Mental health disorders increase the risk of COVID-19

Researchers from the University of California San Francisco (UCSF) and the San Francisco Veterans Affairs Health Care System found that patients over 65 years of age with substance abuse, psychotic disorders, bipolar disorder, adjustment disorder, and anxiety, faced a increased risk, of up to 24%, of progression of COVID-19. For those under 65, the risks were up to 11% higher than for those without a psychiatric history. This finding may be related to an impaired immune system response.

For both groups, data were adjusted for age, sex, race, ethnicity, and vaccine type, as well as for smoking and underlying conditions such as obesity, diabetes, sleep apnea, cardiovascular, lung, kidney and liver diseases, HIV, and cancer. In the study, which was published in JAMA Network Open, researchers tracked data from more than 250,000 patients from the U.S. Department of Agriculture, who had completed their vaccine regimen and had at least one SARS-CoV-2 test.

Just over half (51.4%) of the patients had received at least one psychiatric diagnosis in the past five years and 14.8% developed a COVID outbreak, confirmed by a positive test. Decreased immunity and less protection of new variants may explain the higher rates.

“Our research suggests that the increase in intercurrent infections in people with psychiatric disorders cannot be fully explained by sociodemographic factors or pre-existing conditions,” explained lead author Aoife O'Donovan of the UCSF Weill Institute of Neurosciences, the Veterans Health Care System and from the University of San Francisco. Immunity after vaccination may decline more rapidly or more strongly in people with psychiatric disorders and/or may have less protection against newer variants.”

A study earlier this year, led by the same UCSF researchers, found that people with high anxiety and probable post-traumatic stress disorder, conditions associated with impulsivity, were more likely to engage in behaviors that put them in higher risk of COVID.

The average age of the 263,697 participants was 66 years old and 90.8% were men. Overall, participants with psychiatric disorders had a 3% higher risk of COVID infections in 2021, when adjusted for demographic factors and pre-existing conditions, compared to participants without a psychiatric history. But the risk was 24% higher for those over 65 with substance abuse, 23% higher for those with psychotic disorders, 16% higher for bipolar disorder, 14% for adjustment disorder, and 12% for anxiety. Surprisingly, given the higher incidence of intercurrent infections among younger people, this study showed significantly reduced effects in the under-65 age group.

In addition, the risks were 10% lower in participants with psychotic disorders compared to those who did not have a psychiatric diagnosis, a decrease that O'Donovan attributes to a possible lower socialization among younger people with psychotic disorders compared to older people who “may be less socially isolated because of their greater burden of ill health and contacts with caregivers,” he said. However, the risks of intercurrent infections associated with substance abuse, adjustment disorder, anxiety, and post-traumatic stress disorder were higher in the younger cohort than in their peers without psychiatric diagnosis: 11%, 9%, 4%, and 3%, respectively.

The first author, Kristen Nishimi, PhD, also from the Weill Institute of Neuroscience at UCSF and the San Francisco Veterans Health Care System, believes that the higher incidence of intercurrent infections among older participants may be due to “a lower immune response to the vaccine which has been associated with some psychiatric disorders, which may be more important in older adults”. It is also possible that older adults with psychiatric disorders “may require more frequent in-person care, which could increase their interactions with the health care system,” he added.

Risks for other non-psychiatric conditions were also calculated and adjusted for factors such as obesity and smoking, as well as other underlying conditions. The researchers found that patients with chronic kidney disease had an increased risk of 23%, compared to 20% of HIV, 19% of cardiovascular disease, 18% of COPD, and 13% of sleep apnea. This shows that certain psychiatric conditions, particularly in the age group over 65, face risks that are on a par with other conditions,” O'Donovan said. It is important to consider mental health along with other risk factors and some patients should be prioritized for vaccine boosters and other critical preventive issues.”

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