Male doctor using stethoscope to examine coughing patient in hospital gown.
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Federal health officials linked a wide variation of mental health symptoms with post-COVID conditions, the US Department of Health and Human Services said on Wednesday. 

Some of those mental health issues — including depression, cognitive impairment, anxiety and substance use disorder — are more likely to affect nursing home and other long-term care residents, the agency said in an advisory written by its Substance Abuse and Mental Health Services Administration. 

Such behavioral health symptoms may present in addition to the physical symptoms known to manifest in the weeks following a SARS-CoV-2 infection, such as chest pain, dizziness and coughing.

Social determinants of health can further contribute to long COVID-19 inequities, affecting groups of individuals who live in congregate settings. Due to increased frequency and duration of exposure to COVID, individuals receiving care in a skilled nursing facility may be more likely to develop post COVID conditions, officials have said.

From healthcare discrimination to increased hospitalizations, disabled people are potentially at higher risk for Long COVID. “People with physical disabilities experience increased rates of COVID-19 infection…especially those [with physical disabilities] living in residential or long-term care settings,” SAMHSA said.

Cognitive impairment is one of several long COVID symptoms previous research has shown to dissipate within about one year of initial illness.

Although the full extent of long-term COVID effects on mental health remain undetermined, there are symptoms practitioners can identify to make informed diagnoses, the advisory said.

HHS noted that rates of mental health conditions are higher for people who were hospitalized with COVID or had a longer duration of COVID symptoms. Providers must be made aware of the symptomatic mental health conditions displayed by patients three to six months following a COVID diagnosis, HHS added. At twelve or more weeks after contracting the virus, 32% of survivors reported fatigue and 22% reported cognitive impairments. 

Long COVID patients often require comprehensive treatment including primary and behavioral healthcare. The SAMHSA advisory aims to provide practitioners with system assessment recommendations, tools and intervention strategies, as well as resources for their patients and themselves. 

Because patients with long COVID may experience trauma from living with chronic pain/illness, providers should take a trauma-informed approach when considering the appendices and determining treatment options. This includes validating the patient’s experience, exercising transparency when making a prognosis, and creating a safe and trustworthy atmosphere, HHS said.

Individuals diagnosed with long COVID may benefit greatly from psychotherapy, rehabilitation and pharmacotherapy, the advisory added.