Numerous studies have found that people with serious mental illness (SMI) are disproportionately impacted by COVID-19. A report in Schizophrenia Bulletin now suggests that people with schizophrenia and/or bipolar disorder may remain at elevated risk of death from the virus compared with people without mental illness regardless of the availability of COVID-19 vaccines.
“[D]espite population vaccination efforts that have prioritized people with SMI—and significantly higher vaccination uptake in some SMI groups—disparities still remain in COVID-19 mortality for people with SMI compared [with] the general population,” wrote Lamiece Hassan, Ph.D., of the University of Manchester and colleagues.
For the study, Hassan and colleagues relied on data from the Greater Manchester Care Record—an electronic health record that includes details of primary care visits, hospital stays, and deaths of more than 3 million residents of Manchester, United Kingdom. The researchers compared COVID-19 mortality in three overlapping samples of patients with SMI aged 18 years and older—those with schizophrenia, bipolar disorder, and/or major depressive disorder—from February 1, 2020, through September 30, 2021. (In England, the NHS started administering COVID-19 vaccinations to patients with SMI on December 8, 2020, according to Hassan and colleagues.) Participants were followed up for up to 20 months and their outcomes were compared with people of similar age and sex who did not have a history of mental illness.
The study included 48,912 people with a diagnosis of schizophrenia, 13,932 with bipolar disorder, 152,489 with major depressive disorder, and 773,734 without a history of mental illness. A total of 5,442 participants died due to COVID-19 during the study observation period: 1,083 had schizophrenia, 136 had bipolar disorder, 926 had major depressive disorder, and 3,570 had none of these.
When compared against their respective matched control groups without mental illness, COVID-19 mortality rates were significantly higher among people with schizophrenia (Risk Ratio [RR]: 3.18), bipolar disorder (RR: 2.69), and major depressive disorder (RR: 1.59). After adjusting for vaccination status, demographics, and comorbidities, the researchers found that the risk ratios for COVID-19 related mortality were reduced but remained significantly associated with schizophrenia (RR: 1.61) and bipolar disorder (RR: 1.92), but not major depressive disorder. Compared with being unvaccinated, having received two COVID-19 vaccines was significantly associated with lower risk for COVID-19 mortality among people with schizophrenia and major depressive disorder, but not bipolar disorder, the authors noted.
“These findings strengthen the case for addressing the life-shortening, physical health needs of people with mental illnesses and continued research into the source of vulnerability to COVID-19 to protect these groups from further health disparities,” the authors wrote.
For related information, see the Psychiatric News articles “COVID-19 Greatly Increases Mortality Risk for Schizophrenia Patients, Research Shows” and “Patients With MH Disorders Found More Susceptible to COVID-19, Death.”