Persistent neuropsychiatric symptoms after COVID-19: a systematic review and meta-analysis

James B. Badenoch; Emma R. Rengasamy; Cameron Watson; Katrin Jansen; Stuti Chakraborty; Ritika D. Sundaram; Danish Hafeez; Ella Burchill; Aman Saini; Lucretia Thomas; Benjamin Cross; Camille K. Hunt; Isabella Conti; Sylvia Ralovska; Zain Hussain; Matthew Butler; Thomas A. Pollak; Ivan Koychev; Benedict D. Michael; Heinz Holling; Timothy R. Nicholson; Jonathan P. Rogers; Alasdair G. Rooney

doi:10.1093/braincomms/fcab297

Persistent neuropsychiatric symptoms after COVID-19: a systematic review and meta-analysis

James B. Badenoch, Emma R. Rengasamy, Cameron Watson, Katrin Jansen, Stuti Chakraborty, Ritika D. Sundaram, Danish Hafeez, Ella Burchill, Aman Saini, Lucretia Thomas, Benjamin Cross, Camille K. Hunt, Isabella Conti, Sylvia Ralovska, Zain Hussain, Matthew Butler, Thomas A. Pollak, Ivan Koychev, Benedict D. Michael, Heinz HollingTimothy R. Nicholson, Jonathan P. Rogers, Alasdair G. Rooney^*

^*Corresponding author for this work

Research output: Contribution to journal › Review article › peer-review

160 Citations (Scopus)

Abstract

The nature and extent of persistent neuropsychiatric symptoms after COVID-19 are not established. To help inform mental health service planning in the pandemic recovery phase, we systematically determined the prevalence of neuropsychiatric symptoms in survivors of COVID-19. For this pre-registered systematic review and meta-analysis (PROSPERO ID CRD42021239750), we searched MEDLINE, EMBASE, CINAHL and PsycINFO to 20 February 2021, plus our own curated database. We included peer-reviewed studies reporting neuropsychiatric symptoms at post-acute or later time-points after COVID-19 infection and in control groups where available. For each study, a minimum of two authors extracted summary data. For each symptom, we calculated a pooled prevalence using generalized linear mixed models. Heterogeneity was measured with I2. Subgroup analyses were conducted for COVID-19 hospitalization, severity and duration of follow-up. From 2844 unique titles, we included 51 studies (n = 18 917 patients). The mean duration of follow-up after COVID-19 was 77 days (range 14-182 days). Study quality was most commonly moderate. The most prevalent neuropsychiatric symptom was sleep disturbance [pooled prevalence = 27.4% (95% confidence interval 21.4-34.4%)], followed by fatigue [24.4% (17.5-32.9%)], objective cognitive impairment [20.2% (10.3-35.7%)], anxiety [19.1% (13.3-26.8%)] and post-traumatic stress [15.7% (9.9-24.1%)]. Only two studies reported symptoms in control groups, both reporting higher frequencies in COVID-19 survivors versus controls. Between-study heterogeneity was high (I2 = 79.6-98.6%). There was little or no evidence of differential symptom prevalence based on hospitalization status, severity or follow-up duration. Neuropsychiatric symptoms are common and persistent after recovery from COVID-19. The literature on longer-term consequences is still maturing but indicates a particularly high prevalence of insomnia, fatigue, cognitive impairment and anxiety disorders in the first 6 months after infection.

Original language	English
Article number	fcab297
Journal	Brain Communications
Volume	4
Issue number	1
DOIs	https://doi.org/10.1093/braincomms/fcab297
Publication status	Published - 2022

Keywords

chronic COVID syndrome
COVID-19
Long COVID
neuropsychiatry
post-acute sequelae of COVID-19

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1093/braincomms/fcab297

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Badenoch, J. B., Rengasamy, E. R., Watson, C., Jansen, K., Chakraborty, S., Sundaram, R. D., Hafeez, D., Burchill, E., Saini, A., Thomas, L., Cross, B., Hunt, C. K., Conti, I., Ralovska, S., Hussain, Z., Butler, M., Pollak, T. A., Koychev, I., Michael, B. D., ... Rooney, A. G. (2022). Persistent neuropsychiatric symptoms after COVID-19: a systematic review and meta-analysis. Brain Communications, 4(1), Article fcab297. https://doi.org/10.1093/braincomms/fcab297

