COVID-19 Post-Acute Sequelae More Likely in Patients With Serious Mental Illness
Key Clinical Summary
- Adults with schizophrenia, bipolar disorder, or recurrent major depressive disorder (MDD) have a higher risk of developing postacute sequelae of SARS-CoV-2 (PASC) compared with those without serious mental illness (SMI).
- In a cohort of 1.6 million adults with a documented COVID-19 infection, 27.7% with SMI developed PASC (adjusted OR 1.10).
- Advanced age, chronic disease burden, and hospitalization further increased risk, underscoring the need for targeted, integrated post-COVID care for individuals with SMI.
Patients with schizophrenia, bipolar disorder, or recurrent major depressive disorder (MDD) have a higher risk of developing postacute sequelae of SARS-CoV-2 (PASC) than patients without serious mental illness (SMI), according to a study published in JAMA Network Open.
“Beyond previously described vulnerabilities of patients with SMI to COVID-19 infections and mortality, the present findings support their increased vulnerability to development of PASC following COVID-19 infection,” wrote corresponding author Jyotishman Pathak, PhD, of Weill Cornell Medicine, New York, New York, and study coauthors.
The longitudinal study included 1.6 million adults with a documented COVID-19 infection between March 2020 and April 2023. Among them, 24.8% developed PASC, defined as symptoms present 4 or more weeks after the acute phase of SARS-CoV-2. In the overall sample, 15.9% had a previous SMI diagnosis: 0.7% had schizophrenia, 2.2% had bipolar disorder, and 14.7% had recurrent MDD.
Among patients with SMI, 27.7% developed PASC over 180 days of follow up, according to the findings. The adjusted odds ratio (OR) of developing PASC for patients with SMI was 1.10.
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The likelihood of PASC increased with age, the study found. ORs were 1.04 for patients aged 35 to 44 years, 1.11 for those 45 to 64 years, and 1.18 for those 65 years or older compared with patients younger than 35 years. Race and ethnicity was also a factor, with ORs of 1.12 with Hispanic and 1.08 with non-Hispanic Black race/ethnicity compared with non-Hispanic White race/ethnicity.
Other variables associated with an increased risk of PASC included higher chronic disease burden (ORs were 1.23 with 4 or more chronic diseases and 1.13 for up to 3 chronic diseases) and hospitalization for COVID-19 (ORs were 1.80 with hospitalization and 2.17 with hospitalization that included ventilation).
Patients with commercial insurance had a lower likelihood of PASC, with a 0.85 OR compared with patients with public insurance, researchers reported.
Per individual SMI categories, ORs for PASC were 1.07 in patients with schizophrenia, 1.14 in those with bipolar disorder, and 1.08 in those with recurrent MDD. Within each SMI category, directional associations for variables that increased PASC risk were consistent with findings for SMIs as a whole.
“The consistent patterns observed across different types of SMI support a need for targeted interventions to address the long-term effects of COVID-19…” researchers wrote. “These results emphasize the need for coordinated approaches that simultaneously treat and seek to prevent PASC among adults with SMI.”
