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Acute COVID-19 severity markers predict post-COVID new-onset psychiatric disorders: A 2-year cohort study of 34,489 patients

Molecular Psychiatry volume 30, pages 1329–1337 (2025)Cite this article

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Abstract

New-onset psychiatric disorders are frequent after COVID-19. We aim to determine whether acute COVID-19 severity markers can predict post-COVID new-onset psychiatric disorders. We conducted an electronic health records (EHR) cohort study of patients hospitalized for COVID-19 and without any known history of psychiatric disorders. Patients were included between January 2020 and September 2022 in one of the 36 university hospitals of the Assistance Publique - Hôpitaux de Paris. Acute COVID-19 clinical and biological severity markers were recorded during hospitalization for COVID-19. Psychiatric ICD-10 diagnoses were recorded up to 2 years and 9 months after hospitalization for COVID-19. Predictors of post-COVID new-onset psychiatric disorders were identified based on Cox regression models and sensitivity analyses. Predictive scores were built and tested in age- and sex-stratified populations. A total 34,489 patients hospitalized for COVID-19 were included; 3717 patients (10.8%) had at least one post-COVID new-onset psychiatric disorder. Hospital stay >7 days (HR = 1.72, 95%CI [1.59–1.86], p < 0.001), acute delirium (HR = 1.49, 95%CI [1.28–1.74], p < 0.001), elevated monocyte count (HR = 1.14, 95%CI [1.06–1.23], p < 0.001) and elevated plasma CRP (HR = 0.92, 95%CI [0.86–0.99], p = 0.04) independently predicted post-COVID new-onset psychiatric disorders. Sensitivity analyses confirmed hospital stay >7 days, acute delirium, and elevated monocyte count as predictors. Predictive scores based on these variables had good 12-month positive predictive values, up to 7.5 times more accurate than random in women < 65 years. In conclusion, hospital stay >7 days, acute delirium, and elevated monocyte count during acute COVID-19 predict post-COVID new-onset psychiatric disorders.

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Fig. 1
Fig. 2: Cox multivariate regression model adjusted for age, sex, and preexistent comorbidities: Hazard Ratios for post-COVID new onset psychiatric disorders.
Fig. 3: Predictive scores and survival curves for post-COVID new-onset psychiatric disorders.
Fig. 4: Receiver Operating Curves (ROC) for the predictive scores of post-COVID new-onset psychiatric disorders.

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Data availability

Data from the AP-HP Health Data Warehouse (“Entrepot de données de santé”) can be obtained with permission at https://eds.aphp.fr/.

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Acknowledgements

Data used in preparation of this article were obtained from the AP-HP Covid CDW Initiative database. A complete listing of the members can be found at: (https://eds.aphp.fr/covid-19).

Funding

The funder of the study had no role in study design, data collection, data analysis, data interpretation, or writing of the manuscript.

Author information

Authors and Affiliations

  1. Service Hospitalo-Universitaire de Psychiatrie de Bicêtre, Mood Center Paris Saclay, Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris-Saclay, Hôpital de Bicêtre, Paris, Le Kremlin Bicêtre, France

    Matthieu Gasnier, Emmanuelle Corruble & Romain Colle

  2. MOODS Team, INSERM 1018, CESP (Centre de Recherche en Epidémiologie et Santé des Populations), Université Paris-Saclay, Faculté de Médecine Paris-Saclay, Paris, Le Kremlin Bicêtre, France

    Matthieu Gasnier, Laurent Becquemont, Emmanuelle Corruble & Romain Colle

  3. Unité de Recherche clinique, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France

    Pierre Pinson, Nathanael Beeker & Camille Truong-Allié

  4. Université Paris-Saclay, AP-HP, Centre de Recherche Clinique, Hôpitaux Universitaires Paris-Saclay, Assistance Publique-Hôpitaux de Paris, Hôpital de Bicêtre, Paris, Le Kremlin Bicêtre, France

    Laurent Becquemont

  5. CESP (Centre de Recherche en Epidémiologie et Santé des Populations), Paris, France

    Bruno Falissard

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Contributions

MG conceptualized the study, set up the methodology, write the original manuscript. PP set up the methodology, made the statistical analysis, reviewed the manuscript. NB set up the methodology, made the statistical analysis, reviewed the manuscript. CAT made the statistical analysis, reviewed the manuscript. LB set up the methodology, reviewed the manuscript. BF set up the methodology, reviewed the manuscript. EC set up the methodology, reviewed the manuscript. RC conceptualized the study, set up the methodology, reviewed the manuscript.

Corresponding author

Correspondence to Emmanuelle Corruble.

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Competing interests

Bruno Falissard has been a consultant or speaker for Abbvie, Actelion, Allergan, Almirall, Alnylam, Amgen, Astellas, Astrazeneca, Bayer, Biogen, Biopecs, Bioproject, Biotronik, BMS, Boehringer, Celgène, Daiichi-Sankyio, Ethypharm, Forestlab, Genevrier, Genzyme, Gilead, Grünenthal, GSK, Idorsia, IMS, Indivior, IQVIA, JNJ, Léo, Lilly, Lundbeck, Menarini, MSD, Novartis, Novonordisk, Otsuka, Pfizer, Pierre-Frabre, Recordati, Roche, SANOFI, Servier, Takeda, UCB, ViiV, and Wellmera outside the submitted work. Laurent Becquemont has been a speaker Sanofi Genzyme out of the submitted work. Matthieu Gasnier, Pierre Pinson, Emmanuelle Corruble, Nathanaël Beeker, Camille Truong-Allie and Romain Colle have no conflict of interest.

Ethics approval and consent to participate

All methods were performed in accordance with the relevant guidelines and regulations. This study was approved by the Institutional Review Board of the AP-HP clinical data warehouse (“Entrepôt de Données de Santé (EDS)”, IRB number: IRB00011591). Informed consent was obtained from all participants

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Gasnier, M., Pinson, P., Beeker, N. et al. Acute COVID-19 severity markers predict post-COVID new-onset psychiatric disorders: A 2-year cohort study of 34,489 patients. Mol Psychiatry 30, 1329–1337 (2025). https://doi.org/10.1038/s41380-024-02739-7

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