human brain and covid spike proteins showing potential impact on mental health
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Mental health experts and medical personnel have long understood that serious illnesses and other physical concerns can have a negative impact on psychological well-being. However, the impact of COVID-19 on mental illness, and vice-versa, is unknown.

In addition to managing the effects of an illness or injury itself, patients may also experience considerable stress related to their job status, family responsibilities, academic progress, and/or financial stability after receiving a diagnosis for a major illness.

In the case of a global health crisis like the COVID-19 pandemic, the link between physical health and mental well-being can be magnified by challenges inclduing:

  • Isolation
  • Business and school closures
  • Economic downturns
  • Political strife

For example, the World Health Organization (WHO) reports that COVID-19 is associated with:

  • A widespread sense of social disconnectedness
  • Increases in domestic violence and child abuse
  • Rising rates of suicidal thoughts and behaviors

In this post, we’ll look at studies that evaluated the relationship between COVID-19 and mental health. We’ll examine two questions:

Are people with COVID-19 at increased risk for certain mental health disorders?
Are people with certain mental health disorders more likely experience harm associated with COVID-19?

How Does COVID-19 Affect Mental Health?

Let’s begin by reviewing research on how COVID-19 can affect mental health.

In August 2022, the journal Lancet Psychiatry published an analysis of multiple cohort studies to determine if a relationship exists between COVID-19 and an increased risk of mental illnesses and neurological disorders.

Features of this effort, which was led by Maxime Taquet, PhD, included the following:

  • The research team reviewed data from more than 1.4 million patients diagnosed with COVID-19 over a two-year period
  • Data included infornation on:
    • 185,748 children aged 17 and younger
    • 856,588 adults aged 18-64
    • 242,101 older adults aged 65 and above
  • Researchers matched patients with histories of COVID-19 diagnoses were with others with non-COVID respiratory infections.
  • Researchers collected data from providers in the United States, the United Kingdom, Australia, Bulgaria, India, Malaysia, Spain, and Taiwan.

The research team reviewed data for 14 types of psychiatric conditions and neurological concerns, including:

Here’s what they found.

COVID-19 and Mental Illness

  • Adults diagnosed with COVID-19 had increased risk of developing anxiety or depression.
    • After 43 days, depression risk returned to baseline
    • Anxiety disorder risk remained elevated for 58 days after diagnosis
  • Rates of cognitive deficits, dementia, psychotic disorder, and seizures among adults diagnosed with COVID-19 remained elevated at the conclusion of the analysis.
  • Children diagnosed with COVID-19 showed no increase in depression or anxiety.
  • Children diagnosed with COVID-19 showed an elevated risk for:
    • Cognitive deficits
    • Ischaemic stroke
    • Psychotic disorders
    • Seizures

The research team also noted that the prevalence of post-diagnosis mental health concerns could be influenced by the COVID-19 variant. For example, the onset of the delta variant of COVID-19 led to increased rates of both psychiatric and neurological conditions among adults.

Does Mental Illness Increase the COVID-19 Risk?

It’s not surprising that diagnosis with a serious illness such as COVID-19 can have a negative effect on mental health. But what about when the disorders occur in a different order? What happens if a person has a mental illness before diagnosis with COVID-19?

In November 2022, the journal Translational Psychiatry published a study that addressed the relationship between COVID-19 and mental illness from this perspective.

The researchers evaluated the connection between posttraumatic stress disorder (PTSD) and negative COVID-19 outcomes. They found was people who had a mental health disorder had “a significantly higher risk for hospitalization and death” within two months of diagnosis with COVID-19.

Kristen Nishimi, PhD, MPH, a postdoctoral fellow with the San Francisco Veterans Affairs Health Care System, led the study. Nishimi’s team reviewed data from 228,367 patients who met the following criteria:

  • Received healthcare services through the U.S. Department of Veterans Affairs (VA) between February 2020 and August 2021.
  • Tested positive for COVID-19 on a polymerase chain reaction (PCR) test.
  • Received follow-up care within 60 days after testing positive.

