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Erlangsen A, Qin P, Madsen T, Hawton K, Osler M, Hjorthøj C, Benros ME, Ethelberg S, Mølbak K, Laursen TM, Nordentoft M, Nilsson SF. Association between SARS-CoV-2 infection and self-harm: Danish nationwide register-based cohort study. Br J Psychiatry 2023; 222:167-174. [PMID: 36636817 PMCID: PMC10895503 DOI: 10.1192/bjp.2022.194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 12/06/2022] [Accepted: 12/07/2022] [Indexed: 01/14/2023]
Abstract
BACKGROUND Case studies have linked SARS-CoV-2 infection to suicidal behaviour. However, conclusive evidence is lacking. AIMS To examine whether a history of SARS-CoV-2 infection or SARS-CoV-2-related hospital admission was associated with self-harm in the general population and in high-risk groups. METHOD A cohort design was applied to nationwide data on all people aged ≥15 years and living in Denmark between 27 February 2020 and 15 October 2021. Exposure was identified as having had a positive SARS-CoV-2 PCR test, and further assessed as SARS-CoV-2-related hospital admission. Rates of probable self-harm were examined using adjusted incidence rate ratios (aIRRs). The following subgroups were identified: (a) lower educational level, (b) chronic medical conditions, (c) disability pension, (d) mental disorders, (e) substance use disorders, and history of (f) homelessness and (g) imprisonment. RESULTS Among 4 412 248 included individuals, 260 663 (5.9%) had tested positive for SARS-CoV-2. Out of 5453 individuals presenting with self-harm, 131 (2.4%) had been infected. Individuals with a history of a positive SARS-CoV-2 test result had an aIRR for self-harm of 0.86 (95% CI 0.72-1.03) compared with those without. High rates were found after a SARS-CoV-2-related hospital admission (aIRR = 7.68; 95% CI 5.61-10.51) or a non-SARS-CoV-2-related admission (aIRR = 10.27; 95% CI 9.65-10.93) versus non-infected and not admitted. In sensitivity analyses with a more restrictive definition of self-harm, a positive PCR test was associated with lower rates of self-harm. CONCLUSIONS Individuals with a PCR-confirmed SARS-CoV-2 infection did not have higher rates of self-harm than those without. Hospital admission in general, rather than being SARS-CoV-2 positive. seemed to be linked to elevated rates of self-harm.
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Affiliation(s)
- Annette Erlangsen
- Danish Research Institute for Suicide Prevention, Mental Health Centre Copenhagen, Copenhagen, Denmark; Copenhagen Research Center for Mental Health, Mental Health Centre Copenhagen, Copenhagen, Denmark; Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA; and Center of Mental Health Research, Australian National University, Canberra, Australia
| | - Ping Qin
- National Center for Suicide Research and Prevention, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Trine Madsen
- Danish Research Institute for Suicide Prevention, Mental Health Centre Copenhagen, Copenhagen, Denmark; Copenhagen Research Center for Mental Health, Mental Health Centre Copenhagen, Copenhagen, Denmark; and Section of Epidemiology, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Keith Hawton
- Centre for Suicide Research, University of Oxford, Oxford, UK; and Oxford Health NHS Foundation Trust, Oxford, UK
| | - Merete Osler
- Center for Clinical Research and Prevention, Bispebjerg & Frederiksberg Hospitals, Copenhagen, Denmark; and Section of Epidemiology, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Carsten Hjorthøj
- Copenhagen Research Center for Mental Health, Mental Health Centre Copenhagen, Copenhagen University Hospital, Hellerup, Denmark; and Section of Epidemiology, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Michael E. Benros
- Copenhagen Research Center for Mental Health, Mental Health Centre Copenhagen, Copenhagen, Denmark; and Department of Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark
| | - Steen Ethelberg
- Infectious Disease Epidemiology & Prevention, Statens Serum Institut, Copenhagen, Denmark; and Department of Global Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Kåre Mølbak
- Epidemiological Infectious Disease Preparedness, Statens Serum Institut, Copenhagen, Denmark; and Department of Veterinary and Animal Science, University of Copenhagen, Copenhagen, Denmark
| | - Thomas Munk Laursen
- National Centre for Register-Based Research, Aarhus University, Aarhus, Denmark
| | - Merete Nordentoft
- Danish Research Institute for Suicide Prevention, Mental Health Centre Copenhagen, Copenhagen, Denmark; Copenhagen Research Center for Mental Health, Mental Health Centre Copenhagen, Copenhagen, Denmark; and Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Sandra Feodor Nilsson
