Two studies have confirmed what psychiatrists have suspected since the start of the COVID-19 pandemic: People with psychiatric diagnoses are more susceptible to COVID-19 and its complications, including death.

In a study published in World Psychiatry on October 7, Nora Volkow, M.D., director of the National Institute on Drug Abuse, and colleagues analyzed electronic health record data collected by IBM Watson Health Explorys. The data were collected from 360 hospitals across the United States from 1999 up to July 29, 2020, and represented 20% of the U.S. population. The researchers specifically looked at patients with diagnoses of attention-deficit/hyperactivity disorder (ADHD), bipolar disorder, depression, and schizophrenia. The data included information from more than 61 million adult patients, 1.3 million of whom were diagnosed with a mental disorder within the past year.

Patients with a recent diagnosis of a mental disorder had a significantly higher risk of COVID-19 infection than those without a mental disorder. Those with depression had the greatest risk, followed by patients with schizophrenia. After adjusting for medical comorbidities such as cancer, asthma, chronic kidney disease, and others, the researchers found that patients with depression were seven times more likely to become infected with COVID-19 than those without a mental disorder.

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The study follows up on a similar study Volkow and her colleagues conducted that found that patients with substance use disorders (SUDs) are also more susceptible to COVID-19 (see Psychiatric News).

“These results are showing us how important it is to treat the mental disorder itself,” Volkow told Psychiatric News. “The proper control and management of mental disorders is one factor that will [prevent] COVID-19 infection. If you’re delusional or hallucinating, you’re less likely to follow public health interventions. If you’re depressed, you may be unmotivated or you may not care. We must highlight how critical it is that the symptoms are managed.”

The authors also identified racial and gender disparities. African Americans who had been recently diagnosed with a mental disorder had a higher risk of COVID-19 infection compared with White Americans, particularly for those with depression. Women who had been recently diagnosed with a mental disorder similarly had a higher risk of COVID-19 infection than men, and the strongest gender disparity was present in patients with ADHD.

Alarmingly, the risk of COVID-19 complications was significantly higher for patients with mental disorders. The death rate among patients with recent mental disorder and COVID-19 diagnoses was 8.5%, and the hospitalization rate was 27.4%, compared with 4.7% and 18.6%, respectively, for COVID-19 patients with no mental disorder.

Another study, published in JAMA Network Open on September 30, had similar findings. Researchers at Yale University assessed the outcomes of 1,685 patients who were hospitalized with COVID-19 between February 15 and April 25 in Yale New Haven Health System hospitals. Based on an analysis of electronic health record data, 28% of these patients had a history of psychiatric illness, including those who had an active psychiatric condition, were in remission, or were in recovery when they were admitted for COVID-19.

Overall, 144 of the 473 patients with a psychiatric diagnosis died from COVID-19, compared with 174 of the 1,212 patients with no prior psychiatric diagnosis. Even after factoring in age and medical comorbidities, patients with a prior psychiatric diagnosis who were hospitalized for COVID-19 had a 50% greater risk of death compared with patients with no psychiatric history.

The results of the two studies point to bigger questions that the research community must answer, said lead author Luming Li, M.D. “Why are people with psychiatric conditions more susceptible to COVID-19? Is it the brain disorder itself? Is it the fact that they don’t have the resources they need to practice social distancing and obtain masks and PPE [personal protective equipment]?” Li is an assistant professor of psychiatry at Yale School of Medicine, medical director of clinical operations at Yale New Haven Medical Center, associate medical director of quality improvement at Yale New Haven Psychiatric Hospital, and a member of APA’s Committee on Innovation.

“We really need more research about why people with psychiatric conditions are more susceptible to COVID-19 and what more we can do for this population,” she added. “There might be a number of factors at play,” she continued, adding that she suspects that social determinants of health play a significant role.

“Patients who are properly managed have much better outcomes, but living in this pandemic highlights the importance of ensuring that patients with mental illness get proper treatment and they aren’t neglected,” Volkow said.

Li’s study reported no outside funding. Volkow’s study was funded by the National Institute on Drug Abuse, the Eunice Kennedy Shriver National Institute for Child Health and Human Development, the National Institute on Aging, the American Cancer Society, and the Clinical Translational Science Collaborative of Cleveland. ■