Psychological distress associated with the current COVID-19 outbreak: evidence from electronic health records

Date of ISAC Approval: 
20/04/2020
Lay Summary: 
Current coronavirus disease (COVID-19) outbreak has major impact on the mental functioning of patients diagnosed with the disease, their families, and health professionals working with infected patients. The coexistence of COVID-19 and mental distress can lead to increase pressure on the healthcare services and premature mortality among infected patients. The aim of the proposed research is to use patient medical records data to describe the most common mental distress symptoms among patients susceptible, isolated, or infected with COVID-19, as well as health professionals working directly with these patients. We plan to determine what proportion of these patients experience mental distress symptoms and establish how the combinations of COVID-19 and mental distress impact on quality of life, disability, mortality. We will also investigate whether mental distress n relation to COVID-19 is more common among ethnic minority patients, patients with multimorbidity, and those from a poor socioeconomic background. Moreover, we will examine the consequences of mental distress for patients’ quality of life, access to health services, and continuity of care. Further, we will identify whether public health responses to the COVID-19 are associated with the development of mental distress symptoms. The findings of the project will enable us to propose intervention strategies to better address future viral infectious outbreaks across different populations.
Technical Summary: 
Aims: Recent coronavirus disease (COVID-19) outbreak has so far affected a quarter of the world populations, from young children to older adults. Patients susceptible or diagnosed with COVID-19, their families, and health professionals are at increased risk of experiencing mental distress, including neurological symptoms. The proposed study aims to establish the epidemiology of mental distress among patients susceptible/isolated/diagnosed with COVID-19, and the impact of current care pathways on mental distress symptomatology and prognosis. Whenever feasible, these aims will be explored separately by gender, ethnicity, and socio-economic status (SES). Primary exposures: COVID-19 susceptibility/isolation/infection diagnoses and corticosteroids treatment. Outcomes: Primary study outcome will be incidence mental distress (including neurological symptoms) events during the study period. In addition, the study will estimate COVID-19 related outcomes, including physical impairment, poor quality of life, healthcare utilisations, and all-cause mortality. Study design: Prospective matched cohort study, including a nested case-control study. Methods: Multivariable longitudinal analyses will be implemented using several statistical techniques, including, Cox proportion hazards regression, linear mixed effects models, and conditional logistic regression. Linked datasets: ONS Death registration data, Index of Multiple Deprivation (practice and patient level). Findings: The proposed study will provide novel insights into the mental and neurological distress associated with the current COVID-19 pandemic. It will also identify the impact that COVID-19 burden has on vulnerable subgroups and healthcare professionals’ mental distress. Such information will inform the development of preventive and control strategies associated with future infectious outbreaks.
Health Outcomes to be Measured: 
The study primary outcome will be mental distress and neurological symptoms, defined as the presence of depression, anxiety, sleep problems, self-harm, cognitive impairment, seizures, unexplained pain, los of sensation. Several secondary outcomes will be investigated, including physical disability, quality of life (QoL), safety outcomes, healthcare utilisation, and all-cause mortality.
Collaborators: 

Alex Dregan - Chief Investigator - King’s College London
Alex Dregan - Corresponding Applicant - King’s College London
Fiona Gaughran - Collaborator - King’s College London
Mark Ashworth - Collaborator - King’s College London
Matthew Hotopf - Collaborator - King’s College London
Robert Stewart - Collaborator - King’s College London

Linkages: 
ONS;Patient IMD;Practice IMD (Standard)