A history of certain psychiatric disorders may predispose fully vaccinated COVID-19 survivors to re-infection, according to a examination of 263,697 U.S. veterans published yesterday in JAMA Network Open.
Researchers from the San Francisco Veterans Affairs (VA) Health Care System and the University of California retrospectively analyzed the administrative and electronic health records of U.S. veterans who completed their primary COVID-19 vaccine series at least 14 days earlier from February 20, 2020 to November 16. 2021. Patients had received the Pfizer / BioNTech, Moderna or Johnson & Johnson vaccine.
The mean age was 66.2 years, 90.8% were male, 70.1% were white, 20.5% were black, 8.3% were Hispanic, 9.3% were of other or unknown race, 51.4% had one or more psychiatric diagnoses and 14.8% were re-infected.
Psychiatric disorders included depression, post-traumatic stress disorder, anxiety, adjustment disorder, substance abuse disorder, bipolar disorder, psychosis, attention deficit hyperactivity disorder, dissociation and eating disorders within the last 5 years. Psychiatric disorders were more common in patients under 65 years of age than in their older peers (65.6% versus 43.0%).
Lower risk among younger people
A history of any psychiatric disorder was linked to a 7% higher incidence of COVID-19 reinfection in models adjusted for potential confounders and to a 4% increased incidence in models further adjusted for underlying diseases and smoking.
In fully adapted models, most psychiatric disorders were associated with an increased incidence of reinfection, with the highest risk of substance abuse disorders (adjusted relative risk [aRR]1.16) and for adaptive disorder (aRR, 1.13).
The risk of COVID-19 re-infection was 24% higher for patients aged 65 and older with substance abuse, 23% higher for those with psychotic disorders, 16% for bipolar disorder, 14% for adaptive disorders and 12% for anxiety.
Patients with chronic kidney disease had an increased risk of re-infection of 23% compared with 20% for HIV, 19% for cardiovascular disease, 18% for chronic obstructive pulmonary disease (COPD) and 13% for sleep apnea.
This indicates that elderly patients with certain psychiatric conditions face risks on a par with other medical conditions, said senior author Aoife O’Donovan, PhD, of San Francisco VA, at a University of California, San Francisco. news release. “Mental health is important to consider in conjunction with other risk factors,” she said.
Stratification of the sample at age 65 revealed that associations between psychiatric diagnoses and COVID-19 reinfection were seen in both age groups: 15.9% in those younger than 65 years versus 14.2% in older patients. The compounds were strongest in elderly patients after adjustment for chronic disorders and smoking.
Fully fitted models, however, showed that younger people with psychiatric disorders had a 10% lower incidence of COVID-19 reinfection than those without such a diagnosis.
All disorders except bipolar and psychotic disorders in younger patients were also associated with an increased incidence of re-infection when adjusted for potential confounders, but no longer seen associations for depression, post-traumatic stress and alcohol consumption when adjusting for underlying diseases, obesity, and smoking.
O’Donovan said the lower risk of re-infection among younger versus older people may be due to lower socialization among younger people with psychotic disorders compared to older people who “may be less socially isolated due to their greater burden of ill health and contact with nursing staff. “
Fully adjusted models among elderly patients showed that any psychiatric disorder (aRR, 1.05) and all disorders except post-traumatic stress and alcohol abuse remained associated with an increased incidence of COVID-19 reinfection.
Psychotic disorders were associated with a lower incidence of reinfection among younger patients (aRR, 0.90), but a higher incidence in the older group (aRR, 1.23), although only 2.8% of the sample had a psychotic disorder ( 3.6% among younger patients and 2.3% in the older group).
Decreasing vaccine immunity, new varieties
Before vaccines were widely available, people with psychiatric disorders had an increased risk of COVID-19 infection, hospitalization and death, the researchers noted. And COVID-19 reinfections among the fully vaccinated are relatively common today due to declining vaccine-generated immunity, incomplete vaccination coverage, and the emergence of SARS-CoV-2 variants that can escape immunity, they added.
Risk factors for COVID-19 infection among people with psychiatric disorders include impaired immune function, poor response to vaccines, more risky behaviors that can lead to virus transmission, and high rates of underlying medical conditions such as COPD, cardiovascular disease, and diabetes, which f as well as health-compromising behaviors such as smoking, the authors said.
“It is possible that post-vaccination immunity declines faster or stronger for people with psychiatric disorders, and / or they may have less protection against newer variants,” O’Donovan said.
The authors said that the increased incidence of re-infection among people with psychiatric disorders was not completely explained by sociodemographic factors, vaccine type or timing, chronic conditions, obesity or smoking.
“Psychiatric conditions may be a risk factor for an increased incidence of breakthrough infection independent of these other factors,” the researchers wrote.
“Our results suggest that individuals with psychiatric disorders … should be prioritized for booster vaccinations and other critical preventive measures, including increased SARS-CoV-2 screening, public health campaigns, or COVID-19 discussions during clinical treatment.”