Can COVID-19 cause depression?

COVID-19 and depression: Is there a link?

During the height of the COVID-19 pandemic, medical professionals and researchers didn’t fully understand the long-term effects of the illness. Now that the world has begun moving on from the pandemic, depression after COVID, or “COVID depression,” coming into better focus.

According to the World Health Organization, depression and anxiety rose by 25 percent worldwide during the first year of the pandemic. This astonishing increase in mental health problems was primarily due to the rapid and long-lasting social isolation necessary to fight the pandemic.^[1]

But social isolation wasn’t the only factor contributing to COVID depression. Instead, multiple intense stressors made the increase in depression, anxiety, and other mental health issues possible. These factors include:^[1]

• Grief for loved ones who died from COVID
• Concern about loved ones who contracted COVID
• Stress from caring for COVID patients
• Fear of infection
• Financial concerns due to job loss

These stress factors describe most people's experiences during the pandemic, whether they had COVID or not. But it’s becoming more apparent that having COVID is associated with an even higher incidence of mental health disorders.

For example, one meta-analysis of nearly 70 million electronic health records shows that people with COVID-19 are at a higher risk of developing a psychiatric disorder. Additionally, people already diagnosed with a psychiatric disorder are 65 percent more likely to be diagnosed with COVID.^[2]

Moreover, people already in psychological distress before contracting COVID are 45 percent more likely to develop long COVID. And this isn’t limited to people who are already depressed. People with elevated worry, anxiety, loneliness, and stress are more likely to develop long COVID.^[3]

Other research indicates that more than 40 percent of people with a mild case of COVID have depression and anxiety three months later. The same study examines brain scans of patients that experience COVID depression and those that don’t and found that post COVID depression causes a change in the limbic system.^[4]

This and other changes are discussed in more detail in the next section, but it illustrates that there is a link between COVID and depression in patients that have the virus.

Additionally, anecdotal evidence points to increased psychiatric difficulties in COVID patients (and people who have not contracted the virus, for that matter).

For example, during the height of the pandemic, physicians reported an increase in patients’ emotional distress, including symptoms of anxiety and depression. As new waves of the virus swept across the nation and worldwide, depression symptoms in patients also surged.^[5]

Causes of depression after COVID-19

There are several layers of post COVID depression to explore: risk factors, the virus’ impact on the body, and the psychological effects of the pandemic.

Risk factors for COVID depression

Not everyone with COVID develops depression. What’s more, some people who haven’t contracted the virus have developed depressive disorders. So, what is the link between the two?

Research indicates that certain groups of people are at a higher risk of depression after COVID than others. Young people, women, and people with pre-existing mental or physical health conditions are chief among these groups.^[1]

As well, low-income populations, unmarried people, and people who experience multiple stressors related to the pandemic are more likely to develop depression and other mental health disorders. And these groups didn’t just experience depression immediately once the pandemic hit. Instead, COVID depression rates rose dramatically over time.

Before the pandemic started, about 8.5 percent of American adults reported having elevated symptoms of depression. In the early months of the pandemic, that number rose to 27.8 percent. By 2021, that rate was 32.8 percent.^[6]

While not everyone among that 32.8 percent of the population had one or more risk factors, as outlined earlier, members of lower-income classes and people who experienced multiple levels of COVID-related stressors were represented in greater numbers.

The virus’ impact on the body

The second cause of depression after COVID is the virus’ direct effects on the body, specifically the neurological impacts of having the illness.

As described earlier, more than 40 percent of people with mild COVID have depression and anxiety three months later. Brain scans show that these people experience shrinkage in the limbic area of the brain - an area involved in emotional processing.^[4]

The theory is that COVID changes not only the brain's structure but also how it operates and communicates.^[4] In other words, people who develop COVID depression do so partly because their brains cannot process emotions as they once did, making them more susceptible to the pandemic's grief, stress, and trauma and more likely to develop depression.

Other research points to neuroinflammation caused by COVID as a potential factor in developing post COVID depression. Evidence suggests that immune-mediated damage to the central nervous system is the culprit of COVID-related psychological symptoms of depression. What’s more, researchers postulate that impairment of neurotransmission, brain inflammation, and other disruptions might be related to the increase in the incidence of depression in COVID patients.^[7]

This is to say nothing of the effects of long COVID on patients’ mental health. As if COVID-19 isn’t bad enough, battling it for an extended period can be physically, psychologically, and emotionally draining. As such, “long COVID depression” might be considered a distinct type of COVID-related psychopathology.

Not only do long COVID patients have physiological concerns like organ damage, continuous viral symptoms, and general loss of physical well-being, but they also tend to be more susceptible to depression, anxiety, and other disorders. It’s easy to see why - months and months of reduced activity, increased isolation, dozens of medical treatments, and skyrocketing medical expenses can be mentally debilitating.^[5]

Psychological effects of the pandemic

The final potential cause of COVID and depression includes the psychological effects of living through the pandemic.

As mentioned earlier, people with and without COVID experience grief, fear, anxiety, and uncertainty about the future, to name a few. By themselves, any of these factors could induce depressive symptoms. But when experienced together, they make depression all the more likely.

In fact, some call this cocktail of psychological experiences “post-acute COVID-19 syndrome.”^[7] This syndrome is characterized by depression, anxiety, and cognitive impairments and is typically associated with patients that contract the COVID virus. However, people who haven’t contracted COVID but have one or more risk factors discussed earlier might also develop post-acute COVID-19 syndrome.

Is COVID-19 Linked to Any Other Mental Health Conditions?

COVID-19 patients are susceptible to various mental health conditions other than depression. This includes the following:

• Anxiety disorders are characterized by anxiousness, fear, distress, and panic. Cases of anxiety increased by 25 percent during the first year of the pandemic and affected more than 76 million new patients.^[8]
• Post-traumatic stress disorder (PTSD) is common among people that experience trauma. Though it’s typically associated with veterans of military combat and victims of violence, the pandemic has led to increased feelings of uncertainty, feeling unsafe, increased negative feelings, and difficulty sleeping, among other symptoms associated with PTSD.^[9]
• Obsessive-compulsive disorder (OCD) involves compulsive behaviors and obsessive thoughts that prevent a person from carrying out their daily life. During the pandemic, people with and without an OCD diagnosis experienced worsened OCD-related symptoms.^[10]
• Psychosis involves a detachment from reality, typically as hallucinations or delusions. Though COVID-induced psychosis is very rare, it has been reported worldwide in varying populations in people with no prior history of mental health issues.^[11]
• Suicidal ideation is a term used to describe various thoughts about and considerations of suicide. Studies show that suicidal ideation in the general population during the pandemic was higher than it was before the pandemic.^[12]

If you’re experiencing any of these conditions (with or without COVID), consult your physician or a mental health professional. Likewise, if you have thoughts of suicide, dial 988 to reach the Suicide and Crisis Hotline.