COVID could increase risk of psychosis in survivors


Aaron Kunkler


A new report on behavioral health in Washington states that people who have survived a COVID-19 infection are more likely to suffer long-term mental health impacts and possibly psychosis. 

The December report from the state Department of Health’s Behavioral Health Strike Team said that concern about new variants could create spikes in anxiety. For people who have survived an infection, treatment providers should be aware of new instances of anxiety disorders or PTSD, and risks related to a decline in cognitive function, long COVID, and a new diagnosis known as post-COVID psychosis. 


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A study published in Springer states that the potential for the virus to induce psychosis “is of particular interest given the association with acute suicidal/homicidal ideation and other severe perceptual and behavioral disturbances.” However, it states that much is yet to be discovered about the causes, presentation and treatment. 

Psychosis caused by viral infections has similarly been associated with other novel infectious diseases, including H1N1 influenza, Ebola and SARS. It’s estimated that between .9 and 4% of people exposed to a virus during an epidemic or pandemic develop psychosis or psychotic symptoms, much higher than the median rate of .015%.

People who had a new onset of psychosis related to a COVID infection tended to experience disorganized thinking and confusion, and were less likely to experience paranoia and delusions as part of the psychosis. People who developed this post-COVID psychosis were also less likely to have a family history of psychosis, and more likely to have mild to moderate symptoms which typically resolved quickly with the use of low-dose antipsychotic medications. 

Risk works both ways too, as the Department of Health’s report states that people with preexisting psychiatric diagnosis before COVID had a 65% increased risk of infection, compared to people who only had a diagnosis of a physical health issue. It also states that studies indicate that people with mental disorders or intellectual disabilities were at a greater risk of death compared to the general population before, during and after the first peak of COVID deaths. 

Workforce issues

The Department of Health report also addresses workforce issues in health care. Addressing burnout is essential for those working in health care, it states. In addition, staffing shortages around the country have made work more stressful, as has the politicization of health care. 

Workers should set boundaries around work and home time to protect their mental well-being. It also encourages the development of personal coping plans to reduce burnout, compassion fatigue and moral injury. 

Moral injury occurs when workers are expected to provide care that isn’t in line with what they’ve been trained to deliver, or to a level they expect of themselves. This can be a result of circumstances like implementing crisis standards of care, or a lack of supplies. 

Additional waves of the pandemic may continue to contribute to challenging work conditions as hospitalization rates drive conversations about implementing crisis standards of care. Anxiety and anger may also be common as reaction to news of emerging variants comes out.