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Why COVID poses a greater risk to people with a mental health diagnosis


The CDC recently added people with mental illness to the list of those who should be prioritized for COVID-19 vaccines and boosters. NPR's Rhitu Chatterjee explains why psychiatric disorders put people at higher risk of COVID.

RHITU CHATTERJEE, BYLINE: In the early months of the pandemic, psychiatrist Dr. Luming Li wanted to know if having a mental illness increased people's risk of dying from COVID-19.

LUMING LI: For all the studies that I have looked up, you know, it was all medical conditions of, you know, diabetes, heart disease, etc., etc.

CHATTERJEE: But nothing on mental illness - Li is now the chief medical officer at the Harris Center for Mental Health and IDD in Texas. At the time, she was finishing up a master's degree at Yale, so she decided to explore this herself. She and her colleagues dug into data from five hospitals in the Yale New Haven Health System and looked for people who were hospitalized with COVID-19.

LI: What we found was we had a higher level of mortality for those that had a prior psychiatric history.

CHATTERJEE: In fact, she says, the risk of death increased by 50% for those with a mental illness compared to those without. There have been many studies since that have found a similar connection, including one published in October 2020 that looked at a nationwide database of electronic health records with information on people who tested positive for COVID and those who were hospitalized. It found that there are two things going on.

NORA VOLKOW: If individuals have had a history of a mental disorder, they were more likely, on the one hand, to get infected.

CHATTERJEE: Study author Dr. Nora Volkow.

VOLKOW: And if they got infected, then they were more likely to have negative outcomes, such as hospitalization and death.

CHATTERJEE: Volkow directs the National Institute on Drug Abuse. She says mental illnesses change people's behaviors, which can make them less likely to protect themselves from an infection.

VOLKOW: For example, attention deficit hyperactivity disorder - that leads you to be much more distracted. You may forget, for example, to use your face mask.

CHATTERJEE: The electronic health records also confirmed something that researchers have known for a long time about people with mental illness, that they tend to have poorer overall health and many chronic health problems like obesity, heart disease, diabetes, diseases that we know also increase risk of serious COVID.

ASHWIN VASAN: People who live with chronic mental illness have shortened life spans up to 25 years compared to the general population.

CHATTERJEE: Dr. Ashwin Vasan is the president and CEO of Fountain House, a mental health nonprofit.

VASAN: They suffer prematurely from chronic illnesses, medical neglect.

CHATTERJEE: Vasan says people with mental illness are among the most isolated in society. And that isolation takes an immense toll on their bodies, putting them at a higher risk of chronic illnesses.

VASAN: Study after study showing that it leads to inflammation, immunologic stress, neurodegenerative decline.

CHATTERJEE: He says there's also a clear overlap between serious mental illness and homelessness and substance abuse.

VASAN: About 40% of our chronically homeless population has serious mental illness and addiction.

CHATTERJEE: Most of the 13 million people with serious mental illness in the U.S., he says, are on Medicaid, but 40% have no access to care at all.

VASAN: This is a systematically marginalized, sicker population that has less access to care and supports.

CHATTERJEE: Vasan and other mental health experts are glad to see the CDC finally prioritizing people with mental illness for COVID-19 vaccination, something they say should have happened a long time ago.

Rhitu Chatterjee, NPR News.

(SOUNDBITE OF MUSIC) Transcript provided by NPR, Copyright NPR.

Rhitu Chatterjee is a health correspondent with NPR, with a focus on mental health. In addition to writing about the latest developments in psychology and psychiatry, she reports on the prevalence of different mental illnesses and new developments in treatments.