Magnitude of Mortality Increase in People With Psychiatric Disorders During the Pandemic

Dawn O'Shea

October 11, 2021

People with mental health conditions have been disproportionately affected by the COVID-19 pandemic, according to research published in  The Lancet Regional Health – Europe . The findings suggest that the pandemic has exacerbated pre-existing health inequalities in people living with mental disorders and intellectual disabilities.

The study used prospective data (n=167,122) from the South London & Maudsley NHS Foundation Trust, which is one of Europe’s largest secondary mental health care providers. Data on deaths from 2019 to 2020 were used to assess age- and gender-standardised mortality ratios (SMRs) across nine psychiatric conditions: schizophrenia-spectrum disorders, affective disorders, somatoform/neurotic disorders, personality disorders, learning disabilities, eating disorders, substance use disorders, pervasive developmental disorders, dementia.

The study found that by the second quarter of 2020, when the UK was already experiencing substantial peaks in COVID-19 deaths in the general population (SMR, 1.60; 95% CI, 1.57-1.62), all-cause SMRs increased further in people with psychiatric conditions. COVID-19 SMRs were elevated across all psychiatric conditions studied. Notably, the rate in people with learning disabilities was more than nine times higher than the general population (SMR, 9.24; 95% CI, 5.98-13.64), and approximately five times higher in people with pervasive developmental disorders (SMR, 5.01; 95% CI, 2.40-9.20), eating disorders (SMR, 4.81; 95% CI, 1.56-11.22) and personality disorder (SMR, 4.58; 95% CI, 3.09-6.53). The SMR in schizophrenia-spectrum disorders and dementia were 3.26 (95% CI, 2.55-4.10) and 3.82 (95% CI, 3.42-4.25), respectively. Increased SMRs were similar across ethnic groups.

Following the peak in quarter 2 of 2020, all-cause SMRs across all mental disorder groups by ethnicity reduced back to pre-existing levels and were similar to those noted in 2019. These trends in all-cause mortality persisted in sensitivity analyses when age and gender were standardised to data from London. Compared with 2019, all-cause mortality in quarter 2 of 2020 was elevated 2.60 times (95% CI, 1.51-4.46) in South Asian people with mental disorders and 2.48 (95% CI, 1.86-3.30), 1.96 (95% CI, 1.73-2.22), and 1.73 (95% CI, 1.03-2.91) times in Black Caribbean, White British and Black African people with mental disorders, respectively.

For some conditions (dementia, personality disorders and learning disabilities), SMRs were higher for COVID-19-related mortality compared with other causes of death. In quarter 2 of 2020, COVID-19 SMRs were 3.82 (95% CI, 3.42-4.25) for dementia, 3.26 (95% CI, 2.55-4.10) for schizophrenia-spectrum disorders, 4.81 (95% CI, 1.56-11.22) for eating disorders, 5.01 (95% CI, 2.40-9.20) for pervasive developmental disorders, 9.24 (95% CI, 5.98-13.64) for learning disabilities and 4.58 (95% CI, 3.09-6.53) for personality disorders. By the last quarter of 2020, COVID-19 SMRs were no longer elevated across most diagnoses except for dementia, where an elevated SMR for COVID-19 mortality was still evident (SMR, 1.50; 95% CI, 1.02-2.15).

Inequalities

The authors say the findings show that the pandemic has exacerbated pre-existing health inequalities in people living with mental disorders and intellectual disabilities, suggesting that additional excess mortality has been driven by a heightened risk of death from COVID-19 and/or lockdown measures, added to the elevated risks of all-cause mortality that existed pre-pandemic.

They call for psychiatric disorders and learning disabilities to be given the same vaccine priority as underlying physical health conditions. They recommend that in addition to prioritisation; people with mental disorders may have additional factors that contribute to vaccine hesitancy and this will need to be considered as the pandemic continues.

Commenting on the study, Dr Adrian James, President of the Royal College of Psychiatrists, said: "It’s shameful and utterly heartbreaking that the stark inequalities faced by people with a severe mental illness or learning disability have had such tragic consequences during the pandemic."

"There has never been a more important time to address the inequalities that have been seriously exacerbated by COVID-19, including helping vulnerable people get vaccinated. The new Office for Health Improvement and Disparities is aiming to ‘level up the health of our nation’. As a society, we have a moral duty to ensure this means improving the health of people with a severe mental illness or learning disability and reducing inequalities in mental health."

Dr Charley Baker, Associate Professor of Mental Health at the University of Nottingham, said: "These results are entirely unsurprising but should be no less shocking for their predictability. There has been systemic government-level under-interest and under-investment in the overall health of people with learning disabilities and people with severe and enduring mental health problems for decades and - despite platitudes used at the time - this was demonstrably magnified during the pandemic. While staff ‘on the ground’ may have done [the] absolute best they could, there are gaping healthcare inequalities in ensuring that some of the most vulnerable people in society are better supported and better prioritised for good quality healthcare access."

Das-Munshi J, Chang CK, Bakolis I, Broadbent M, Dregan A, Hotopf M, Morgan C, Stewart R. All-cause and cause-specific mortality in people with mental disorders and intellectual disabilities, before and during the COVID-19 pandemic: cohort study. Lancet Regional Health – Europe. 2021 Oct 7 [Epub ahead of print]. doi: 10.1016/j.lanepe.2021.100228.

This article originally appeared on Univadis, part of the Medscape Professional Network.

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