Why people with mental illness have a higher risk of COVID

Digitally generated image of carved male head multilayer with covid-19 cells inside on blue background.

Andriy Onufriyenko | Getty Images

Even before the federal government’s latest decision last week to approve COVID boosters for all adults, it had already recommended them in October to people with certain high-risk conditions. Along with diseases like diabetes and heart disease, this list included mental health conditions.

The decision to prioritize people with psychiatric diagnoses in the early rollout of boosters came after a growing number of studies linking mental disorders with a higher risk of both COVID-19 infection and severe outcomes.

Last year, researchers analyzed data from five hospitals in the Yale New Haven Health System to see how people with a mental health diagnosis who were hospitalized with COVID-19 fared compared to others.

“What we found was that we had a higher level of mortality for those who had a previous psychiatric history,” says psychiatrist Dr. Luming Li, who was working on his master’s degree at Yale University at the time.

The risk of death from COVID-19 increased by 50 percent for those with a history of mental illness compared to those without such a history, says Li, who is now chief physician at the Harris Center for Mental Health and IDD in Texas.

Another study published last year examined a nationwide database of electronic health records with information on people who tested positive for COVID-19 and those who were hospitalized.

If a person had a history of a mental illness, they were more likely to be infected, “says study author Dr. Nora Volkow, director of the National Institute on Drug Abuse.” And if they were infected, then they were more likely to. have negative outcomes, such as hospitalization and death. “

There are several things going on that explain it, she says.

First, mental illness changes people’s behavior, which may make them less likely to protect themselves from an infection, with measures such as social distancing or wearing masks.

Second, people with mental illness tend to have poorer overall health and many chronic health problems, such as diabetes, cardiovascular problems, or kidney disease.

“It is this very high incidence of comorbid medical conditions that is likely to actually put them at greater risk of adverse outcomes. [from COVID-19], “says Volkow.

It is well known that people with mental illness on average live shorter lives and die from health conditions other than their psychiatric diagnosis.

“They suffer prematurely from chronic diseases, medical care failure,” says Dr. Ashwin Vasan, president and CEO of Fountain House, a nonprofit organization for mental health.

They are also among the most isolated in society, he says, and that isolation takes a huge toll on their bodies, putting them at a higher risk of chronic diseases.

“There has been study after study showing that it leads to inflammation, immunological stress, neurodegenerative decline, immunological impairment, endocrinological impairment,” says Vasan. That equates to smoking 15 cigarettes a day, he notes.

And many medications used to treat mental illness, especially antipsychotics, also increase the risk of these chronic health problems, Volkow says.

“This has been one of the biggest challenges we have with the use of antipsychotics in general, which help control certain symptoms of schizophrenia, but which are negatively associated with a much higher risk of diabetes and hypertension and metabolic disorders,” she says.

The risk is certainly not the same for all psychiatric diagnoses. It is higher for people with severe mental illness than, for example, mild depression. But as Vasan pointed out, mental illness is not a static thing.

“People’s severity of mental illness and disability can ebb and flow depending on the amount of care and support they receive,” he says. “Whether you are in the throes of crisis or not, or you are dealing with your chronic mental illness, we know at an epidemiological level of population health that you are at greater risk.”

There is also a clear overlap between severe mental illness and homelessness and substance abuse, which are also associated with high risk of infection and severe COVID-19.

“About 40 percent of our chronically homeless population has severe mental illness and addiction,” Vasan says.

Most of the 13 million people with serious mental illness in the United States are on Medicaid, he says, but 40 percent do not have access to care at all.

“This is a systematically marginalized, sicker population that has less access to care and support,” he says.

For all these reasons, Vasan and other mental health experts were pleased to see that the Centers for Disease Control and Prevention prioritized people with mental illness for COVID-19 vaccination, something they say should have happened long before.

However, many people with mental illness, especially those with severe mental illness (people with significant impairments in their daily functioning) may not be aware of their own risks or the new recommendations, Li says.

It is important for both health professionals and family members to also be aware of the risks of severe COVID-19 that people with mental diagnoses face and help ensure they are vaccinated, Li says.

“It will be a very important first step to make sure they have their vaccines to start with, and secondly to be able to get the boosters,” she says.

Copyright 2021 NPR. Visit https://www.npr.org to see more.

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