana M, Ognyanova K, et al. Factors associated with self-reported symptoms of depression among adults with and without a previous COVID-19 diagnosis. JAMA Network Open. 2021;4(6):e2116612.