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title = "Persistent neuropsychiatric symptoms after COVID-19: a systematic review and meta-analysis",

abstract = "The nature and extent of persistent neuropsychiatric symptoms after COVID-19 are not established. To help inform mental health service planning in the pandemic recovery phase, we systematically determined the prevalence of neuropsychiatric symptoms in survivors of COVID-19. For this pre-registered systematic review and meta-analysis (PROSPERO ID CRD42021239750), we searched MEDLINE, EMBASE, CINAHL and PsycINFO to 20 February 2021, plus our own curated database. We included peer-reviewed studies reporting neuropsychiatric symptoms at post-acute or later time-points after COVID-19 infection and in control groups where available. For each study, a minimum of two authors extracted summary data. For each symptom, we calculated a pooled prevalence using generalized linear mixed models. Heterogeneity was measured with I2. Subgroup analyses were conducted for COVID-19 hospitalization, severity and duration of follow-up. From 2844 unique titles, we included 51 studies (n = 18 917 patients). The mean duration of follow-up after COVID-19 was 77 days (range 14-182 days). Study quality was most commonly moderate. The most prevalent neuropsychiatric symptom was sleep disturbance [pooled prevalence = 27.4% (95% confidence interval 21.4-34.4%)], followed by fatigue [24.4% (17.5-32.9%)], objective cognitive impairment [20.2% (10.3-35.7%)], anxiety [19.1% (13.3-26.8%)] and post-traumatic stress [15.7% (9.9-24.1%)]. Only two studies reported symptoms in control groups, both reporting higher frequencies in COVID-19 survivors versus controls. Between-study heterogeneity was high (I2 = 79.6-98.6%). There was little or no evidence of differential symptom prevalence based on hospitalization status, severity or follow-up duration. Neuropsychiatric symptoms are common and persistent after recovery from COVID-19. The literature on longer-term consequences is still maturing but indicates a particularly high prevalence of insomnia, fatigue, cognitive impairment and anxiety disorders in the first 6 months after infection.",

keywords = "chronic COVID syndrome, COVID-19, Long COVID, neuropsychiatry, post-acute sequelae of COVID-19",

author = "Badenoch, {James B.} and Rengasamy, {Emma R.} and Cameron Watson and Katrin Jansen and Stuti Chakraborty and Sundaram, {Ritika D.} and Danish Hafeez and Ella Burchill and Aman Saini and Lucretia Thomas and Benjamin Cross and Hunt, {Camille K.} and Isabella Conti and Sylvia Ralovska and Zain Hussain and Matthew Butler and Pollak, {Thomas A.} and Ivan Koychev and Michael, {Benedict D.} and Heinz Holling and Nicholson, {Timothy R.} and Rogers, {Jonathan P.} and Rooney, {Alasdair G.}",

note = "Publisher Copyright: {\textcopyright} 2022 The Author(s) 2021. Published by Oxford University Press on behalf of the Guarantors of Brain.",

year = "2022",

doi = "10.1093/braincomms/fcab297",

language = "English",

volume = "4",

journal = "Brain Communications",

issn = "2632-1297",

publisher = "Oxford University Press",

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Badenoch, JB, Rengasamy, ER, Watson, C, Jansen, K, Chakraborty, S, Sundaram, RD, Hafeez, D, Burchill, E, Saini, A, Thomas, L, Cross, B, Hunt, CK, Conti, I, Ralovska, S, Hussain, Z, Butler, M, Pollak, TA, Koychev, I, Michael, BD, Holling, H, Nicholson, TR, Rogers, JP & Rooney, AG 2022, 'Persistent neuropsychiatric symptoms after COVID-19: a systematic review and meta-analysis', Brain Communications, vol. 4, no. 1, fcab297. https://doi.org/10.1093/braincomms/fcab297

TY - JOUR

T1 - Persistent neuropsychiatric symptoms after COVID-19

T2 - a systematic review and meta-analysis

AU - Badenoch, James B.

AU - Rengasamy, Emma R.

AU - Watson, Cameron

AU - Jansen, Katrin

AU - Chakraborty, Stuti

AU - Sundaram, Ritika D.

AU - Hafeez, Danish

AU - Burchill, Ella

AU - Saini, Aman

AU - Thomas, Lucretia

AU - Cross, Benjamin

AU - Hunt, Camille K.

AU - Conti, Isabella

AU - Ralovska, Sylvia

AU - Hussain, Zain

AU - Butler, Matthew

AU - Pollak, Thomas A.

AU - Koychev, Ivan

AU - Michael, Benedict D.

AU - Holling, Heinz

AU - Nicholson, Timothy R.

