Summary: People with PTSD had a 9% higher risk of hospitalization and an 8% higher risk of death after contracting COVID-19 than people without the disorder. Those with psychosis had a 58% increased risk of death associated with COVID-19, and those with bipolar disorder had a 29% increased risk of dying from coronavirus.
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A new study shows that COVID-19 patients who also had post-traumatic stress disorder (PTSD) were more likely to die or be hospitalized than those without a psychiatric disorder. For patients with other mental illnesses, the risks were substantially 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 with patients with the virus and without psychiatric care. diagnosis, adjusting for age, sex, race, and concurrent medical conditions.
The researchers also quantified the risks for patients with other psychiatric disorders, corroborating findings from other studies.
People with psychosis had a 58% increased risk of death and a 66% increased risk of hospitalization, relative to people without psychiatric diagnoses, the researchers reported in their study, which was published in translational psychiatry on November 22, 2022.
For those 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, Ph.D., of the UCSF Department of Psychiatry and Behavioral Sciences and the San Francisco VA Health Care System Mental Health Service, the researchers tracked data from more than a quarter of million veterans enrolled in US Department of Veterans Affairs health care services who tested positive for COVID between February 2020 and August 2021, with the majority of cases occurring before the vaccine. In all, 6% of the veterans had died and 15% had been hospitalized within 60 days of testing positive.
The average age of the veterans was 60 years and 90% were men. Twenty-six percent had PTSD and another 28% had a different psychiatric diagnosis.
To remove the effects of any confounding variables, the researchers compared veterans with each mental health disorder with veterans without a psychiatric disorder, adjusting for age, gender, race, and ethnicity.
In addition, they adjusted for co-occurring medical conditions, such as diabetes, cancer, and HIV, and cardiovascular, pulmonary, renal, and liver diseases, as well as factors such as smoking and obesity.
PTSD may be milder and better managed in older veterans
Surprisingly, the PTSD group fared better than patients with all other psychiatric disorders, which also included adjustment disorder, anxiety, and alcohol use and substance use disorders.
“PTSD is routinely evaluated in the VA Health Care System, so it can be more reliably detected for even less severe cases, compared to other psychiatric conditions,” said Nishimi, who is also affiliated with the Weill Institute. of Neurosciences at UCSF.
“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 better managed,” he said, noting that PTSD in COVID patients younger than 65 produced worse results than in older patients. patients (16% increased risk of hospitalization compared to 6% for the 65+ cohort).
The researchers also found that patients with alcohol or substance use disorder were significantly more likely to be hospitalized for COVID: 62% and 45%, respectively. But death rates were about the same as those without a psychiatric diagnosis, indicating that a lack of a caregiver or social support and a higher incidence of homelessness could be driving these higher hospitalization rates.
Concurrent conditions explain the worst result, but not completely
The number of deaths and hospitalizations was markedly 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, adjusting only for age, gender, race, and ethnicity, they had a 13% increased risk of death from COVID. This compares with an 8% increased risk when other medical conditions and smoking and obesity were 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 worse COVID outcomes for people with PTSD and other mental illnesses.
Other mechanisms that could explain the increased risks for mentally ill patients include elevated inflammation and dysregulated immune function, said lead author Aoife O’Donovan, Ph.D., also of the UCSF Department of Psychiatry and Behavioral Sciences. and the San Francisco Veterans Health Care System.
“The psychological stress of the pandemic in general, or the experience of SARS-CoV-2 infection itself, may have exacerbated psychiatric symptoms, potentially affecting the inflammatory response. Additionally, PTSD can accelerate cellular aging by shortening telomeres, which increases the risk of age-associated diseases,” he 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 activity. inflammation that underlies many adverse reactions. COVID results.
The study follows previous research showing that mentally ill COVID patients were more likely to experience a COVID outbreak.
Study co-authors include Daniel Bertenthal, MPH, of the San Francisco VA Health Care System; Dr. Thomas C. Neylan; Emily A. Dolsen, MD; and Karen H. Seal, MD, of UCSF and the San Francisco VA Health Care System.
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About this research news on mental health, PTSD and COVID-19
Author: press office
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Contact: Press Office – UCSF
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original research: Open access.
“Post-traumatic stress disorder and risk of hospitalization and death after COVID-19 infection” by Kristen Nishimi et al. translational psychiatry
Summary
Post-traumatic stress disorder and risk of hospitalization and death after COVID-19 infection
Post-traumatic stress disorder (PTSD) is associated with increased risk of physical illness and early mortality.
However, we do not know if the risk of adverse outcomes from coronavirus disease 2019 (COVID-19) is also increased.
In this retrospective cohort study, we examined the associations of PTSD and other psychiatric disorders with risk of hospitalization and death within 60 days of COVID-19 infection in 228,367 US Department of Veterans Affairs (VA) patients. who tested positive for COVID-19 between February 2020 and August 2021 (age m = 60.6, 89.5% male).
Generalized linear models estimated the associations of PTSD and other psychiatric disorders with outcomes after a positive SARS-CoV-2 test, adjusting for sociodemographic, medical, and behavioral factors.
Among 228,367 VA patients, 25.6% had PTSD and 28.2% had a psychiatric disorder other than PTSD. In the 60 days after a positive COVID-19 test, 15% of patients were hospitalized and 6% died. Patients with PTSD were at increased risk of both hospitalization (adjusted relative risk, ARR = 1.18, 95% CI 1.15–1.21) and death (ARR = 1.13, 95% CI 1, 08–1.19) in relation to those without psychiatric disorders, adjusting for sociodemographics.
The estimates remained significant when the models were further adjusted for medical comorbidities and smoking. Patients with other psychiatric disorders were also at increased risk of adverse outcomes from COVID-19, with effect sizes larger than PTSD in older patients (≥65 years) but not in younger patients.
In this large-scale study of VA patients, people with PTSD and other psychiatric disorders had a higher vulnerability to serious adverse outcomes from COVID-19; therefore, people with PTSD should also be considered at higher risk for severe COVID-19 outcomes and potentially prioritized for early vaccination, screening, and treatment intervention for COVID-19.
