This fall, the CDC identified mental disorders as underlying health conditions that can lead to more severe cases of COVID-19 or even death from the virus. To be clear, this differs from studies suggesting that COVID-19 cases have led to an increase in diagnoses of mental illness. POPSUGAR spoke to two medical professionals about how some mental illnesses can increase your risk of severe or fatal COVID-19 – here’s what we know.
What mental illnesses could put you at higher risk for severe COVID-19?
The CDC writes, “Having mood disorders, including depression, and schizophrenia spectrum disorders may make you more likely to become seriously ill from COVID-19.” In updating the list of underlying medical conditions associated with a higher risk of severe COVID-19, the CDC cited two meta-analyses published in The Journal of the American Medical Association (JAMA) as evidence. One reviewing 21 studies suggested that people with pre-existing mood disorders of depression or bipolar disorder were more likely to be hospitalized for and die from COVID-19 compared to those without mood disorders. No association was found between “serious events” (oxygen therapy, ventilation, ICU admission, etc.) and pre-existing mood disorders. Another meta-analysis that reviewed 16 studies identified major mental health disorders, namely schizophrenia and/or bipolar disorder, as the greatest risk of death from COVID-19.
Katlyn Nemani, MD, a research assistant professor in NYU Langone Health’s division of psychiatry, emphasized that, in her view, people with a serious mental illness, particularly schizophrenia, are most at risk. “The CDC is basing their guidance on the available evidence; hopefully future research will help refine this list of conditions,” she noted to POPSUGAR.
dr. Nemani was the lead author of a study from NYU Langone that specifically linked schizophrenia with increased mortality in COVID-19 patients, second only to age as the greatest risk factor for death from COVID-19. The study, published in JAMA and included in both of the above meta-analyses, showed that COVID-19 patients with schizophrenia were approximately 2.7 times more likely to die when evaluating 45-day mortality rates and adjusting for demographic and medical risk factors. Mood and anxiety disorders were not associated with a higher risk of death in this one study (Dr. Nemani pointed out that discrepancies in results between her study and others may be due to the way different mental health disorders are grouped).
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Chronic Mental Illness Can Affect Your Immune System
dr. Nemani stressed that mental illness can compromise a person’s immune system, which is one reason people with severe cases of mental illness are more at risk for advanced cases of COVID-19. Christine Crawford, MD, MPH, associate medical director at the National Alliance on Mental Illness, similarly told The New York Times that chronic mental illness “can impair the body’s immune system,” making people more vulnerable.
Researcher and licensed clinical psychologist Raquel Martin, PhD, explained to POPSUGAR that while mental disorders affect everyone’s body differently, they can be chronic stressors, and chronic stressors cause a reduction in T cells that help fight infection. Your body also releases catecholamines (e.g., dopamine, adrenaline, and norepinephrine) as a stress response, but having high levels of catecholamines for long periods of time can lead to complications such as elevated blood pressure, digestive issues, and headaches (she explains this more on TikTok) . Such complications make your body less protected and, again, more vulnerable.
dr. Nemani said one possible explanation for the increased risk she and her team have observed in people with schizophrenia is an abnormal immune response to infection. She explained: “There are at least two immune-mediated mechanisms that contribute to the mortality risk from COVID-19: an ineffective response to the virus shortly after exposure and a harmful inflammatory response later in the course of infection, when the immune system overstrains. reaction that can damage the body’s own tissues.” She noted that there is a large body of evidence suggesting that people with schizophrenia may be less effective at fighting off viruses and increasingly susceptible to harmful inflammatory responses that may be related to genetic and other environmental risk factors.
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Other factors may influence the severity of COVID-19 in people with mental illness
Comorbidities of mental disorders — other mental or physical illnesses that occur at the same time — can affect a person’s overall health. dr. Nemani explained that, for example, people with schizophrenia are more likely to have heart disease and obesity, which are “established risk factors for COVID-19 death.” CEO of the American Psychological Association Arthur Evans, Jr., PhD, told the… NOW Aside from the pandemic, people with severe mental illness are generally expected to live 10 to 25 years less than those who don’t.
dr. Martin emphasized that common practices to promote physical health, such as diet, hydration and exercise, can be influenced by mental illness, which negatively impact the body and further affect a person’s susceptibility to disease. dr. Nemani cited a few other possible factors for higher COVID-19 death rates in people with severe mental illness, including “environmental social factors such as overcrowded housing, barriers to receiving health care and lack of social support.” In addition, she said “psychiatric symptoms such as apathy, disinhibition, or cognitive impairment” can hinder a person’s willingness to follow or adhere to preventative safety precautions and seek medical attention.
dr. Nemani stated that getting vaccinated is “probably the most effective thing people can do to protect themselves” and that it should be a priority.