The COVID-19 pandemic has had devastating mental health consequences for millions of people around the world, from children still reeling from the impact of extended school closures to older adults who’ve struggled with bouts of profound isolation.

New research published this week shines a light on another group of people whose mental health and well-being have been hit particularly hard over the past two years: people infected with COVID-19.

The findings, published in the peer-reviewed medical journal The BMJ, suggest that people who had COVID-19 were overall about 60% more likely than those who never caught the disease to be battling serious mental health consequences in the year after their initial recovery.

The researchers analyzed the medical records of more than 150,000 adults in the United States who tested positive for the coronavirus between March 2020 and January 2021. They found that those infected with the virus were 35% more likely to develop anxiety disorders and roughly 40% more likely to experience depression or sleep disorders within the year after their diagnosis.

Those who developed COVID were also 34% more likely to have an opioid use disorder and 20% more likely to develop a substance use disorder involving drugs or alcohol.

“While we’ve all suffered during the pandemic, people who have had COVID-19 fare far worse mentally,” study researcher Dr. Ziyad Al-Aly, a clinical epidemiologist at Washington University in St. Louis, said in a statement. “We need to acknowledge this reality and address these conditions now before they balloon into a much larger mental health crisis.”

Researchers have been aware of the link between COVID and mental health struggles since the early days of the pandemic.

A study from the fall of 2020, for example, found that people who had COVID were twice as likely to develop depression, anxiety or dementia in the three months after their diagnosis. The connection appears to be bidirectional, meaning that people with certain mood disorders are at greater risk of developing severe COVID, which is why they were cleared for booster shots before the general public, and that people who are infected are at greater risk of developing mental health issues.

The big question is why, and experts believe the answer is multilayered. Certainly the psychological stress of the pandemic may play a significant role, as can the emotional turmoil of coping with an infection and subsequent symptoms that can arise and last for months on end.

But experts also increasingly believe that COVID itself may have a direct impact on the brain.

“Our findings suggest a specific link between SARS-CoV-2 [the virus that causes COVID] and mental health disorders,” Al-Aly said. “We’re not certain why this is, but one of the leading hypotheses is that the virus can enter the brain and disturb cellular and neuron pathways, leading to mental health disorders.”

Notably, the new BMJ study found that people who’d been infected with the coronavirus were 80% more likely than those who weren’t to be experiencing symptoms of brain fog, such as forgetfulness and confusion.

Researchers are still trying to better understand exactly how COVID may cross the central nervous system and affect the brain. There is even some evidence that otherwise healthy people with relatively mild initial infections can experience brain inflammation, though such cases are rare.

Millions of people are grappling with symptoms of long-haul COVID, as estimates suggest up to 1 in 4 patients struggles with the condition regardless of the severity of their initial infection. There is an urgent need for expanded support and treatment for those people, including those who have developed mental health concerns.

Even before the pandemic, people with mental health disorders slipped through the cracks en masse. More than half of those with mental illnesses do not get treated. But interventions such as therapy and medication can be highly effective, so it is critical to reach out to a primary care physician or mental health professional if you have any concerns.

Experts say the need to connect people with mental health support and care is now greater than ever.

“People need to know that if they have had COVID-19 and are struggling mentally, they’re not alone, and they should seek help immediately and without shame,” Al-Aly said.

If you or someone you know needs help, call 1-800-273-8255 for the National Suicide Prevention Lifeline. You can also text HOME to 741-741 for free, 24-hour support from the Crisis Text Line. Outside the U.S., please visit the International Association for Suicide Prevention for a database of resources.