Long COVID patients present with a wide range of symptoms, many of which can seem unrelated. The syndrome’s impacts can be seen across multiple body systems, including the pulmonary, circulatory, and neurological systems. Attempts to understand the syndrome’s symptomatic processes are ongoing, and providers are still often at a loss regarding prioritization of symptoms and effective treatment combinations. Clinicians writing in the June 27, 2022 issue of Nursing Times say that, for optimal effectiveness of care, patients’ physical and mental symptoms need to be addressed with a holistic and integrated approach.*

Long COVID mental health needs

Mounting evidence shows that people who have had COVID-19 are at increased risk for mental health issues, such as anxiety, depression, and cognitive dysfunction. In one study, 34% of people who tested positive for COVID were then diagnosed with a neurological or mental health disorder within six months. These include, among others:

• Post-traumatic stress disorder (PTSD), possibly made worse by prior hospitalization
• Acute stress/adjustment disorders, from personal life changes and loss of self-identity
• Living with the stigma of a poorly understood condition, including being doubted by those who minimize or trivialize their symptoms

The authors say that combining these social factors with the uncertainties surrounding Long COVID can promote poor psychological health and even clinical depression.

A holistic approach has become more commonplace in both physical and mental health practice. It allows clinicians to investigate how past experiences and personal beliefs may be affecting patients’ health. For people suffering with Long COVID, write the authors, “This may be their first assessment that considers their mind, body, and spirit. Simply being heard may be a therapeutic intervention in itself.”

Meeting mental health needs

Mental health/psychiatric nurses are in a key position to help Long COVID patients, assessing physical, psychological, and social well-being for an accurate picture of the disease’s impact. 

Risk assessment, including risk for suicide, should be included in all patient evaluations. According to the 2022 National Confidential Inquiry into Suicide and Safety in Mental Health (NCISH), 25% of suicides involved a physical illness. High-risk Long COVID patients were more likely to be:

• Older in age,
• Living by themselves, and/or
• On long-term sick leave.

People with long-term conditions were more likely to have a diagnosed mood disorder than those without long-term conditions. Alcohol and drug use were not common, however, in high-risk individuals.

Five (5) principles of treating mental health

The authors encourage health providers to avoid preconceived notions about the causes of symptoms, and advise that the language they use should indicate belief and validation of the patient while still conveying realistic uncertainties about the condition itself.

Five (5) principles of mental health “first aid” widely used by the U.K. National Health Service (NHS) during the pandemic are:

• Listening non-judgmentally,
• Offering information and reassurance,
• Encouraging support strategies such as self-help,
• Assessing risk (including suicide), and
• Encouraging proper professional help.

Tools such as the Patient Health Questionnaire (PHQ-9) can help assess patients’ depression and anxiety after COVID-19. 

The authors add that the mental health needs of family members and other caregivers should also be kept in mind, and that peer support groups can be helpful for all involved.

Whole-person care

“It is becoming clear that these symptoms can have multiple, and interactive, causal mechanisms, including neurological and psychological processes,” the authors conclude. “Maintaining people’s mental well-being alongside investigation and treatment of physical symptoms is a key intervention that all health professionals must adopt.”

*Stucke, J., Maxwell, E. & House, J. (2022, June 27). Long Covid 2: supporting the mental and physical needs of patients. Nursing Times [online], 118(7). https://www.nursingtimes.net/clinical-archive/long-term-conditions/long-covid-2-supporting-the-mental-and-physical-needs-of-patients-27-06-2022