COVID-19-Related Mortality Risk in People With Severe Mental Illness: A Systematic and Critical Review

Abstract

Background: Increasing clinical evidence suggests that people with severe mental illness (SMI), including schizophrenia spectrum disorders, bipolar disorder (BD), and major depressive disorder (MDD), are at higher risk of dying from COVID-19. Several systematic reviews examining the association between psychiatric disorders and COVID-19-related mortality have recently been published. Although these reviews have been conducted thoroughly, certain methodological limitations may hinder the accuracy of their research findings.Methods: A systematic literature search, using the PubMed, Embase, Web of Science, and Scopus databases (from inception to July 23, 2021), was conducted for observational studies assessing the risk of death associated with COVID-19 infection in adult patients with pre-existing schizophrenia spectrum disorders, BD, or MDD. Methodological quality of the included studies was assessed using the Newcastle-Ottawa Scale (NOS).Results: Of 1,446 records screened, 13 articles investigating the rates of death in patients with pre-existing SMI were included in this systematic review. Quality assessment scores of the included studies ranged from moderate to high. Most results seem to indicate that patients with SMI, particularly patients with schizophrenia spectrum disorders, are at significantly higher risk of COVID-19-related mortality, as compared to patients without SMI. However, the extent of the variation in COVID-19-related mortality rates between studies including people with schizophrenia spectrum disorders was large because of a low level of precision of the estimated mortality outcome(s) in certain studies. Most studies on MDD and BD did not include specific information on the mood state or disease severity of patients. Due to a lack of data, it remains unknown to what extent patients with BD are at increased risk of COVID-19-related mortality. A variety of factors are likely to contribute to the increased mortality risk of COVID-19 in these patients. These include male sex, older age, somatic comorbidities (particularly cardiovascular diseases), as well as disease-specific characteristics.Conclusion: Methodological limitations hamper the accuracy of COVID-19-related mortality estimates for the main categories of SMIs. Nevertheless, evidence suggests that SMI is associated with excess COVID-19 mortality. Policy makers therefore must consider these vulnerable individuals as a high-risk group that should be given particular attention. This means that targeted interventions to maximize vaccination uptake among these patients are required to address the higher burden of COVID-19 infection in this already disadvantaged group.

Household Financial Hardship Factors Are Strongly Associated with Poorer Latino Mental Health During COVID-19

“…These findings are concerning given the fact that even before the pandemic, financial hardship, unemployment, and discrimination based on race/ethnicity had been identified in studies of Latino mental health to have a deleterious impact including development of psychiatric disorders such as depression [21][22][23]. As noted earlier in this analysis, research has shown that people with psychiatric disorders had poor COVID outcomes in comparison to those not struggling with mental health, which raises concerns that the combination of economic adversity and poor mental health could be contributing to Latino infection and mortality [4][5][6][7]9]. Our findings echo those of a previous survey that showed an overall socio-economic disadvantage for US Latinos during the COVID-19 pandemic including problems paying bills, reliance on food banks, struggles to afford health care, and lost health insurance [20].…”

“…Although there exists an emergent scholarship on Latino COVID-19 health outcomes and studies exploring the intersection of the virus and mental health, research probing the question of how the pandemic has affected Latino mental health remains sparse [1][2][3]. This issue is a critical avenue for inquiry, given that recent studies suggest that US adults as a whole who suffer mental health disorders are at escalated risk for COVID-19 infection, complications, and mortality [4][5][6][7][8][9]. An analysis of electronic health records from 61 million adult patients assessing the impact of a diagnosis within the past year of bipolar disorder, depression, attention-deficit/ hyperactivity disorder (ADHD), and schizophrenia found that a recent psychiatric disorder diagnosis significantly increased risk for COVID-19 infection [6].…”

Depression, aging, and immunity: implications for COVID-19 vaccine immunogenicity

“…The authors reported an association between pre-existing mood disorders and risk of hospitalization (OR = 1.31) and COVID-19–related death (OR = 1.51) but not increased susceptibility to COVID-19 (OR = 1.27) [ 142 ]. A recent systematic review painted an even more concerning picture, estimating a 2–4-fold increased risk of mortality in patients with schizophrenia and 1.5–2-fold greater mortality risk in individuals with MDD [ 143 ].…”

“…Fourth, biological aging has been hypothesized to be accelerated in multiple psychiatric disorders [ 110 , 158 , 159 ] and older age is a risk factor for adverse outcomes after SARS-CoV-2 infection [ 160 , 161 ]. Fifth, psychiatric medications have been proposed as potential moderators of COVID-19 disease severity [ 143 ], although teasing apart the effects of psychiatric disorders from comorbid medical conditions, and the direct pharmacological effect of various classes of anti-depressants, mood-stabilizers, and anti-psychotic medications, is challenging. Sixth, social and lifestyle factors associated with psychiatric illnesses such as substance use [ 162 , 163 ], lack of exercise [ 164 ], sleep disturbance [ 131 ], and social isolation [ 165 ] have all been independently linked with impaired viral immunity or susceptibility to COVID-19, more specifically.…”

Health indicators and poor health dynamics during COVID-19 pandemic

“…The COVID-19 crisis has also been shown to have implications for wellbeing as measured by depressive symptoms (Oyenubi et al, 2021;Posel et al, 2021) and self-assessed health . This is important for the prevalence of depressive symptoms across socioeconomic status during the pandemic since individuals with pre-existing mental health issues have been shown to be at higher risk of hospitalization and death due to COVID-19 (Ceban et al, 2021;De Hert et al, 2021).…”