Written by Lamiece Hassan

In our paper recently published in Molecular Psychiatry, we set out to look at how people with mental illness have been affected by COVID-19. People with mental illness already fare worse in terms of experiencing more physical health problems than average. In fact, it is well-recognised that people with severe mental illnesses can expect a reduction in life expectancy by as much as 15-20 years. But how has COVID-19 affected people with mental illnesses? We aimed to find out whether people with mental illness were more likely to get COVID and, if they caught it, were they at risk of more serious outcomes.

We looked at anonymised patient records from a large sample of older adults (aged 65 years on average) from the UK with different mental illnesses, including 1,925 people with psychotic disorders, such as schizophrenia, 1,483 with bipolar disorder and 41,448 with major depression. We also used records from 402,440 people with no record of having had a mental illness for comparison purposes.

We found that people with psychotic disorders were almost five times more likely to die from COVID-19 and three times more likely to be hospitalised. The odds of dying from COVID-19 were almost four times higher in people with bipolar disorder and twice as high in people with major depressive disorder.

The natural next step might to ask to what extent were underlying physical illnesses responsible for the higher rates we found. We used statistical models that took into account a range of factors, including gender, age, ethnicity, smoking, obesity and the impact of various physical health conditions that people had, such as diabetes and respiratory conditions. Collectively, these factors only partly explained our findings, accounting for just under 50% of the extra risk we saw. This suggests that aside from differences in underlying conditions, there are likely to be other factors at play which haven’t yet been identified.

Our research shows that once again, people with mental illness, and particularly those with schizophrenia, are more likely to be at risk of physical illness. If we don’t proactively protect people with mental illnesses, COVID-19 could further worsen these disparities in physical health. In the short-term, increasing access to vaccination programmes, testing and treatment for COVID-19 could be helpful. Over the longer term, research like ours raises important questions about where these extra risks come from and how to address these broader inequalities in health for people with mental illness.

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