COVID-19 and mental illness: any evidence of a link?

In a previous blog post, I argued that a mental illness should be considered to be an “underlying condition” that puts us at much higher risk in the COVID-19 era, because the stress of an infection or hospitalization could seriously threaten our recovery from whatever mental illness we are dealing with.

I still strongly believe that those of us with a mental illness have an “underlying condition” and are therefore at higher risk for relapse if we become ill with COVID-19, but a recent study in The Lancet Psychiatry takes this a step further. The authors reviewed the electronic health records of over 60,000 people with a COVID-19 diagnosis. They then assessed whether that diagnosis was associated with increased rates of subsequent psychiatric diagnoses, or not.

They also flipped this and asked whether patients with a history of psychiatric illness were at higher risk of being diagnosed with COVID-19.

In other words, they wanted to see if there’s a unidirectional association (either between COVID-19 and psychiatric diagnosis or between psychiatric diagnosis and COVID-19 illness), or a bidirectional association going in both directions.

COVID-19 affects mental health…

The researchers found that in patients with no previous psychiatric history, a COVID-19 diagnosis was significantly associated with increased incidence of a first psychiatric diagnosis compared with six other health events: influenza, other respiratory tract infections, skin infection, gall stones, kidney stones, and fracture of a large bone. In other words, people with these six other diagnoses did not suffer from psychiatric effects in the weeks and months after their diagnoses in the same way that people with COVID-19 did. (The most common psychiatric diagnoses after COVID-19 were anxiety disorders, insomnia, and dementia.)

So, the research proved a unidirectional association between COVID-19 and subsequent psychiatric illnesses.

… and mental illness puts us at greater risk for COVID-19

The researchers were somewhat less certain of their results going in the other direction when they asked: are people with a history of psychiatric illness at greater risk of getting ill with COVID-19? Detailed information about socioeconomic factors (which might bias the results) is not always clear in electronic records, and so the researchers call for further study into this question. Nevertheless, they conclude: “… a psychiatric diagnosis might be an independent risk factor for COVID-19.”

Beware these “bidirectional associations”

This study proves that COVID-19 definitely affects the mental health of survivors in the short-term, and that pre-existing psychiatric problems might put us at higher risk of contracting COVID-19.

In other words, there appear to be what the authors call “bidirectional associations between COVID-19 and psychiatric disorders.”

But hold on! If it’s true that people with psychiatric problems are at higher risk for getting COVID-19 infection, surely we need to ask:

Why might this be so? Can you give some possible reasons?

  • Homelessness

  • Concurrent addictions

  • Inadequate and/or overcrowded housing

  • Poverty > poor nutrition > weak immune system > more susceptible to infection

  • Inadequately treated for psychiatric problems > can’t take good care of self, take personal protective measures, follow health guidelines, etc.

  • Lack of family and community support

  • Other?

Might any of these risk factors put you personally at risk for COVID-19? If so, is there anything you can do to reduce your risk?

Take good care,

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©2020 Merryl Hammond

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