Patients with COVID-19, who also had post-traumatic stress disorder (PTSD), were more likely to die or be hospitalized than those without a psychiatric disorder. And for patients with other mental illnesses, the risks were significantly higher.
Researchers from UC San Francisco and the San Francisco VA Health Care System found that veterans with PTSD had an 8% increased risk of death if they had COVID and a 9% increased risk of hospitalization, compared to patients with the virus and no psychiatric disorder . diagnosis, adjustment for age, gender, race, and co-occurring medical conditions.
The researchers also quantified the risks for patients with other psychiatric disorders, confirming findings from other studies. Those with psychosis had a 58% increased risk of death and a 66% increased risk of hospitalization, compared to those with no psychiatric diagnosis, the researchers reported in their study, published in Translational Psychiatry on Nov. 22, 2022.
For people with bipolar disorder, the increased risks of death and hospitalization were 29% and 46%, respectively, and for major depression, they were 13% and 21%, respectively.
Led by first author Kristen Nishimi, PhD, of the UCSF Department of Psychiatry and Behavioral Sciences, and the Mental Health Service of the San Francisco VA Health Care System, the researchers tracked data from more than a quarter of a million veterans serving in the United States. were registered. The Department of Veterans Affairs health service, who had tested positive for COVID between February 2020 and August 2021, with most cases occurring before the vaccine. Overall, 6% of veterans had died and 15% had been hospitalized within 60 days of testing positive.
The average age of the veterans was 60 and 90% were male. Some 26% had PTSD and another 28% had another psychiatric diagnosis.
To eliminate the effects of any confounding variables, the researchers compared veterans with each mental disorder to veterans with no psychiatric disorder, adjusting for age, gender, race and ethnicity. In addition, they were adjusted for co-occurring medical conditions, including diabetes, cancer and HIV, and cardiovascular, lung, kidney and liver diseases, as well as factors such as smoking and obesity.
PTSD can be milder, better managed in older vets
Surprisingly, the PTSD group outperformed patients with all other psychiatric disorders, including adjustment disorder, anxiety and alcohol use and substance use disorders.
“PTSD is routinely screened in the VA Health Care System, so it can be more reliably detected, even for minor cases, compared to other psychiatric conditions,” said Nishimi, who is also affiliated with the UCSF Weill Institute for Neurosciences. “Older veterans, who may have been diagnosed with PTSD many years ago and have chronic PTSD, may have symptoms that are relatively less severe or more manageable,” she said, noting that PTSD in patients under age 65 with COVID had worse outcomes than in older patients (16% higher risk of hospitalization compared to 6% for the over-65 cohort).
The researchers also found that patients with a substance use disorder or alcohol use disorder were significantly more likely to be hospitalized for COVID: 62% and 45%, respectively. But the mortality rates were about the same as those with no psychiatric diagnosis, indicating that a lack of caregiver or social support and an increased incidence of homelessness may be driving these higher hospitalization rates.
Concomitant conditions explain worse outcome – but not fully
The number of deaths and hospitalizations was significantly higher when the researchers did not account for co-occurring medical conditions. For example, when patients with PTSD were compared to those without psychiatric disorders, adjusted only for age, sex, race and ethnicity, they had a 13% higher risk of death from COVID. This compares to an 8% higher risk when other medical conditions and smoking and obesity are taken into account.
Consistent with previous evidence, this suggests that unhealthy habits such as physical inactivity, poor diet and smoking, as well as co-occurring medical conditions, may contribute to poorer COVID outcomes for patients with PTSD and other mental illnesses.
Other mechanisms that may explain higher risks for patients with mental illness include increased inflammation and dysregulated immune function, said senior author Aoife O’Donovan, PhD, also of the UCSF Department of Psychiatry and Behavioral Sciences, and of the San Francisco VA. Health Care System. “Psychological stress due to the pandemic in general, or the experience of the SARS-CoV-2 infection itself, may have exacerbated psychiatric symptoms, which could influence the inflammatory response. In addition, PTSD can accelerate cellular aging, shortening telomeres, increasing the risk of age-related diseases,” she said.
“While other psychiatric conditions have been linked to comorbidities, inflammation and health risk behaviors, PTSD in particular is characterized by lower levels of the stress hormone cortisol, which has anti-inflammatory properties that may be beneficial in reducing the inflammatory activity underlying many adverse consequences of COVID.”
The study follows previous research showing that COVID patients with mental illness were more likely to experience breakthrough COVID.
Co-authors: Daniel Bertenthal, MPH, of the San Francisco VA Health Care System; Thomas C. Neylan, physician; Emily A. Dolsen, PhD; and Karen H. Seal, MD, of UCSF and the San Francisco VA Health Care System.
Funding: Department of Veterans Affairs and UCSF (see document for more details).