Study Reveals Adults With Mental Disorders Are At Significantly Higher Risk of COVID-19 and Have Poorer Outcomes

A systematic study based on the health histories of over 61 million American adults has found that people with a recent diagnosis of a mental disorder have a significantly increased risk for COVID-19 infection and tend to have worse outcomes than people infected with COVID-19 who don’t have a mental disorder.

“Recent diagnosis” in the study was defined as within the last year. Those recently diagnosed with depression had the greatest risk of COVID infection, followed by those recently diagnosed with schizophrenia.

For those recently diagnosed with a mental disorder who also contracted COVID-19, the death rate was 8.5%, far above the 4.7% death rate in COVID-19 patients in the study with no mental disorder.

The study showed that the negative impacts of COVID/mental health co-morbidities were most pronounced in African-Americans and women. Among people with a recent diagnosis of mental disorder, African-Americans were found to have a higher COVID-19 infection risk than Caucasians. Women with chronic or recent mental disorder diagnoses were more likely to be infected with COVID-19 than men.

The study was led by Nora Volkow, M.D., Director of the NIH’s National Institute on Drug Abuse (NIDA). She is a member of the BBRF Scientific Council.

Her team examined electronic health records of 61.7 million Americans aged 18 or over, 11.2 million of whom (18%) had a lifetime diagnosis of a mental disorder—recently, within the last year, or prior. A total of 1.3 million in the database had a recent mental health diagnosis. Within the same set of 61.7 million people, 15,110 had been infected with the COVID-19 virus, and 5,450 of these individuals (36%) had a lifetime mental health diagnosis; of these, 3,430 were diagnosed within the last year. It was in this latter group—recently diagnosed and contracting COVID—that the death rate was 8.5%.

Importantly, the study, which appeared in the journal World Psychiatry, was designed to reveal correlations, but is not able to judge causality. Nevertheless, Dr. Volkow commented that “the proper control and management of mental disorders is one factor that will [tend to prevent] COVID-19 infection. If you’re delusional or hallucinating, you’re less likely to follow public health interventions. If you’re depressed, you may be unmotivated or you may not care.”

In their paper, Dr. Volkow and colleagues identify individuals with mental disorders as a “highly vulnerable population for COVID-19 infection.” They note that those with mental illness have “life circumstances that place them a higher risk for living in crowded hospitals or residences, or even in prisons,” environments in which infections can spread rapidly. Also, “people with serious mental illnesses are likely to be socioeconomically disadvantaged,” a fact which “might force them to work and live in unsafe environments. Homelessness and unstable housing may affect their ability to quarantine. Stigma may result in barriers to access to healthcare for patients infected with COVID-19, or make them reluctant to seek medical attention for fear of discrimination.”

The team also noted that “higher sensitivity to stress, common among patients with mental disorders, will make it harder for them to cope with the uncertainties, isolation, and economic challenges linked with the COVID-19 pandemic—increasing their risk for relapse and disease exacerbation.”

Yet another factor which may help explain the unique risks faced by those with mental disorders who contract COVID-19 is the increased likelihood that they suffer another major medical comorbidity such as heart disease, diabetes, COPD (lung disease), or substance-use disorders. All of these can contribute to greater severity and poorer outcomes in people who contract the virus.

The researchers suggest that overlapping biological factors may also be implicated. One example is elevated inflammation in the body, which not only can exacerbate COVID response but is also suspected of contributing, in at least some cases, to causality in depression, schizophrenia, and bipolar disorder.

Dr. Volkow and colleagues express the hope that their results will highlight “the need to recognize and address modifiable vulnerability factors and prevent delays in the provision of health care” in people with psychiatric disorders who are infected with the COVID-19 virus.

Drs. QuanQiu Wang and Rong Xu of Case Western Reserve University were co-authors of the paper.