- Copenhagen Research Center for Mental Health, Mental Health Centre Copenhagen, Copenhagen University Hospital, Hellerup, Denmark
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Gasnier M, Choucha W, Radiguer F, Faulet T, Chappell K, Bougarel A, Kondarjian C, Thorey P, Baldacci A, Ballerini M, Ait Tayeb AEK, Herrero H, Hardy-Leger I, Meyrignac O, Morin L, Lecoq AL, Pham T, Noel N, Jollant F, Montani D, Monnet X, Becquemont L, Corruble E, Colle R. Comorbidity of long COVID and psychiatric disorders after a hospitalisation for COVID-19: a cross-sectional study. J Neurol Neurosurg Psychiatry 2022; 93:jnnp-2021-328516. [PMID: 35953265 DOI: 10.1136/jnnp-2021-328516] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 06/07/2022] [Indexed: 01/09/2023]
Abstract
OBJECTIVES Long COVID is a major public health issue. Whether long COVID is comorbid with psychiatric disorders remains unclear. Here, we investigate the association between long COVID, psychiatric symptoms and psychiatric disorders. DESIGN Cross-sectional. SETTINGS Bicêtre Hospital, France, secondary care. PARTICIPANTS One hundred seventy-seven patients admitted in intensive care unit during acute phase and/or reporting long COVID complaints were assessed 4 months after hospitalisation for an acute COVID. MAIN OUTCOME MEASURES Eight long COVID complaints were investigated: fatigue, respiratory and cognitive complaints, muscle weakness, pain, headache, paraesthesia and anosmia. The number of complaints, the presence/absence of each COVID-19 complaint as well as lung CT scan abnormalities and objective cognitive impairment) were considered. Self-reported psychiatric symptoms were assessed with questionnaires. Experienced psychiatrists assessed Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition-based diagnoses of psychiatric disorders. RESULTS One hundred and fifteen (65%) patients had at least one long COVID complaint. The number of long COVID complaints was associated with psychiatric symptoms. The number of long COVID complaints was higher in patients with psychiatric disorders (mean (m) (SD)=2.47 (1.30), p<0.05), new-onset psychiatric disorders (m (SD)=2.41 (1.32), p<0.05) and significant suicide risk (m (SD)=2.67 (1.32), p<0.05) than in patients without any psychiatric disorder (m (SD)=1.43 (1.48)). Respiratory complaints were associated with a higher risk of psychiatric disorder and new-onset psychiatric disorder, and cognitive complaints were associated with a higher risk of psychiatric disorder. CONCLUSIONS Long COVID is associated with psychiatric disorders, new-onset psychiatric disorders and suicide risk. Psychiatric disorders and suicide risk should be systematically assessed in patients with long COVID.
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Affiliation(s)
- Matthieu Gasnier
- Service Hospitalo-Universitaire de Psychiatrie de Bicêtre, Mood Center Paris Saclay, Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris-Saclay, Hôpital de Bicêtre, Le Kremlin Bicêtre, France
- MOODS Team, INSERM 1018, CESP (Centre de Recherche en Epidémiologie et Santé des Populations), Université Paris-Saclay, Faculté de Médecine Paris-Saclay, Le Kremlin Bicêtre, France
| | - Walid Choucha
- Service Hospitalo-Universitaire de Psychiatrie de Bicêtre, Mood Center Paris Saclay, Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris-Saclay, Hôpital de Bicêtre, Le Kremlin Bicêtre, France
- MOODS Team, INSERM 1018, CESP (Centre de Recherche en Epidémiologie et Santé des Populations), Université Paris-Saclay, Faculté de Médecine Paris-Saclay, Le Kremlin Bicêtre, France
| | - Francois Radiguer
- Service de réanimation chirurgicale, Hôpital de Bicêtre, Le Kremlin-Bicêtre, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Theo Faulet
- Service Hospitalo-Universitaire de Psychiatrie de Bicêtre, Mood Center Paris Saclay, Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris-Saclay, Hôpital de Bicêtre, Le Kremlin Bicêtre, France
- MOODS Team, INSERM 1018, CESP (Centre de Recherche en Epidémiologie et Santé des Populations), Université Paris-Saclay, Faculté de Médecine Paris-Saclay, Le Kremlin Bicêtre, France
| | - Kenneth Chappell
- Service Hospitalo-Universitaire de Psychiatrie de Bicêtre, Mood Center Paris Saclay, Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris-Saclay, Hôpital de Bicêtre, Le Kremlin Bicêtre, France
- MOODS Team, INSERM 1018, CESP (Centre de Recherche en Epidémiologie et Santé des Populations), Université Paris-Saclay, Faculté de Médecine Paris-Saclay, Le Kremlin Bicêtre, France
| | - Aurore Bougarel
