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People With Mental Illness at High Risk for COVID-19 Complications

The CDC says depression, schizophrenia and more are eligible for vaccine boosters

cutout illustration of a persons head showing their brain and covid cells floating outside

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Millions of Americans who suffer from depression, other mood disorders or schizophrenia now have something in common with those who have cancer, diabetes or obesity: They are officially at high risk for being hospitalized or dying from COVID-19, according to the Centers for Disease Control and Prevention (CDC).

The CDC recently added the mental health disorders to its list of more than a dozen conditions linked to severe COVID-19, which already included people with substance abuse problems and neurological conditions such as dementia. The change means that people with mental illness are now among the high-risk groups that qualify for vaccine booster shots, regardless of their ages or jobs. And those who are still unvaccinated are on notice that the vaccine is especially important for them.

This update to the list applies to a huge group of people: More than 19 million U.S. adults have had a major depressive episode, 7 million have symptoms of bipolar disorder and 1.5 million experience schizophrenia in a year, according to the National Alliance on Mental Illness (NAMI). 

Advocates pushed for and now are applauding the change. In a letter signed by 16 mental health organizations, including the American Psychological Association and the American Psychiatric Association, executives wrote that “this new guidance by the CDC directing public health officials to prioritize those with mental health conditions identified as high risk for severe illness or death due to COVID‐19 will have a drastic impact on survival rates, with only modest public investment needed.”

They also noted that the CDC’s underlying-condition list is used by many communities “to allocate scarce resources … to target outreach, for eligibility to access booster shots, for services and housing and other important benefits, and we encourage them to do so as quickly as possible.” 

Lisa Dailey, the executive director of the Treatment Advocacy Center, which advocates for people with severe mental illnesses and was among those strongly supporting the CDC move, says it became increasingly evident that the additions to the list were necessary as more studies came out showing a link between mental illnesses and COVID-19 complications: [The studies] “just made us more and more concerned that this population isn't receiving the prioritization that they need, and that is warranted by the research.”

It’s not just about getting them priority access to the COVID-19 booster shot, Dailey adds. It’s also important for raising awareness: “If people in this group don't know that they're at increased risk, they won't take extra precautions” to avoid infection.  

The studies  

One of the studies considered by the CDC found that patients with mental illness were about one-third more likely to die from COVID-19 than those without mental illness. The study, published in JAMA Psychiatry in July, pointed toward a particularly high risk in those with bipolar disorder and schizophrenia. A second study from the same journal last month pooled results from 21 previous studies of 91 million people and found no increase in infection rates, but significantly more COVID-19-related hospitalizations and deaths among those who had been diagnosed with depression or other mood disorders before they contracted COVID-19 compared to those without a mood disorder. Led by researchers from the University of Toronto, investigators speculated on the reasons, noting that some people with mood disorders also have immune system problems. They also have elevated rates of obesity, heart disease, smoking and substance abuse, all of which increase COVID-19 risks. Poverty, poor health care access, lack of sleep, lack of exercise and group living situations might also play roles, they wrote.

Anxiety is another common mental condition that might be linked with poor COVID-19 outcomes. A recent study from the CDC found that "anxiety and fear-related disorders” were strongly associated with death among hospitalized patients — but researchers wrote that it was possible that anxiety caused by COVID-19 itself might be at least partly to blame. More research on the possible anxiety link is needed, the researchers said.


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Why the higher risk

While noting that those facing poverty and the other problems mentioned above are certainly likely to be more vulnerable to COVID-19-related hospitalization and death, Crystal Clark, M.D., associate professor of psychiatry and behavioral sciences at Northwestern University Feinberg School of Medicine, says there may be other reasons that people with mental illnesses might be at risk.

She surmises that the cause may at least in part be related to how COVID-19 affects the brain, which scientists still don’t quite understand. But, she says, “The COVID virus attacks the central nervous system... and anything that attacks the central nervous system is hitting your brain. That’s where your emotions are controlled and your mood is managed.”

Clark suspects that while mental health problems might worsen COVID-19, COVID-19 might also worsen mental health problems. “Something is happening in these different regions of the brain that leads to changes in emotions," she says. "We are seeing changes in mood for people who have never had mood symptoms, so for those who have a mental illness, you can see how that could add fuel to the fire or be a trigger for an episode or a worsening.”

Advocates, however, say that answering “why” there’s an apparent connection between mental illness and COVID-19 complications is less important — at least in the midst of a public health crisis — than addressing the problem. “Why would schizophrenia have anything to do with an increased mortality risk?” Dailey asks, rhetorically. “We may not know the answer to that question, but we do know that it exists .... It’s just one of those things where if you follow the science, it's clear what you need to do.”

Kim Painter is a contributing writer who specializes in health and psychology. She frequently writes for AARP's Staying Sharp and previously worked as a health reporter and columnist at USA Today.

Christina Ianzito is the travel and books editor for aarp.org and AARP The Magazine and also edits and writes health, entertainment and other stories for aarp.org. She received a 2020 Lowell Thomas Award for travel writing.