Changes in mental health following COVID-19 infection: Results of a prospective cohort study in Mongolia
Keywords:
COVID-19, Depression, Anxiety, Insomnia, Post-traumatic stress disorder, Prospective cohort studyAbstract
Objective: COVID-19 has been associated with persistent neuropsychiatric complications, yet prospective evidence from low- and middle-income countries remains limited. This study evaluated 12-month longitudinal changes in depression, anxiety, insomnia, and post-traumatic stress disorder (PTSD) among hospitalized patients with COVID-19 compared with non-COVID-19 controls in Mongolia. Methods: This prospective cohort study included 459 adults (326 COVID-19 cases and 133 controls) recruited from hospitals affiliated with the Mongolian National University of Medical Sciences between 2021 and 2023. Participants without baseline mental disorders were assessed at 7–14 days, 3 months, and 12 months using the PHQ-9, GAD-7, ISI, and PCL-5. Data were analyzed using X² tests, independent t-tests, and relative risk (RR) estimates, with statistical significance defined as p < 0.05. Results: The mean age of participants was 46.3 ± 13.8 years, and 58.4% were female. At 12 months, depression (37.3% vs. 16.9%; RR = 2.22, 95% CI: 1.28–3.83; p = 0.003) and anxiety (28.0% vs. 11.2%; RR = 2.49, 95% CI: 1.25–4.96; p = 0.006) remained significantly more common in the COVID-19 group than in controls. Insomnia decreased over time (33.3% vs. 49.4%; RR = 0.67; p = 0.037), whereas PTSD prevalence remained low in both groups (<3%, p > 0.05). Female participants and those aged 40–59 years showed a higher risk of adverse mental health outcomes. Conclusions: COVID-19 infection was associated with a significantly increased long-term risk of depression and anxiety up to 12 months after infection. These findings support routine mental health screening and sustained psychological follow-up as part of post-COVID care and provide evidence to inform long-term mental health policy in Mongolia.
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