Long COVID and its Impact on Psychiatric Functioning
Over the past several years, the world as a whole has been forced to adjust to a new virus, mandatory quarantines, tremendous losses, and new health problems that are related to having contracted the COVID-19 virus. The term “long COVID” has become part of many people’s daily vocabulary and its impacts are far-reaching and overwhelming.
However, long COVID is often used as a broad term used to encompass a variety of symptoms by the general public. In her article describing treatment options for those with long COVID, Schreiber (2021) noted that approximately 10% of individuals who contracted COVID-19 developed long COVID. Generally, symptoms of long COVID include, but are not limited to, fatigue, decreased endurance, cognitive impairments, neuropsychological deficits, brain fog, intense anxiety, anhedonia, insomnia, short-term memory loss, and poor concentration/attention (Calkins, 2023). Individuals who were in intensive care units are also at risk of developing difficulties with swallowing and full-body weakness (Stringer, 2021). Yu et al. (2022) also note that individuals with long COVID are at risk of significant illnesses including strokes, cognitive and memory disorders, nervous system disorders, musculoskeletal disorders, sensory disorders, and Guillain-Barre syndrome (though it is likely that this list is longer).
Taquet et al. (2021) found that COVID-19 survivors appear to be at increased risk for psychological symptoms and diagnoses than their peers who had not contracted COVID-19. Additionally, they note that the psychiatric effects of COVID-19 appear to be broad (Taquet et al., 2021). Horsey and Needham (2020) found that approximately 1/3 of survivors who had experienced acute respiratory failure or shock demonstrated neuropsychological test scores consistent with a moderate traumatic brain injury (TBI) approximately 1 year after hospitalization. Similarly, authors found that approximately 1/4 to 1/3 of survivors experienced anxiety, depression, and PTSD symptoms.
Given the above statistics, researchers and therapists agree that all COVID-19 survivors need to be assessed for mental health symptoms once immediate health concerns have been addressed. The need to assess and monitor mental health symptoms among survivors is particularly important as media coverage emphasizing COVID-19 death rates, illness spread, and stigma often intensifies symptoms (Horsey & Needham, 2020). As with any mental health concern, early intervention is recommended to improve outcomes.
Calkins (2023) recommends using a CBT-based approach to assist individuals in understanding the relationship between their mood and their cognitive functioning. Additionally, the concept of pacing is often recommended to assist individuals with significant cognitive impairment. Similarly, Schreiber (2021 recommends making changes in the environment (i.e. increasing social support, creating a task list, using digital reminders, etc.) to assist in reducing the impacts of cognitive impairment and brain fog. Stringer (2021) also recommends that psychological treatment integrate relaxation and breathing strategies to assist individuals in managing their mood to better manage their cognitive functioning.
As a final note, Stringer (2021) recommends that family, medical providers, and friends assist in maintaining a diary while their loved one is hospitalized. This diary can be used to document medical procedures, names of providers, new diagnoses, meals, and even bedding changes. These diaries can help to contextualize hallucinations or other experiences that may be contributing to psychiatric distress. Similarly, Schreiber (2021) notes that survivors often experience long periods in which they have no memory of their time in the hospital. As stated above, this can contribute to significant emotional distress. It is therefore vitally important that those around these survivors can assist in filling in these memory gaps to assist in reducing anxiety and depression.
Unfortunately, COVID-19 continues to significantly impact the lives of numerous people around the world. While the initial infection is devastating in and of itself, long COVID is becoming increasingly common and recognized by both medical providers and the general public. Like most chronic illnesses, long COVID often has far-reaching and long-lasting impacts on mental health. However, with CBT and other treatment modalities, these symptoms can be minimized over time.
About the Author
Dr. Montes is a licensed clinical psychologist and co-owner of Cognitive Behavior Therapy Center in Chesapeake, VA.
Calkins, H. (2022, November 1). The cognitive impact of Long Covid: What can psychologists do. Monitor on Psychology. https://www.apa.org/monitor/2022/11/psychologists-long-covid
Hosey, M.M., Needham, D.M. (2020). Survivorship after COVID-19 ICU stay. Nat
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Schreiber, M. (2021, July 1). Treating patients with long COVID. Monitor on Psychology. https://www.apa.org/monitor/2021/07/treating-long-covid
Stringer, H. (2021, April 25). Rehabilitation psychology and Covid Long-haulers: 4 questions for Abigail Hardin. Monitor on Psychology. https://www.apa.org/monitor/2021/06/conversation-hardin
Taquet, M., Luciano, S., Geddes, J.R., & Harrison, P.J. (2021). Bidirectional associations between COVID-19 and psychiatric disorder: Retrospective cohort studies of 62 354 COVID-19 cases in the USA. The Lancet Psychiatry, 8(2). https://doi.org/10.1016/S2215-0366(20)30462-4
Xu, E., Xie, Y., & Al-Aly, Z. (2022). Long-term neurologic outcomes of COVID-19. Nature Medicine, 28(11), 2406–2415. https://doi.org/10.1038/s41591-022-02001-z