https://kclpure.kcl.ac.uk/portal/en/publications/is-infection-with-covid19-causing-an-increased-risk-of-psychological-distress-psychotropic-prescribing-or-sleep-and-fatigue-problems(a1979edd-3821-454a-b488-b9c716e49e7b).html Is infection with COVID-19 causing an increased risk of psychological distress, psychotropic prescribing or sleep and fatigue problems? A study of patients in English primary care Contribution to journal › Article › peer-review Kathryn M Abel, Matthew J Carr, Darren M Ashcroft, Trudie Chalder, Carolyn Chew-Graham, Holly Hope, Navneet Kapur, Sally McManus, Sarah Steeg, Roger T Webb, Matthias Pierce Overview Citation formats Original language English Journal JAMA Network open Accepted/In press 23 Sep 2021 King's Authors Trudie Chalder (Psychological Medicine, Psychological Medicine and Integrated Care Clinical Academic Group, NIHR Maudsley Biomedical Research Centre) Abstract Importance Infection with COVID-19 is linked to fatigue and sleep problems, long after the acute phase of the illness. In addition, there are concerns of COVID-19 infection causing psychiatric illness; however, evidence of a direct effect is inconclusive. Objective The primary hypothesis was: there is an increased risk of incident or repeat psychiatric illness, fatigue and sleep problems following COVID-19 infection. The secondary hypotheses were that the increase was largest for anxiety, those from deprived areas and women. The analysis plan was pre-registered (https://osf.io/n2k34/). Design Matched cohorts were assembled using a UK primary care registry (the CPRD-Aurum database). Patients were followed-up for up to 10 months, from 1st February 2020 to 9th December 2020. Setting Primary care database of 11,923,499 adults (>16 years). Participants From 232,780 adults with a positive COVID-19 test (after excluding those with <2 years historical data or <1 week follow-up), 86,922 without prior mental illness, 19,020 with anxiety or depression, 1,036 with psychosis, 4,152 with fatigue and 4,539 with sleep problems were matched to up to four controls based on gender, general practice and year of birth. A negative control used patients who tested negative for COVID-19. Main Outcomes and Measures Cox proportional hazard models estimated the association between a COVID-19 positive test and subsequent psychiatric morbidity (depression, anxiety, psychosis, or self-harm), sleep problems, fatigue or psychotropic prescribing. Models adjusted for comorbidities, ethnicity, smoking and BMI. Results 232,780 patients with a COVID-19 positive test were identified, 56.2% were female, their median age was 42 and 20.5% were from ethnic minority groups. After adjusting for observed confounders, there was an association between testing positive for COVID-19 and almost all markers of psychiatric morbidity, fatigue and sleep problems. The adjusted hazard ratio (aHR) for incident psychiatric morbidity was 1.75 (95% CI 1.56-1.96). However, there was a similar risk of incident psychiatric morbidity for those with a negative COVID-19 test (aHR 1.57, 95% CI 1.51-1.63) and a larger increase associated with influenza (aHR 2.97, 95% CI 1.36-6.48). Conclusion and Relevance In this study of adults registered at an English primary care practice during the pandemic, there was consistent evidence that COVID-19 infection elevates risk of fatigue and sleep problems. However the results from the negative control analysis suggests that unobserved confounding may be responsible for at least some of the positive association between COVID-19 and psychiatric morbidity.