Evidence was found that individuals with mental health disorders had worse outcomes from COVID-19 compared with the general population. These results of an umbrella review were published in BMC Psychiatry.
Investigators from the World Health Organization (WHO) Collaborating Centre for Research and Training in Mental Health and Service Evaluation searched publication databases from inception through October 2021 for systematic reviews evaluating physical health outcomes from COVID-19 depending on mental health status.
A total of 9 reviews, 5 of which included meta-analyses, were included in this review.
For patients with any mental health disorder, 1 study reported a significantly higher risk for contracting SARS-CoV-2 (odds ratio [OR], 1.71). Stratified by type of mental disorder, the risk for COVID-19 remained elevated among patients with a mood disorder (OR, 2.02) or an anxiety disorder (OR, 1.63) but not for those with schizophrenia spectrum disorders (OR, 1.72; 95% CI, 0.62-4.77). Conversely, data from another study did not find an association between mood disorders and SARS-CoV-2 infection (OR, 1.50; 95% CI, 0.75-2.99).
Severe COVID-19 illness was reported to be more likely among patients with any mental disorder in 2 meta-analyses (OR range, 1.32-1.77). However, stratified by type of mental disorder, data were conflicting. For example, 1 study found a significant relationship between severe disease and mood disorders (OR, 1.34) whereas 2 others did not (OR range, 0.99-1.27). The 2 studies which evaluated the relationship between schizophrenia spectrum disorders and severe COVID-19 did not report significant associations.
With regard to COVID-19 mortality, all 4 meta-analyses that examined this outcome reported significant positive associations (OR range, 1.38-1.52). Mortality associated with COVID-19 was significantly related with mood disorders in all 3 analyses (OR range, 1.36-1.57) and both analyses evaluating schizophrenia spectrum disorders (OR range, 1.68-2.28). Conversely, neither study relating mortality with anxiety disorders reported significant findings.
The limitations of this review included the overall paucity of data, the lack of data from low- and middle-income countries, and the fact that depression and bipolar disorders were combined into a single “mood disorder” group.
Review authors concluded, “The COVID-19 pandemic has affected people with preexisting mental disorders more severely than people without in terms of physical health. People with preexisting mental disorders, and especially those with mood or schizophrenia spectrum disorders, should have been considered at risk of severe course and increased mortality from COVID-19, similar to other identified risk groups such as patients with somatic health conditions.”
Bertolini F, Witteveen AB, Young S, et al. Risk of SARS-CoV-2 infection, severe COVID-19 illness and COVID-19 mortality in people with pre-existing mental disorders: an umbrella review. BMC Psychiatry. 2023;23(1):181. doi:10.1186/s12888-023-04641-y