The Lancet Psychiatry recently published the largest systematic review and meta-analysis to date on the outcomes of people with psychiatric disorders who got COVID. An analysis of data on nearly 1.5 million people with COVID-19 found that those with preexisting mental health disorders faced twice the risk of hospitalization or death after being infected with the coronavirus. The findings could have implications on COVID-19 prevention measures and who is considered high risk. Here’s a closer look at the research.
The Study
For this report, which was initiated by the Immuno-NeuroPsychiatry Network of the European College of Neuropsychopharmacology, researchers looked at data from 33 studies from 22 countries. The data included information on 1,469,731 people with COVID-19, nearly 44,000 of whom had mental health disorders. There were nearly equal numbers of men and women with mental health disorders in this analysis. The researchers found strong evidence that people with preexisting mental health conditions face twice the risk of hospitalization or death from COVID-19 compared with other patients. People with severe mental illness tended to have higher mortality rates from COVID-19, but not increased risk of hospitalization, potentially the result of disparities in access to healthcare. “There is always disparity and discrimination in healthcare with respect to age, gender, race, socioeconomic status, et cetera,” says Noah Greenspan, DPT, a cardiopulmonary and complex medical physical therapist who has been treating COVID-19 long-haulers since last August, and the founding director of Pulmonary Wellness Foundation and the Covid Rehab & Recovery Clinic at H&D Physical Therapy. “Therefore, it is no surprise that an already disadvantaged population would have difficulty accessing care and getting the treatments they need.” Those with psychotic and mood disorders, as well as people who had previously been treated with medications for anxiety, depression, and psychoses, were also among the groups most vulnerable to dying from COVID-19. Substance abuse disorders were particularly associated with a higher risk of hospitalization from COVID-19.
Connections Between Mental Health and COVID-19
There are a variety of possible explanations behind the increased risk of severe illness and death from COVID-19 among people with mental health disorders. It might have to do with a combination of biological differences and lifestyle factors, says Thomas Kannon, DNP, a psychiatric mental health nurse practitioner and assistant dean for graduate online nursing programs at Regis College. “One major factor that may contribute to a higher risk for people with psychiatric illnesses is that the stress on their bodies from the anxiety and depression can suppress their immune systems,” he says. “They have higher levels of cortisol, typically get less quantity and quality sleep, and are less likely to engage in as much self-care such as proper diet, exercise, and hygiene.” Kannon adds: “All of these things can contribute to increased likelihood of exposure to COVID-19, increased severity of symptoms, and decreased care seeking.” The risk of death from COVID-19 may also be exacerbated by other underlying conditions that often go undiagnosed in people with severe mental illness. “We know the life expectancy in persons with severe mental illness is 25 to 30 years younger than the general population. This is due to untreated—but treatable—illnesses, such as diabetes and heart disease,” explains Jill A. RachBeisel, MD, chief of psychiatry at the University of Maryland Medical Center and associate professor at the University of Maryland School of Medicine. She continues: “We also know that persons with chronic medical illness are also at higher risk to be infected by COVID. This compounds the risk even further for those with severe mental illness. [The combination of] increased risk due to co-morbid medical problems and decreased access to care leads to getting sicker faster without quick access to treatment.”
Raising Greater Awareness Could Improve Outcomes
Despite the latest findings, the Centers for Disease Control and Prevention (CDC) has yet to list most mental health conditions as reasons to take extra precautions against COVID-19. “The medical community was focused on the physical presentation of the infection and fighting the disease as it impacted the respiratory and immune system. High-risk populations were linked to those who were compromised, including the elderly and already immunocompromised individuals,” says RachBeisel. Aside from limited research, stigma about mental health disorders may have also led to this risk factor going largely unacknowledged. RachBeisel says breaking down these preconceived notions is critical to improving care and health outcomes among people with mental illness. “Public awareness and reducing stigma are critical to supporting and improving the lives of this very vulnerable population,” she says. “Having a severe mental illness or a substance use disorder results in an increase of untreated medical problems, which in turn result in a lower life expectancy. Raising awareness of mental illness and the associate risks of early death is what is needed.” The information in this article is current as of the date listed, which means newer information may be available when you read this. For the most recent updates on COVID-19, visit our coronavirus news page. Experts say this connection likely involves a combination of factors, such as biological changes, lifestyles, and disparities in access to healthcare. The findings may influence public health officials as they continue to revise known risk factors for COVID-19 and guidelines to protect the most vulnerable individuals.