- Service Hospitalo-Universitaire de Psychiatrie de Bicêtre, Mood Center Paris Saclay, Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris-Saclay, Hôpital de Bicêtre, Le Kremlin Bicêtre, France
| | - Christian Kondarjian
- Service Hospitalo-Universitaire de Psychiatrie de Bicêtre, Mood Center Paris Saclay, Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris-Saclay, Hôpital de Bicêtre, Le Kremlin Bicêtre, France
| | - Paul Thorey
- Service Hospitalo-Universitaire de Psychiatrie de Bicêtre, Mood Center Paris Saclay, Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris-Saclay, Hôpital de Bicêtre, Le Kremlin Bicêtre, France
| | - Antoine Baldacci
- Service Hospitalo-Universitaire de Psychiatrie de Bicêtre, Mood Center Paris Saclay, Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris-Saclay, Hôpital de Bicêtre, Le Kremlin Bicêtre, France
| | - Maryne Ballerini
- Service Hospitalo-Universitaire de Psychiatrie de Bicêtre, Mood Center Paris Saclay, Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris-Saclay, Hôpital de Bicêtre, Le Kremlin Bicêtre, France
| | - Abd El Kader Ait Tayeb
- Service Hospitalo-Universitaire de Psychiatrie de Bicêtre, Mood Center Paris Saclay, Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris-Saclay, Hôpital de Bicêtre, Le Kremlin Bicêtre, France
- MOODS Team, INSERM 1018, CESP (Centre de Recherche en Epidémiologie et Santé des Populations), Université Paris-Saclay, Faculté de Médecine Paris-Saclay, Le Kremlin Bicêtre, France
| | - Hugo Herrero
- Service Hospitalo-Universitaire de Psychiatrie de Bicêtre, Mood Center Paris Saclay, Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris-Saclay, Hôpital de Bicêtre, Le Kremlin Bicêtre, France
- MOODS Team, INSERM 1018, CESP (Centre de Recherche en Epidémiologie et Santé des Populations), Université Paris-Saclay, Faculté de Médecine Paris-Saclay, Le Kremlin Bicêtre, France
| | - Isabelle Hardy-Leger
- Service de médecine interne et immunologie clinique, Hôpital de Bicêtre, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Olivier Meyrignac
- Service de radiologie diagnostique et interventionnelle, Hôpital de Bicêtre, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Luc Morin
- Service de réanimation pédiatrique et médecine néonatale, Hôpital de Bicêtre, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Anne-Lise Lecoq
- Centre de Recherche Clinique, Hôpitaux Universitaires Paris-Saclay, Assistance Publique-Hôpitaux de Paris, Hôpital de Bicêtre, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Tài Pham
- Service de médecine intensive-réanimation, hôpital de Bicêtre, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Nicolas Noel
- Service de médecine interne et immunologie clinique, Hôpital de Bicêtre, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Fabrice Jollant
- Service Hospitalo-Universitaire de Psychiatrie de Bicêtre, Mood Center Paris Saclay, Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris-Saclay, Hôpital de Bicêtre, Le Kremlin Bicêtre, France
- MOODS Team, INSERM 1018, CESP (Centre de Recherche en Epidémiologie et Santé des Populations), Université Paris-Saclay, Faculté de Médecine Paris-Saclay, Le Kremlin Bicêtre, France
| | - David Montani
- Service de pneumologie et soins intensifs respiratoires, Hopital Bicêtre, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Xavier Monnet
- Service de pneumologie et soins intensifs respiratoires, Hopital Bicêtre, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Laurent Becquemont
- MOODS Team, INSERM 1018, CESP (Centre de Recherche en Epidémiologie et Santé des Populations), Université Paris-Saclay, Faculté de Médecine Paris-Saclay, Le Kremlin Bicêtre, France
- Centre de Recherche Clinique, Hôpitaux Universitaires Paris-Saclay, Assistance Publique-Hôpitaux de Paris, Hôpital de Bicêtre, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Emmanuelle Corruble
- Service Hospitalo-Universitaire de Psychiatrie de Bicêtre, Mood Center Paris Saclay, Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris-Saclay, Hôpital de Bicêtre, Le Kremlin Bicêtre, France
- MOODS Team, INSERM 1018, CESP (Centre de Recherche en Epidémiologie et Santé des Populations), Université Paris-Saclay, Faculté de Médecine Paris-Saclay, Le Kremlin Bicêtre, France
| | - Romain Colle
- Service Hospitalo-Universitaire de Psychiatrie de Bicêtre, Mood Center Paris Saclay, Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris-Saclay, Hôpital de Bicêtre, Le Kremlin Bicêtre, France
- MOODS Team, INSERM 1018, CESP (Centre de Recherche en Epidémiologie et Santé des Populations), Université Paris-Saclay, Faculté de Médecine Paris-Saclay, Le Kremlin Bicêtre, France
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