How Mental Health Problems Can Increase COVID Risk: Shots


Digitally generated image of a multi-layered cutout male head with covid-19 cells inside against a blue background.

Andriy Onufriyenko / Getty Images


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Andriy Onufriyenko / Getty Images


Digitally generated image of a multi-layered cutout male head with covid-19 cells inside against a blue background.

Andriy Onufriyenko / Getty Images

Even before the recent federal government decision last week to allow COVID-19 boosters to all adults, it had already recommended them in October for people with certain high-risk conditions. Along with illnesses like diabetes and heart disease, this list included mental health issues.

The decision to prioritize people with a psychiatric diagnosis in the early deployment of boosters came after a growing number of studies linked mental health disorders to a higher risk of COVID infection. 19 and serious 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 have been hospitalized with COVID-19 fare compared to others.

“What we found out was that we had a higher level of mortality for those with a psychiatric history,” explains psychiatrist Dr Luming Li, who was working on his masters at Yale University at the time. .

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

Another study published last year examined a national electronic health records database containing information on people who tested positive for COVID-19 and those who have been hospitalized.

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

There are several things that explain this, she says.

On the one hand, mental illnesses alter people’s behaviors, which can make them less likely to protect themselves from 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 issues, such as diabetes, cardiovascular issues, kidney disease.

“It is this very high prevalence of comorbid medical conditions that is likely to put them at a greater risk of negative results. [from COVID-19]”, says Volkow.

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

“They are suffering prematurely from chronic diseases, from medical neglect,” says Dr Ashwin Vasan, president and CEO of Fountain House, a nonprofit mental health organization.

They are also among the most isolated in society, he says, and this isolation has a huge impact on their bodies, putting them at higher risk for chronic disease.

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

And many drugs used to treat mental illnesses, especially antipsychotics, also increase the risk of these chronic health conditions, Volkow explains.

“This has been one of the main challenges we have with the overall use of antipsychotics, which help control some symptoms of schizophrenia but are negatively associated with a much higher risk of diabetes, hypertension and metabolic diseases. “, she says.

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

“The severity of people’s mental illness and disability can fluctuate depending on the amount of care and support they receive,” he says. “Whether or not you are in a crisis or managing your chronic mental illness, we know overall, at the epidemiological level of population health, that you are at greater risk.”

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

“About 40% of our chronically homeless population suffers from severe mental illness and addiction,” Vasan said.

Most of the 13 million people with severe mental illness in the United States receive Medicaid, he says, but 40% have no access to care.

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

For all of these reasons, Vasan and other mental health experts were happy to see that the CDC was prioritizing people with mental illness for COVID-19 vaccination, which they said should have happened well. before.

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

It is important that healthcare workers and family members are also aware of the risks of severe COVID-19 faced by people with a mental health diagnosis, and help ensure that they are vaccinated, a Li said.

“This will be a very important first step in making sure they have their vaccines to start, and then, second, to be able to get the boosters,” she says.

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