CDC Says Mental Health Disorders Pose High Risk for COVID-19

The Centers for Disease Control and Prevention (CDC) recently added certain mental health disorders to its list of medical conditions that put people at high risk for severe COVID-19.

The list, updated on October 14, now includes schizophrenia spectrum disorders and mood disorders like depression. The addition means that millions of Americans can qualify for a COVID-19 booster based on their mental health diagnosis.

In 2019, an estimated 19.4 million U.S. adults had at least one major depressive episode, according to the National Institute of Mental Health. Schizophrenia is less common than other mental disorders, but still affects about 20 million people worldwide, according to the World Health Organization. Studies suggest that schizophrenia and bipolar disorders present the highest risk of COVID-19 mortality among other mental disorders.

Lockdowns and social distancing have taken a toll on people's mental health. But new research shows that people with mental health disorders are also at higher risk of contracting COVID-19.

“It’s not just a one-way action. A mental disorder increases risk for COVID-19,” Rong Xu, PhD, director of the center for AI in drug discovery at Case Western Reserve University’s School of Medicine, tells Verywell. “COVID-19, or the pandemic, can also increase the risk of mental disorders.”

In a study co-authored by Xu, researchers found that 18% of COVID-19 patients experienced depression in their lifetime and 9.7% had a recent depression diagnosis. Less than 1% of the patients had a lifetime or recent diagnosis of schizophrenia.

This study relied on electronic health records and offered insights on the association between mental health conditions and higher risk of COVID-19. But researchers were unable to confirm direct causality.

Social and Biological Connections Between COVID-19 and Mental Health

Different mental disorders may affect the risk of contracting COVID-19 in various ways. 

People with depression may experience a lack of motivation and neglect to partake in preventative measures against COVID-19 or seek treatment when necessary, according to the study. Those struggling with schizophrenia may experience delusional thinking that might lead them to oppose wearing a face mask. 

Patients with any mental disorder also tend to have a higher sensitivity to stress, which could hinder their ability to cope with the challenges of the pandemic and increase their risk for relapse.

“The sales of alcohol have gone up. The use of substances has gone up. Isolation and lockdowns have made it difficult for people with mental health disorders to stay on an even keel,” Davis says. “We do have to be careful, especially with people who are vulnerable for mental health, to make sure that they get the kind of basic care that they need.”

Researchers also pointed out that people with mental health disorders may live in crowded residences, hospitals or even prisons, where an infection could spread rapidly if it entered the facility. They’re also likely to be socially disadvantaged, putting them at risk of unsafe living and working environments. They may also lack a safe place to quarantine if they become infected.

“It's not just wearing a mask. It's whether you engage in risky behavior,” Pamela B. Davis, MD, PhD, a pediatrics professor at Case Western Reserve University School of Medicine, tells Verywell.

In October, Davis and Xu co-authored a paper on the risk of COVID-19 breakthrough cases among people with substance use disorders. They found that substance use disorders also posed high risks for COVID-19. When compared to the general public, people with mood and anxiety disorders are twice as likely to be addicted to drugs, according to the National Institute on Drug Abuse (NIDA).

Biological factors—like inflammation, which can play a role in depression, schizophrenia, and bipolar disorders—are comparable to how the COVID-19 infection manifests in the immune system.

Patients with severe mental disorders are also more likely to have comorbidities like cancer and heart disease, which could put them at higher risk of getting infected and becoming severely ill. Even without these comorbid medical conditions, studies show that people with mental disorders appear more susceptible to the virus.

Some antidepressants are being studied as treatment for COVID-19,  indicating that there may be an “underlying biological mechanism between mental disorders and COVID-19 outcomes,” Xu says.

What Will Researchers Do Next?

Discerning the “cause and effect” between risks of COVID-19 and mental health disorders is muddled, the researchers say. Just as mental disorders pose a higher risk for the coronavirus, the virus also increases risks of developing mental health problems.

Going forward, Davis and Xu will be using a grant to study the pandemic’s impact on long-term mental health. They will examine whether some of the challenges brought on by quarantine and isolation are temporary or here to stay. 

Regardless of what the new study finds, it will be important for people to stay on top of treatment for mental health and for providers to assist patients in need, the researchers say.

“We need to make sure that people take care of the underlying morbidities that set them up for risk for COVID infections,” Davis says. “We could make sure that people get appropriate treatments for the underlying risk factors.”

The information in this article is current as of the date listed, which means newer information may be available when you read this. For the most recent updates on COVID-19, visit our coronavirus news page.