Ramadan M, Malaka L, Ghabrah R, Sulimani A, Aljadani F, Al Dosari L, Alsiary R. Risk of neurological and psychiatric diagnoses in COVID-19 survivors: A multicenter retrospective cohort study using electronic health records. World J Psychiatry 2025; 15(12): 109680 [PMID: 41357944 DOI: 10.5498/wjp.v15.i12.109680]
Corresponding Author of This Article
Majed Ramadan, PhD, Senior Researcher, Department of Population Health, King Abdullah International Medical Research Center, Ar Rimayah, Riyadh 22490, Riyadh, Saudi Arabia. ramadhanm@kaimrc.edu.sa
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Ecology
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Retrospective Cohort Study
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Dec 19, 2025 (publication date) through Feb 27, 2026
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World Journal of Psychiatry
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2220-3206
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Ramadan M, Malaka L, Ghabrah R, Sulimani A, Aljadani F, Al Dosari L, Alsiary R. Risk of neurological and psychiatric diagnoses in COVID-19 survivors: A multicenter retrospective cohort study using electronic health records. World J Psychiatry 2025; 15(12): 109680 [PMID: 41357944 DOI: 10.5498/wjp.v15.i12.109680]
World J Psychiatry. Dec 19, 2025; 15(12): 109680 Published online Dec 19, 2025. doi: 10.5498/wjp.v15.i12.109680
Risk of neurological and psychiatric diagnoses in COVID-19 survivors: A multicenter retrospective cohort study using electronic health records
Majed Ramadan, Lara Malaka, Remaz Ghabrah, Aljodi Sulimani, Farah Aljadani, Lama Al Dosari, Rawiah Alsiary
Majed Ramadan, Department of Population Health, King Abdullah International Medical Research Center, Riyadh 22490, Riyadh, Saudi Arabia
Lara Malaka, Remaz Ghabrah, Aljodi Sulimani, Farah Aljadani, Lama Al Dosari, College of Medicine, King Abdulaziz University, Jeddah 22490, Makkah al Mukarramah, Saudi Arabia
Rawiah Alsiary, Department of Cancer, King Abdullah International Medical Research Center, Jeddah 22490, Makkah al Mukarramah, Saudi Arabia
Author contributions: Ramadan M conceptualized and designed the study, drafted the manuscript, supervised data collection, and oversaw the analytical strategy; Ramadan M and Alsiary R developed the methodological framework, verified analytic consistency, and contributed to interpretation of the qualitative data; Malaka L, Ghabrah R, Sulimani A, Aljadani F, and Al Dosari L contributed to data collection, transcription, preliminary coding, participated in literature review, coding validation, and theme refinement; all authors reviewed and approved the final version of the manuscript and agree to be accountable for all aspects of the work.
Institutional review board statement: The study was conducted in accordance with the ethical standards of the Declaration of Helsinki and approved by the Institutional Review Board of King Abdullah International Medical Research Center (Approval No. SPJ24/008/7).
Informed consent statement: This is a retrospective study, the requirement for informed consent was waived by the Institutional Review Board at King Abdullah International Medical Research Center.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Data sharing statement: The data supporting the findings of this study are available from the corresponding author upon reasonable request. Access to the data may be subject to institutional or ethical restrictions.
Corresponding author: Majed Ramadan, PhD, Senior Researcher, Department of Population Health, King Abdullah International Medical Research Center, Ar Rimayah, Riyadh 22490, Riyadh, Saudi Arabia. ramadhanm@kaimrc.edu.sa
Received: May 18, 2025 Revised: June 2, 2025 Accepted: October 13, 2025 Published online: December 19, 2025 Processing time: 193 Days and 19.1 Hours
Abstract
BACKGROUND
The neurological and psychiatric sequelae of coronavirus disease 2019 (COVID-19) have been documented, yet further data are needed to thoroughly evaluate the impact of COVID-19 on brain health years after the infection.
AIM
To examine whether COVID-19 infection is associated with exacerbation, recurrence, or progression of pre-existing neurological or psychiatric disorders - a high-risk population that is underrepresented in COVID-19 outcome research in National Guard Health Affair patients in 4-years following a COVID-19 diagnosis.
METHODS
For this multicenter retrospective cohort study, we used data from the National Guard hospitals electronic health records network (BestCare) with over 10 million patients. Our cohort comprised patients who had a COVID-19 diagnosis; a matched control cohort included patient did not expose to COVID-19 in same period. Age and sex were matching factors. We estimated the incidence of 14 neurological and psychiatric outcomes in nearly 4 years after a confirmed diagnosis of COVID-19. Using a multiple logistic regression, we compared incidences with those in propensity score-matched cohorts of patients with no exposure to COVID-19.
RESULTS
Our primary cohort comprised 4437 patients diagnosed with COVID-19, and our propensity-score 1:1 matched control cohort comprised 4437 individuals. Nearly two-third of the COVID-19 cohort (71%) were diagnosed in 2020, and 2021. The most prevalent diagnoses for both cohorts were epilepsy 30.68%, mood disorder 23.92%, and nerve plexus disorder 22.13%. Dementia was nearly 4 times higher among COVID-19 cohort (8.27%) compared to the control cohort (2.57%). Five neurological and psychiatric outcomes had odds ratios (OR) that were significantly higher than 1 for people who had COVID-19 compared to people who had never been infected. These outcomes were cognitive deficit OR = 1.54, 95% confidence interval (CI): 1.23-1.91, P = 0.0001; nerve plexus disorder OR = 1.13, 95%CI: 1.01-1.25, P = 0.02; substance use disorder OR = 1.95, 95%CI: 1.12-3.38, P = 0.01; mood disorder OR = 1.16, 95%CI: 1.05-1.29, P = 0.003; and anxiety disorder OR = 1.39, 95%CI: 1.07-1.79, P = 0.01.
CONCLUSION
The study highlights the persistent risk of neurological and psychiatric conditions in COVID-19 survivors up to four years post-infection. Although the incidence was lower than in previous large studies, long-term consequences remain significant, emphasizing the need for ongoing monitoring and support in mental health and neurological care.
Core Tip: This multicenter retrospective cohort study used electronic health records from the National Guard Health Affairs system in Saudi Arabia to evaluate long-term neurological and psychiatric outcomes in coronavirus disease 2019 (COVID-19) survivors. Among 4437 COVID-19 patients matched 1:1 by age and sex with uninfected controls, several conditions - such as cognitive deficit, mood and anxiety disorders, and substance use - were significantly more common up to four years post-infection. This study provides one of the longest follow-up assessments to date and highlights the enduring burden of COVID-19 on brain health, underscoring the need for extended mental and neurological surveillance in affected population.
