Summary: People with PTSD had a 9% increased risk of hospitalization and an 8% increased risk of death after contracting COVID-19 compared to people without the disorder. People 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 the coronavirus.
A new study shows that 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. 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 without a psychiatrist diagnosis, taking into account age, sex, race and concurrent medical conditions.
The researchers also quantified the risks for patients with other psychiatric disorders, corroborating the results of other studies.
People with psychosis had a 58% increased risk of death and a 66% increased risk of hospitalization, compared to those without a 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, Ph.D., of UCSF’s Department of Psychiatry and Behavioral Sciences, and the Mental Health Service of the San Francisco VA Health Care System, researchers tracked the data of more than a quarter of a million veterans registered with the U.S. Department of Veterans Affairs Health Services, who had tested positive for COVID between February 2020 and August 2021, with most cases occurring before the vaccine. A total of 6% of veterans had died and 15% had been hospitalized within 60 days of testing positive.
The average age of veterans was 60 and 90% were male. About 26% had PTSD and a further 28% had a different psychiatric diagnosis.
To eliminate the effects of any confounding variables, the researchers compared veterans with each mental health disorder to veterans without a psychiatric disorder, adjusting for age, gender, race, and ethnicity.
Additionally, they were adjusted for co-occurring medical conditions, including diabetes, cancer and HIV, and cardiovascular, lung, kidney and liver disease, as well as factors such as smoking and obesity.
PTSD may be milder and better managed in older vets
Surprisingly, the PTSD group fared better than patients with all other psychiatric disorders, which also included adjustment disorders, anxiety, alcohol use, and substance use disorders .
“PTSD is routinely screened for in the VA health care system, so it can be detected more reliably even in milder cases, compared to other psychiatric disorders,” 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 relatively less severe or better managed symptoms,” she said, noting that PTSD in patients younger than 65 with COVID has shown poorer results than in older people. patients (risk of hospitalization 16% higher compared to 6% for the cohort aged 65 and over).
The researchers also found that patients with substance or alcohol use disorders were significantly more likely to be hospitalized with COVID: 62% and 45%, respectively. But death rates were about the same as those without a psychiatric diagnosis, indicating that a lack of caregiver or social support and an increased incidence of homelessness may be behind these higher hospitalization rates. students.
Concomitant conditions explain worse outcomes, but not completely
The number of deaths and hospitalizations was significantly higher when the researchers did not take co-occurring medical conditions into account. For example, when patients with PTSD were compared to those without psychiatric disorders, adjusting 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, smoking and obesity were taken into consideration.
Consistent with previous evidence, this suggests that unhealthy habits like physical inactivity, poor diet, and smoking, along with co-occurring medical conditions, may contribute to worse COVID outcomes for patients with PTSD and other illnesses. mental.
Other mechanisms that could explain higher risks for patients with mental illness include elevated inflammation and dysregulated immune function, said lead author Aoife O’Donovan, Ph.D., also from the Department of Psychiatry and of Behavioral Sciences from UCSF, and the San Francisco VA Health Care System.
“The psychological stress of the pandemic as a whole, or the experience of SARS-CoV-2 infection itself, may have exacerbated psychiatric symptoms, which could affect the inflammatory response. Additionally, PTSD can accelerate cellular aging, shorten telomeres, thereby 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 that underlies many of the adverse outcomes of COVID.
The study follows previous research that shows COVID patients with mental illness were more likely to experience a COVID breakthrough.
Study co-authors include Daniel Bertenthal, MPH, of the San Francisco VA Health Care System; Thomas C. Neylan, MD; Emily A. Dolsen, Ph.D.; and Karen H. Seal, MD, of UCSF and the San Francisco VA Health Care System.
About this research news on mental health, PTSD and COVID-19
Author: Press office
Contact: Press office – UCSF
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Original research: Free access.
“Post-traumatic stress disorder and the risk of hospitalization and death from COVID-19 infection” by Kristen Nishimi et al. Translational psychiatry
Post-traumatic stress disorder and risk of hospitalization and death from COVID-19 infection
Post-traumatic stress disorder (PTSD) is associated with an increased risk of physical illnesses and early mortality.
However, we do not know if it also increases the risk of adverse effects from coronavirus disease 2019 (COVID-19).
In this retrospective cohort study, we examined the associations of PTSD and other psychiatric disorders with the risk of hospitalization and death within 60 days of COVID-19 infection in 228,367 US Department of Veterans Affairs patients. (VA) who tested positive for COVID-19 between February 2020 and August 2021 (age m=60.6, 89.5% male).
Generalized linear models estimated 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% suffered from PTSD and 28.2% suffered from a psychiatric disorder other than PTSD. Within 60 days of a positive COVID-19 test, 15% of patients were hospitalized and 6% died. Patients with PTSD had an increased risk of hospitalization (adjusted risk ratio, ARR=1.18, 95% CI 1.15-1.21) and death (ARR=1.13, 95% CI 1 .08-1.19) compared to those without psychiatric disorders, adjusting for socio-demographic.
The estimates remained significant when the models were further adjusted for medical comorbidities and smoking. Patients with other psychiatric disorders also had an increased risk of adverse COVID-19-related outcomes, with larger effect sizes than PTSD in older (≥65) but not younger patients.
In this large-scale study of VA patients, people with PTSD and other psychiatric disorders had an increased vulnerability to serious adverse effects of COVID-19; thus, individuals with PTSD should also be considered at higher risk for severe COVID-19 outcomes, and potentially prioritized for vaccination, screening, and early therapeutic intervention for COVID-19.
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