Mental health can play a role in breakthrough COVID infections, study shows

‘In terms of public policy, we need to think of mental health as a really important target in any pandemic’

It’s well understood that breakthrough COVID-19 cases are more likely among individuals with underlying physical health conditions. But mental health also plays an important role in breakthrough infections, even among vaccinated and boosted people, a new study released today from the University of California, San Francisco shows.

Patients over 65 with substance abuse or psychotic disorders including bipolar disorder, adjustment disorder and anxiety faced an increased risk of up to 24% of catching COVID, even after being fully vaccinated, UCSF researchers found in a report published today in the medical peer-review journal JAMA Network Open. People under 65 with these psychiatric conditions also showed an 11% increased risk compared with peers without a psychiatric history.

“Patients with psychiatric disorders have a heightened risk for breakthrough infections,” said Aoife O’Donovan, associate professor in the Department of Psychiatry and Behavioral Sciences at UCSF and senior author of the study. “The causes are multifactorial, but this suggests we need to pay more attention to protecting patients who have pre-existing psychiatric disorders.”

Certain psychiatric disorders such as depression and post-traumatic stress disorder can lead to a higher risk for a host of other physical health problems, such as inflammation and impaired immune function, according to O’Donovan.

But physical, social, behavioral and mental factors all contribute to someone’s individual chances of a breakthrough infection, she explained. That could include experiencing anxiety that causes an individual to express more caution, or the exact opposite if someone copes with stress by engaging in more risky behaviors.

The same group of UCSF researchers found in a study published earlier this year that people with high anxiety and post-traumatic stress disorder were more likely to engage in behavior that increased their exposure to COVID.

“In terms of public policy, we need to think of mental health as a really important target in any pandemic,” said O’Donovan. “People were being imposed with unprecedented layers of stress, which can cause many psychiatric conditions. We need to be prioritizing mental health care no matter what else is going on.”

To complete the study, O’Donovan and her team looked at data from 263,697 participants who had completed their full vaccine series. They also relied on data shared by San Francisco Veterans Affairs. Data in the study was adjusted for age, sex, race, ethnicity and vaccine type. It was also adjusted for behavioral and physical conditions such as smoking, HIV and cancer.

When booster shots were first rolled out and prioritized for certain groups, people with schizophrenia and depression were prioritized. The most recent data shows that additional mental health issues could also put individuals, especially those over age 65, at even greater risk than what was previously understood.

The professor said she hopes policy-makers will plan for future emergencies and health crises with mental health as an important influence on physical health and overall wellbeing.

“Patients with psychiatric disorders have a higher risk for a whole host of other physical health problems. Maybe that’s an under-appreciated aspect of psychiatric disorders,” said O’Donovan. “If we didn’t accept it before, now is the time we really need to start thinking about mental and physical health as interrelated to one another.”

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