Psychiatrists are Uncovering Connections Between Viruses and Mental Health

Christina Animashaun/Vox

Immune responses to viruses like SARS-CoV-2 may affect mental health, and vice versa. Doctors are uncovering exactly how. When the Covid-19 pandemic hit, one of the biggest questions was: Why do some people get so much sicker than others? It’s a question that has forced researchers to confront some deep mysteries of the human body, and come to conclusions that have startled them.

By the fall of 2020, psychiatrists were reporting that among the many groups who were high risk, people with psychiatric disorders, broadly, seemed to be getting more severe forms of Covid-19 at a higher rate. Katlyn Nemani, an NYU neuropsychiatrist, decided to dig deeper, asking: Just how much more at risk, and which conditions?

In January, she and a group of colleagues published a study of 7,348 Covid-19 patients in New York. One finding was stark: People with a schizophrenia spectrum diagnosis faced more than two and a half times the average person’s risk of dying from Covid-19, even after controlling for the many other factors that affect Covid-19 outcomes, such as cardiovascular disease, diabetes, smoking, obesity, and demographic factors — age, sex, and race.

“That was a pretty shocking finding,” Nemani says. The patients all were hospitalized in the same medical system, in the same region, which implies they weren’t receiving radically different treatments, she says. In sum, it all suggests that the risk was closely linked to the mental illness itself and not to some other variable.

Since then, more studies have come out — as well as metastudies pooling the conclusions of those studies — showing worse Covid-19 outcomes among people with diagnosed mental health disorders including depression, bipolar disorder, and schizophrenia.

Some of this isn’t surprising; a lot of people with mental health issues experience a general increased risk of poor health outcomes. But the pandemic started to shine a brighter light on why, bolstering a hypothesis that’s been accruing evidence in recent years.

It appears that something in the body, something biological associated with these disorders, may be at play. “That suggests there’s a physiologic vulnerability there in these folks,” said Charles Raison, a psychiatrist and researcher at the University of Wisconsin Madison. 

It’s not necessarily that people with schizophrenia or mood disorders are more likely to become infected with Covid-19. Rather, once they are infected, “the outcomes are worse,” Nemani says. Depending on the study and the severity of the mental health diagnosis, people with these conditions are, roughly, between 1.5 and 2 times more likely to die of Covid-19 than average, after adjusting for other risk factors (unadjusted risk is even higher).

The level of increased risk, Nemani says, is “on par with what we’re seeing for other well-established risk factors like heart disease and diabetes.” What’s happening? Why would mental illness make someone more vulnerable to a respiratory disease? Psychiatrists who study these mental illnesses say the culprit might lie in a connection between mental health and the immune system.

They’re finding that mental health stressors could leave people more at risk for infection, and, most provocatively, they suspect that responses in the immune system might even contribute to some mental health issues.There’s a lot that’s unknown here. But the pandemic is giving researchers a new window into these questions. And the research “might teach us something about how to protect these people from infection going forward,” Nemani says.

How the immune system can impact mental health

In September, the Centers for Disease Control and Prevention updated its list of underlying conditions that put people at higher risk for severe Covid-19, adding mood disorders — like depression and bipolar disorder — and schizophrenia spectrum diagnoses, a group that accounts for around 34 million Americans. It was a recognition of the growing evidence published by Nemani and colleagues across medicine, and prioritizes this group for vaccines and booster shots.

Roger McIntyre, a psychiatrist at the University of Toronto, is one of the co-authors of one of two systematic review studies that the CDC cited in its change. (Nemani is a co-author on the second.) To him, it’s no surprise that mental illness imparts an infection risk. “A thread that has been woven through many of these disorders is immune or inflammatory dysregulation,” McIntyre says.

That is, problems with the immune system tend to coincide with mental health issues. And problems with the immune system can lead people to have worse outcomes when it comes to SARS-CoV 2, the virus that causes Covid-19.

“Most of the time in medicine, it’s hard to have one singular explanation for anything,” he cautions. That’s especially true here in the discussion of why people with certain mental health issues might be more at risk for severe disease. People living with mental illnesses like schizophrenia, bipolar disorder, and major depression tend to have shorter-than-average life spans and worse health overall….Continue reading

Source: Can depression worsen Covid-19 and other infections? And can a virus make you depressed? – Vox

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