- People with mental health disorders are about twice as likely to die from Covid than people without such disorders.
- The findings are based on a meta-analysis of 16 studies from seven countries.
- The researchers urge public health officials to prioritise people with mental illness as part of controlling the pandemic.
Certain people are at a higher risk for serious infection and death if they contract Covid-19, the disease caused by SARS-CoV-2, than others. The factors that place people at high risk, however, have largely centred on factors such as having underlying medical conditions, increased age, and being male.
But people with mental health disorders also have almost double the risk (1.8 times) of Covid-related death compared to those without mental health disorders, according to a systematic review and meta-analysis of 16 studies from seven countries.
The authors of the study looked at population-based data from Denmark, France, Israel, South Korea, Spain, the UK, and the US.
Schizophrenia spectrum disorders and/or bipolar disorder – the most severe mental health disorders – had the highest likelihood of causing Covid-related death (2.3 times), senior author of the study, Dr Guillaume Fond, of Aix-Marseille University in France and colleagues, found.
The results, the researchers said, underscore the need for patients with mental health disorders to be seen as a high-risk population in the context of Covid-19.
“ … 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,” they wrote.
The studies were all published between December 2019 and July 2020 and included data from almost 19 100 patients.
The findings were published in JAMA Psychiatry on 27 July 2021.
Explaining the link
According to the authors, people with mental health disorders can have multiple comorbidities, such as diabetes and hypertension, identified as risk factors for severe Covid.
A study published this year, for instance, found that people who have type 2 diabetes and high cholesterol levels are not only at higher risk for severe Covid-related hospitalisation but were also more likely to contract the disease, Health24 reported.
Additionally, mental health disorders are also associated with certain factors that have previously been linked to poor Covid outcomes, including socioeconomic deprivation and barriers to care, explained the authors.
Other factors that may increase the risk of death for people in this group include immunological disturbances and the effects of psychiatric medications.
The fact that patients with schizophrenia and/or bipolar disorders have the highest risk for Covid mortality may be explained by their particular immunological profile, which leads to changes in their immune systems.
For example, abnormal cytokine levels have been found in the cerebrospinal fluid of patients with schizophrenia and bipolar disorders, which can contribute to severe Covid outcomes, they explained. Cytokines are proteins that are released by immune cells in order to generate an immune response.
One of the aims of the study was for researchers to find out whether patients with mental health disorders were at increased risk of admission to intensive care units (ICUs) as a result of Covid infection compared to patients without mental health disorders.
Unfortunately, only four of the studies in the meta-analysis included data about ICU admissions, rendering the sample insufficient for meta-analysis, they said.
The team was also unable to analyse the mental health disorders separately, which may cause important discrepancies between diagnoses. And while several of the population-based studies from South Korea, the US, and France indicated that severe mental health disorders were risk factors for Covid-related death, the results were less clear for other mental health disorders, including depressive disorders, anxiety disorders, eating disorders, and personality disorders.
Another downfall was that the majority of the studies included in their review were conducted throughout the first wave of Covid-19 cases. Since testing for Covid was limited in some countries, it likely led to discrepancies in mortality rates by country, they added.
'Urgent research priority'
Future studies, therefore, should evaluate the risk for patients with each mental health disorder more accurately, they suggested, considering they were unable to do so due to the limited published data.
“Determining whether patients with mental health disorders are at high risk of severe Covid-19 is an urgent research priority and can alert health policymakers and lead to adaptions in preventive care and disease management strategies to meet their health needs,” they stressed.
Moreover, training made available for ICU staff on mental health disorders could potentially reduce mental illness stigma, they said, and consequently, improve ICU admission of patients with mental health disorders.