AU - Rogers, Jonathan P.

AU - Rooney, Alasdair G.

PY - 2022

Y1 - 2022

N2 - The nature and extent of persistent neuropsychiatric symptoms after COVID-19 are not established. To help inform mental health service planning in the pandemic recovery phase, we systematically determined the prevalence of neuropsychiatric symptoms in survivors of COVID-19. For this pre-registered systematic review and meta-analysis (PROSPERO ID CRD42021239750), we searched MEDLINE, EMBASE, CINAHL and PsycINFO to 20 February 2021, plus our own curated database. We included peer-reviewed studies reporting neuropsychiatric symptoms at post-acute or later time-points after COVID-19 infection and in control groups where available. For each study, a minimum of two authors extracted summary data. For each symptom, we calculated a pooled prevalence using generalized linear mixed models. Heterogeneity was measured with I2. Subgroup analyses were conducted for COVID-19 hospitalization, severity and duration of follow-up. From 2844 unique titles, we included 51 studies (n = 18 917 patients). The mean duration of follow-up after COVID-19 was 77 days (range 14-182 days). Study quality was most commonly moderate. The most prevalent neuropsychiatric symptom was sleep disturbance [pooled prevalence = 27.4% (95% confidence interval 21.4-34.4%)], followed by fatigue [24.4% (17.5-32.9%)], objective cognitive impairment [20.2% (10.3-35.7%)], anxiety [19.1% (13.3-26.8%)] and post-traumatic stress [15.7% (9.9-24.1%)]. Only two studies reported symptoms in control groups, both reporting higher frequencies in COVID-19 survivors versus controls. Between-study heterogeneity was high (I2 = 79.6-98.6%). There was little or no evidence of differential symptom prevalence based on hospitalization status, severity or follow-up duration. Neuropsychiatric symptoms are common and persistent after recovery from COVID-19. The literature on longer-term consequences is still maturing but indicates a particularly high prevalence of insomnia, fatigue, cognitive impairment and anxiety disorders in the first 6 months after infection.

AB - The nature and extent of persistent neuropsychiatric symptoms after COVID-19 are not established. To help inform mental health service planning in the pandemic recovery phase, we systematically determined the prevalence of neuropsychiatric symptoms in survivors of COVID-19. For this pre-registered systematic review and meta-analysis (PROSPERO ID CRD42021239750), we searched MEDLINE, EMBASE, CINAHL and PsycINFO to 20 February 2021, plus our own curated database. We included peer-reviewed studies reporting neuropsychiatric symptoms at post-acute or later time-points after COVID-19 infection and in control groups where available. For each study, a minimum of two authors extracted summary data. For each symptom, we calculated a pooled prevalence using generalized linear mixed models. Heterogeneity was measured with I2. Subgroup analyses were conducted for COVID-19 hospitalization, severity and duration of follow-up. From 2844 unique titles, we included 51 studies (n = 18 917 patients). The mean duration of follow-up after COVID-19 was 77 days (range 14-182 days). Study quality was most commonly moderate. The most prevalent neuropsychiatric symptom was sleep disturbance [pooled prevalence = 27.4% (95% confidence interval 21.4-34.4%)], followed by fatigue [24.4% (17.5-32.9%)], objective cognitive impairment [20.2% (10.3-35.7%)], anxiety [19.1% (13.3-26.8%)] and post-traumatic stress [15.7% (9.9-24.1%)]. Only two studies reported symptoms in control groups, both reporting higher frequencies in COVID-19 survivors versus controls. Between-study heterogeneity was high (I2 = 79.6-98.6%). There was little or no evidence of differential symptom prevalence based on hospitalization status, severity or follow-up duration. Neuropsychiatric symptoms are common and persistent after recovery from COVID-19. The literature on longer-term consequences is still maturing but indicates a particularly high prevalence of insomnia, fatigue, cognitive impairment and anxiety disorders in the first 6 months after infection.

KW - chronic COVID syndrome

KW - COVID-19

KW - Long COVID

KW - neuropsychiatry

KW - post-acute sequelae of COVID-19

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U2 - 10.1093/braincomms/fcab297

DO - 10.1093/braincomms/fcab297

M3 - Review article

AN - SCOPUS:85139096051

SN - 2632-1297

VL - 4

JO - Brain Communications

JF - Brain Communications

IS - 1

M1 - fcab297

ER -

Persistent neuropsychiatric symptoms after COVID-19: a systematic review and meta-analysis

Abstract

Keywords

UN SDGs

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