Risk of neurological and psychiatric diagnoses in COVID-19 survivors: A multicenter retrospective cohort study using electronic health records

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.

Keywords: COVID-19; Neurological disorders; Psychiatric sequelae; Electronic health records; Retrospective cohort study; Long-term outcomes

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.