770 - COVID-19 Infection is Associated with Incident Prescription of Antidepressants

Publication Number: 770.4240

Cade M. Nylund, Uniformed Services University of the Health Sciences F. Edward Hebert School of Medicine, Bethesda, MD, United States; Apryl Susi, Uniformed Services University of the Health Sciences F. Edward Hebert School of Medicine, Bethesda, MD, United States; Zella Berill, Uniformed Services University of the Health Sciences F. Edward Hebert School of Medicine, Bethesda, MD, United States; Elizabeth J. Hisle-Gorman, Uniformed Services University of the Health Sciences F. Edward Hebert School of Medicine, Bethesda, MD, United States

Background: COVID-19 infection has been shown to increase clinical rating scores for anxiety and depression. It is not known whether COVID-19 infection is associated with the development of mental health symptoms requiring pharmaceutical treatment.

Objective: This study evaluates the causal relationship between COVID-19 infection and incident initiation of treatment with antidepressants.

Design/Methods: A propensity score-matched cohort study using the Military Health System Database data for children 0-17 years of age was performed. ICD-10 codes and laboratory tests identified patients with COVID-19 infections from July 2020 to June 2021. Counts of all inpatient and outpatient diagnoses, procedures, and outpatient medication prescription data one year preceding the COVID-19 infection were categorized according to clinical classification software. Using 1770 clinical variables, age, sex and month, a propensity score for COVID-19 exposure was matched 2:1 non-exposed to exposed and on age and sex. Dispensed antidepressants in the categories listed in Table 1 were aggregated. Any subject who had a prescription in the year before their cohort entry date were excluded. Participants were followed for a year with time to censoring as either loss to follow-up or infection with COVID-19. Cox Proportional Hazards Model was used.

Results: There were 61,170 participants in the study, 20,390 with COVID-19 and 40,780 controls. 47.70% were female and median age was 10 (interquartile range [IQR], 5-14). 1,502 subjects were prescribed antidepressants for the first time; 590 (2.89%) with COVID-19 infection and 912 (2.24%) among controls. The number of new prescriptions in each class of antidepressants are listed in Table 1. The median age for those prescribed an antidepressant was 14 years; IQR, 12-16) and 66.1% were female (n= 993). Children with COVID-19 were more likely to have a new antidepressant prescribed (HR, 1.26; 95% confidence interval, 1.14- 1.40; see figure 1), however after adjusting for pre-COVID-19 counts of healthcare utilization the association of COVID-19 became insignificant (p=0.09).

Conclusion(s): Children 0-17 years of age diagnosed with COVID-19 had a higher risk of newly prescribed antidepressants. Statistical significance was lost after adjusting for prior healthcare utilization suggesting pre-existing conditions were effect modifiers and healthcare seeking behavior may have confounded results. Understanding how COVID-19 exacerbates and affects the development of mental health will assist in more effective screening, diagnosis and treatment strategies.

Table 1 Number of New Antidepressant Prescriptions by Medication Class in Cohort
Medication Class table.pdf

Figure 1 Cumulative Incidence Percent of Subjects with a Newly Prescribed Antidepressant by COVID-19 Exposure Status