Mental Illness Tied to Worse COVID-19 Outcomes, Including Death

Megan Brooks

April 01, 2021

Editor's note: Find the latest COVID-19 news and guidance in Medscape's Coronavirus Resource Center.

Preexisting mental illness is tied to worse COVID-19 outcomes, including death, results of a large meta-analysis show.

"It's imperative that healthcare providers address and treat prediagnosed mental disorders among COVID-19 patients, as this is a risk factor that may affect COVID-19 mortality," Ahmad Toubasi, MD, Faculty of Medicine, University of Jordan, Amman, Jordan, told Medscape Medical News.

The study was published online March 3 in Psychiatry Research.

Mixed Findings

The literature is mixed on the relationship between having a preexisting mental disorder and COVID-19 severity and mortality.

Some studies suggest mental illness increases the risk for severe COVID-19 and mortality, whereas other studies show no association.

For this reason, "it was important to pool all of the studies concerning this topic in one comprehensive systematic study. By doing so, we were able to acquire a large enough number of COVID-19 patients in order to reveal more reliable results and answers," said Toubasi.

The meta-analysis included 16 studies with a total of 634,338 COVID-19 patients, including 68,023 (10.7%) who had been diagnosed with a mental disorder before testing positive for COVID-19.

In the studies that provided data about types of mental disorders, 43% of patients suffered from mood disorders, and 16% suffered from schizophrenia, schizotypal disorder, and delusional disorders.

In a model that included all 16 studies but that was not fully adjusted, prediagnosis with mental disorders significantly increased the risk for severe COVID-19 and mortality (odds ratio [OR], 1.76; 95% CI, 1.29 – 2.41).

The significant increase in risk for severe COVID-19 and mortality among patients with a preexisting mental disorders remained significant in the fully adjusted model (OR, 1.52; 95% CI: 1.20 – 1.93) that included only the studies that adjusted for confounding variables.

Higher Mortality

COVID-19 mortality was higher among patients with schizophrenia, schizotypal disorder, and delusional disorders in comparison with patients with mood disorders.

In a subgroup analysis of each healthcare system, pooled data from studies conducted in the United Kingdom showed a nonsignificant association between preexisting mental disorders and COVID-19 severity and mortality; in contrast, the association was significant with respect to pooled data from studies conducted in South Korea and the United States.

"It was fascinating to learn that the results could be different across different countries. This is a critical piece of information, as it could be attributed to better mental health care services in some countries over others," said Toubasi.

A limitation of the analysis is the "substantial heterogeneity" ―that is, high variation in study outcomes between the included studies ― in the fully adjusted model (I2 = 63%; P = .03).

The studies also had only limited data on specific types of mental disorders. "This is a very important limitation, as different mental illnesses may impact COVID-19 outcomes differently," the authors say.

Information on the severity of the mental illness and what medications patients were taking was also largely unavailable.

Bidirectional Relationship

Reached for comment, Brittany LeMonda, PhD, senior neuropsychologist at Lenox Hill Hospital, New York City, told Medscape Medical News that the relationship between COVID-19 and mental health is "bidirectional, meaning that individuals with psychiatric illness are more likely to contract COVID, and those who suffer from COVID are more likely to develop psychiatric symptoms after the diagnosis."

LeMonda also noted that patients with certain types of mental illness, such as schizophrenia, which influences behaviors and overall health more significantly than mood disorders, may be more susceptible to contracting the virus and then developing more severe symptoms.

This new study is "important," LeMonda said, "because it is a large meta-analysis documenting the positive association between COVID-19 and mental health/psychiatric illness.

"Understanding this relationship is vital in identifying who might be at greater risk for contracting COVID, developing more severe symptoms, and also report lingering symptoms," she added.

"Interventions aimed at reducing the spread of the virus among individuals with psychiatric illness is important. These individuals are also at risk for more complications and worse disease course, given their mental health," she said.

The study received no specific funding. Toubasi and LeMonda have disclosed no relevant financial relationships.

Psychiatry Res. Published online March 3, 2021. Full text

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