Mental illness linked to COVID-19 breakthrough infection
Mental illness linked to COVID-19 breakthrough infection

Mental illness linked to COVID-19 breakthrough infection

Psychiatric disorders are linked to an increased risk of COVID-19 breakthrough infection, especially among older adults, new research shows.

“Psychiatric disorders remained significantly associated with incident breakthrough infections in addition to sociodemographic and medical factors, suggesting that mental health is important to consider in relation to other risk factors,” the investigators, led by Aoife O’Donovan, PhD, University of California, San Francisco, write.

Individuals with psychiatric disorders “should be prioritized for booster vaccinations and other critical prevention efforts, including increased SARS-CoV-2 screening, public health campaigns, or COVID-19 discussions during clinical treatment,” they add.

The study was published online April 14 at JAMA network open.

Elderly most vulnerable

The researchers reviewed the records of 263,697 veterans who were fully vaccinated against COVID-19.

Just over half (51.4%) had one or more psychiatric diagnoses within the last 5 years, and 14.8% developed breakthrough COVID-19 infections, confirmed by a positive SARS-CoV-2 test.

Psychiatric diagnoses among veterans included depressionpost-traumatic stress, anxiety, adjustment disorder, substance abuse disorder, bipolar disorderpsychosis, attention deficit hyperactivity disorder (ADHD), dissociation and eating disorders.

In the pooled sample, a history of any psychiatric disorder was associated with a 7% higher incidence of breakthrough COVID-19 infection in models adjusted for potential confounders (adjusted relative risk [aRR]1.07; 95% CI, 1.05-1.09) and a 3% higher incidence in models further adjusted for underlying medical comorbidities and smoking (aRR, 1.03; 95% CI, 1.01-1.05).

Most psychiatric disorders were associated with a higher incidence of breakthrough infection, with the highest relative risk observed for substance abuse disorders (aRR, 1.16; 95% CI, 1.12 -1.21) and adjustment disorders (aRR, 1.13; 95) % CI, 1.10- 1.16) in fully adjusted models.

Elderly vaccinated veterans with psychiatric illnesses appear to be most vulnerable to COVID-19 gene infection.

In veterans aged 65 years and older, all psychiatric disorders were associated with an increased incidence of breakthrough infection, with increases in incidence from 3% to 24% in fully adjusted models.

In the younger veterans, on the other hand, only anxiety, adaptation, and substance abuse disorders were associated with an increased incidence of breakthrough infection in fully adapted models.

Psychotic disorders were associated with a 10% lower incidence of breakthrough infection among younger veterans, perhaps due to greater social isolation, the researchers say.

Risky behavior or impaired immunity?

“While some of the larger observed effect sizes are compelling at the individual level, even the relatively modest effect sizes can have a large effect at the population level when considering the high incidence of psychiatric disorders and the global reach and extent of the pandemic,” O’Donovan and colleagues write. .

They note that psychiatric disorders, including depression, schizophrenia, and bipolar disorder, have been linked to decreased cellular immunity and blunt response to vaccines. Therefore, it is possible that people with psychiatric disorders have a poorer response to COVID-19 vaccination.

It is also possible that immunity after vaccination decreases faster or stronger in people with psychiatric disorders, and they may have less protection against new variants, they add.

Patients with psychiatric disorders could be more likely to engage in risky behaviors to contract COVID-19, which may also increase the risk of breakthrough infection, they say.

The study was supported by a UCSF Department of Psychiatry Rapid Award and the UCSF Faculty Resource Fund Award. O’Donovan does not report any relevant information.

JAMA Network Open. Published online April 14, 2022. Full text.

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