Patients with severe mental health disorders like schizophrenia and bipolar disorders are nearly three times more likely to die from COVID 19 if they fall ill than individuals who do not have a mental illness, new research published in JAMA Psychiatry has found. The mortality rate is 1.8 times more than the average healthy person for other mental health problems.
Several population-based studies from South Korea, the US, and France revealed that severe mental health disorders like schizophrenia spectrum disorders and/or bipolar disorders are risk factors for increased COVID-19 mortality. The results were less clear for other mental health disorders like depressive disorders, anxiety disorders, eating disorders, and personality disorders.
Targeted As High Risk Population
The findings suggested that patients with COVID-19 and mental health disorders should be targeted as a high-risk population for severe virus forms, requiring enhanced preventive and disease management strategies like vaccinations, treatment and specific training for hospital staff.
"Mental health disorders were associated with increased COVID-19–related mortality after adjustment for the main clinical risk factors for severe COVID-19. Thus, patients with mental health disorders should have been targeted as a high-risk population for severe forms of COVID-19, requiring enhanced preventive and disease management strategies," the study stated.
As per the study, patients with mental health disorders can have multiple comorbidities that have been identified as risk factors for severe COVID-19: diabetes, hypertension, chronic obstructive respiratory disease, and end-stage kidney disease. Mental health disorders are also associated with socioeconomic deprivation and reduced access to care-two important factors of poor COVID-19 outcomes.
Other factors like lack of healthcare, higher propensities for addiction, the effects of psychiatric medication and other social factors can also increase the chances of death for this group.Increased ICU admission was found in US patients with COVID-19 with alcohol and/or substance use disorders, while decreased ICU admission was found in French patients with COVID-19 with schizophrenia.
The findings were derived from an analysis of 16 studies for which medical records of more than 19,000 people in 7 countries were examined. They were unable to assess the risk from different mental disorders accurately. Schizophrenia, depression, bipolar disorder, anxiety, personality disorder, addiction, eating disorders etc. were included, which are different from mental disorders but were featured in many of the studies used and commonly co-occurred with mental illnesses.
One study included patients with insomnia and dementia in the mental health disorder group. Insomnia is prevalent, while dementia is associated with COVID-19 prognosis and should be analyzed separately, the study stated. One study (published as a letter) did not clearly define its mental health disorder groups.
The study is in line with earlier research in January this year, that associated psychiatric disorders with mortality among patients with Covid 19. In this study, a schizophrenia spectrum diagnosis was associated with an increased risk of death after adjusting for demographic and medical risk factors. However, mood and anxiety disorders were not associated with an increased risk of mortality.
Of the 26, 540 patients tested, 7,348 tested positive for SARS-CoV-2. Of eligible patients with positive test results, 75 patients (1.0%) had a history of a schizophrenia spectrum illness, 564 (7.7%) had a history of a mood disorder, and 360 (4.9%) had a history of an anxiety disorder. After adjusting for demographic and medical risk factors, a premorbid diagnosis of a schizophrenia spectrum disorder was significantly associated with mortality and anxiety disorders were not associated with mortality after adjustment. Compared with other risk factors, a diagnosis of schizophrenia ranked behind only age in the strength of an association with mortality.
The COVID-19 pandemic has created unprecedented challenges to the health care system globally. Identifying risk factors associated with poor outcomes is essential to guide clinical decision-making, target enhanced protective measures, and allocate limited resources. Risk factors identified to date include older age, male sex, cardiovascular disease, and diabetes. Differences in outcomes by socioeconomic status and race have also received attention, highlighting the potential for the pandemic to deepen existing health inequalities. However, evidence evaluating psychiatric diagnoses as potential risk factors for severe or fatal COVID-19 is limited.
According to the experts, one among five Covid patients is diagnosed with a mental illness within three months of recovery. Those suffering from long Covid, brain and loss of thinking abilities are common. In addition, 23% of mild Covid-19 patients suffer from depression, whereas 16% suffer from anxiety in such cases.