Tuesday, December 01, 2020

Please Not True

 A Lancet study found that one-in-five of those diagnosed with CoVid "develop" mental illness within the next 90 days.  

In the three months following testing positive for COVID-19, 1 in 5 survivors were recorded as having a first time diagnosis of anxiety, depression or insomnia. This was about twice as likely as for other groups of patients in the same period, the researchers said.
We really, really do not want this to be even partly true.  Once kindled, mental health issues tend to recur under later stresses, even if there are periods with few or no symptoms in between. Crises are often labor intensive for medical facilities. 20% is a big number, so that's a lot of extra misery in the world. There have been earlier reports of neurological sequelae to C19, and I remain worried about that. Maybe that is part of what is getting picked up in this study.

With that in mind, let me tell you how it may not be this bad.  Bsking pointed out that the first finding is often the most robust in just about everything. The bigger number jumps out and asks to be studied.  I believe it was Asimov who said that science does not progress by Eureka moments, but by scientists looking at results and muttering "Now, that's strange..."* So you are looking at bits of information culled from electronic records, and there may be three effects that eventually turn out to occur about equally, but whatever one just happened to show up more in the first run gets noticed.  Let's study that.

Next, absent from the list of illnesses are bipolar disorder and schizophrenia, which would be really frightening. The three conditions listed are among the most over-diagnosed. Nervousness is different than anxiety. The latter is formless, an uneasiness looking for something to attach to, while the former is related to a specific something.  You can be nervous about a job interview, and that's just a response to a life difficulty. People can be sad because they are grieving, but not have depression. However, they look and feel the same in the moment, and in the face of the stressor it may be hard to discern what is up.  Also, if the doctor wants to give you an anxiolytic or an anti-depressant, she might err on the side of puffing up the chart a bit for insurance purposes.  So...particularly if it is early in the course of events, a person might be nervous - you did just get diagnosed with something that might kill you.  Or they might be sad, especially if including the sudden quarantine thoughts of mortality. They might find it harder to sleep.  These might be just the normal responses to bad news.  I said might. My worry is that while some of this is over-reading the situation, some of it is going to turn out to be real.

Just to editorialise slightly, something similar could be up with the economic fallout. If you lose your job you might get "nervous" and "sad" and "lose sleep." If you are talking with a doctor about this it might get called anxiety, depression, and insomnia. It isn't easy to draw clear lines.  In fact, it is often impossible. We are going to find downstream effects of all of this.  Students who graduate into a recession have less career success their entire lives, but we only discover it decades later, in aggregate.  You can't necessarily see that in any individual over the first year. So if a business takes a hit and limps along for a while but two years later goes under it doesn't show up in the statistics for 2020.  If the owner, or one of the people who had the best job she was likely to get for a while gets more and more discouraged and commits suicide two years after that we don't mark it anywhere as being related to the illness or our economic downturn because of it.  It might be years before someone picks up a blip in the numbers and says "The over-55 group who went through the crisis in 2020 developed dementia earlier - or never did get back to full employment - or reported more sleep problems the rest of their lives, or whatever.  When only looking at individuals it's hard to see that, because one might have only been affected 1%, not even noticeable, while his neighbor was affected 30% but it was attributed to other causes.  His business may have been rocky anyway.  His co-existing conditions might be most of the problem, but CoVid took a few years off the end fifteen years later.

*Prazosin is a blood-pressure medication, but guys in the VA system were mentioning "Y'know, doc, I haven't been having nightmares since I started this." Now it is a PTSD med.

7 comments:

james said...

I gather it takes a while for some people to completely recover--3 out of about 10 that I know personally took more than 10 weeks. Three months from positive diagnosis may not be always long enough. Wouldn't general physical weakness have an effect on things like depression and anxiety--pushing something non-pathological over the (as you point out, rather flexible) borderline?

Assistant Village Idiot said...

Yup. Yup. And yup.

GraniteDad said...

I think part of the problem for all of us here is that we want to know the answers to all of it so we can help solve it for people. But we won’t know for many years. So both people who get it and people who want to help people who got it want to find specific items they can focus on. It seems far too bleak to say “Wait 10 years and let’s see how this actually impacted children.”

Unknown said...

Didn't see any link to the study in that report. It is here:

https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(20)30462-4/fulltext

(at least for those on internet from some institution with access . . .)

David Foster said...

This is confusing. If a person has a positive test but remains asymptomatic, then calling him a 'survivor' seems inappropriate.

Also, it seems quite possible that for some people, the mere fact of a Covid diagnosis is so terrifying that it leads to long-lasting psychological sentiments, and would do so even if the diagnosis was actually a false positive. There seem to be a lot of people walking around pretty close to the edge even in 'normal' times.

Donna B. said...

I have a long-time friend (from the early 70s) who is a survivor of Covid. He wasn't healthy when he got it (Type 1 diabetes with complications) and he got it in February when the health care system didn't really know what they were dealing with. He got out of rehab in September. He still can't walk for more than a few feet. He does not have any mental health problems that would be unexpected considering the ordeal he's undergone, in fact... to my way of thinking he has fewer. Of course, I'm not a part of his household interacting with him daily and I realize he may be putting on a good show for his long-distance friends and relatives. If so, his wife and daughter are doing it also. I also realize his online persona has never been the everyday, at home, 24 hr one. I also think his is a worst-case survivor story -- not anywhere near the norm.

Then there is my oldest granddaughter who I interact with at least weekly. She just finished her 3rd 'quarantine' due to being in the vicinity of someone who tested positive (orthodontist office, volleyball team, classroom) although (as far as we know) none of them showed any symptoms. We do know for sure the last one didn't. Because some of these overlapped, she's "only" been quarantined for a total of 31 days since July. And she's "only" had to get tested twice. Her mental state has evolved from "OK, I've got to do this to protect others" to "Not again!" and anger. She's 13 -- am I wrong in wondering whether these feelings might have a long-term effect on her personality?

And, while not Covid related, just when her latest quarantine was up, schools here have been closed for at least a week because of a ransomware attack.

I think my daughter, a school system employee (IT, not a teacher), has it right that the students are still learning but they are not learning what was on the curriculum.

Linda Fox said...

So far, what I'm seeing about after-hospitalization/prolonged isolation effects on physical and mental illnesses is consistent with what happens in other diseases - you get wasted and weak muscularly, have trouble recovering mentally, and have little energy/motivation for life's challenges.
Not unusual. Not necessarily indicative of COVID's after-effects, but more likely related to prolonged convalescence.