This fall, the CDC identified mental health disorders as underlying health conditions that may result in more serious cases of COVID-19 or, even, dying from the virus. To be clear, this differs from studies suggesting COVID-19 cases have led to increased mental illness diagnoses. POPSUGAR spoke to two medical professionals about how some mental illnesses can increase your likelihood of severe or fatal COVID-19 — here's what we know.
Which Mental Illnesses Could Mean You're at Higher Risk of Severe COVID-19?
The CDC writes, "Having mood disorders, including depression, and schizophrenia spectrum disorders can make you more likely to get severely ill from COVID-19." When updating its list of underlying medical conditions associated with higher risk for severe COVID-19, the CDC cited two meta-analyses published in The Journal of the American Medical Association (JAMA) as evidence. One that reviewed 21 studies suggested those with preexisting mood disorders of depression or bipolar disorder were more likely to get hospitalized for, and die from, COVID-19 compared with those without mood disorders. It did not find an association between "severe events" (oxygen therapy, ventilation, admission to the ICU, etc.) and preexisting mood disorders. Another meta-analysis that reviewed 16 studies identified severe mental health disorders, namely schizophrenia and/or bipolar disorder, as posing the most risk of COVID-19 death.
Katlyn Nemani, MD, research assistant professor in NYU Langone Health's Department of Psychiatry, stressed that, in her view, people with severe mental illness, schizophrenia in particular, are at the most risk. "The CDC is basing their guidance on the data that's available; hopefully future research will help refine this list of conditions," she noted to POPSUGAR.
Dr. Nemani was the lead author of a study out of NYU Langone that specifically linked schizophrenia to increased mortality in COVID-19 patients, second only to age as the greatest risk factor for COVID-19 death. The study, published in JAMA and included in both meta-analyses mentioned above, showed that COVID-19 patients with schizophrenia had about 2.7 times increased odds of dying when evaluating 45-day mortality rates and adjusting for demographic and medical risk factors. Mood disorders and anxiety disorders were not associated with higher risk of death in this one study (Dr. Nemani pointed out that discrepancies in results between her study and others could be due to how different mental disorders are grouped together).
Chronic Mental Illness Can Impact Your Immune Function
Dr. Nemani stressed that mental illness can affect one's immune system, which is one reason that people with severe cases of mental illness may be more at risk of 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 health conditions can "wreak havoc on the body's immune system," making people more vulnerable.
Researcher and licensed clinical psychologist Raquel Martin, PhD, explained to POPSUGAR that though mental health disorders impact everyone's body differently, they can be chronic stressors, and chronic stressors cause a reduction of T cells which help fight infection. Your body also releases catecholamines (dopamine, adrenaline, and noradrenaline, for example) as a stress response, but having high levels of catecholamines for long periods of time can lead to complications like increased blood pressure, digestion issues, and headaches (she explains this more on TikTok). Such complications make your body less protected and, again, more vulnerable.
Dr. Nemani said that one potential explanation for the escalated risk she and her team 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 COVID-19 mortality risk: an ineffective response to the virus shortly after exposure and a harmful inflammatory response later in the course of infection, when the immune system develops an overexuberant response that can damage the body's own tissues." She noted that there is a large body of evidence suggesting people with schizophrenia may be less effective at fending off viruses and increasingly prone to damaging inflammatory responses that could be "related to genetic and other environmental risk factors."
Other Factors May Influence the Severity of COVID-19 in People With Mental Illness
Comorbidities of mental disorders — other mental or physical illnesses occurring at the same time — can impact a person's overall health. Dr. Nemani explained that those with schizophrenia, for instance, are more likely to experience heart disease and obesity, which are "established risk factors for COVID-19 mortality." CEO of the American Psychological Association Arthur Evans, Jr., PhD, told the NYT that pandemic aside, people with major mental illness generally are expected to live 10 to 25 years less than people who do not.
Dr. Martin stressed that overall practices to promote physical health like nutrition, hydration, and exercise could be impacted by mental illness, taking a toll on the body and further impacting a person's susceptibility to illness. Dr. Nemani named a few other potential factors for higher COVID-19 mortality rates in people with severe mental illness, including "socioenvironmental factors such as overcrowded housing, barriers to receiving health care, and lack of social supports." Additionally, she said that "psychiatric symptoms such as apathy, disinhibition, or cognitive deficits" may interfere with a person's willingness to follow or commit to preventative safety measures and seek medical attention.
Dr. Nemani stated that getting vaccinated "is probably the single most effective thing people can do to protect themselves," and that it should be a priority.