Demographic data and health information for the subjects included the following:

  • Average age: 61
  • Gender: 89.5% male.
  • Presenec of mental ilness: 8% o
  • PTSD diagnosis within five years prior to testing positive for COVID: 6%
  • Presence of co-occurring mental health disorder and PTSD: 82.2%
  • Non-PTSD mental health conditions: 2%

The team found that, when compared with patients with no history of mental illness prior to COVID-19 diagnosis, those with any type of mental health concern had increased risk for a variety of negative outcomes.

Here’s what they found.

Mental Illness Before COVID-19 Diagnosis: Impact on Outcomes

  • Subjects with any psychiatric disorder:
    • 27% higher rate of hospitalization
    • 19% higher rate of death
  • Patients with psychosis:
    • 66% higher rate of hospitalization
    • 58% higher rate of death
  • Subjects with bipolar disorder disorder:
    • 46% higher rate of hospitalization
    • 29% higher rate of death
  • Patients with major depressive disorder:
    • 21% higher rate of hospitalization
    • 13% higher rate of death
  • Subjects with PTSD:
    • 9% higher rate of hospitalization
    • 8% higher rate of death

“In our sample of VA patients, PTSD and other psychiatric disorders increased the risk for poorer COVID-19 outcomes across younger and older patient groups, suggesting that psychiatric disorders increase the risk for adverse COVID-19 sequelae across adulthood,” the researchers wrote. “This elevated risk remained even when accounting for medical comorbidities and smoking.”

Young People, Mental Illness, & COVID-19

In April 2023, the open access journal Scientific Reports published an article that combined elements of the two studies previously discussed in this post.

The Scientific Reports article looked at how the pandemic impacted the mental health of young people in Germany. Researchers also explored how the presence (or absence) of pre-existing mental illness influenced the outcomes.

About the Study

  • A research team led by Ronja Kleine of the Institute for Therapy and Health Research in Kiel, Germany, reviewed data from:
    • 6,945 adolescents (aged 14-17)
    • 7,184 young adults (aged 18-21).
  • The researchers focused on symptoms of anxiety and depression both prior to and during the pandemic.
  • The team used a modified version of the Patient Health Questionnaire (PHQ-4) to assess symptoms of both disorders.

After dividing the subjects into two groups – one with anxiety or depression before COVID-19, the other without anxiety or depression before COVID-19, the research team analyzed their responses. Here’s what they found.

The Impact of Depression Before or After COVID-19

  • Before the pandemic began, 20% of respondents reported symptoms of depression
  • By the second year of the pandemic, 63% reported symptoms of depression
  • Depression scores increased the greatest amount among people who did not struggle with this disorder prior to the pandemic:
    • Between 2019 and 2021, scores on  the modified PHQ-4 increased by 222% in this group, from an average score of 7.2 to an average score of 23.2
  • Among those who had depression prior to the pandemic, depression scores decreased slightly during the first year, then stabilized:
    • Average scores in 2019: 26.7
    • In 2020: 25.9
    • In 2021: 25.8

The study respondents also revealed the following changes in anxiety

The Impact of Anxiety Before or After COVID-19

  • The percentage of respondents who reported symptoms of anxiety increased:
    • 2019: 17.8%
    • 2021: 51.1%
  • In the group of respondents who did not have pre-pandemic anxiety, the average score on the modified PHQ-4 increased by 187%:
    • 2019: 6.5
    • 2021:18.7
  • For those who had anxiety before the pandemic, the average score remained stable:
    • 2019: 28.5
    • 2021: 28.6

The research team noted that 81.6% of respondents demonstrated a change in their overall mental health during the first two years of the pandemic. This indicates that neither age nor gender nor pre-pandemic mental health status granted immunity from pandemic-related changes.

However, for many individuals, a history of depression or anxiety mitigated the mental health impact of the pandemic.

The study subjects with preexisting anxiety or depression showed relatively minor changes. Adolescents and young adults without anxiety or depression before the pandemic reported “an alarming increase” in symptoms of both disorders as the COVID-19 crisis continued.

The Value of Treatment

As we alluded to in the introduction to this post, the connection between physical health and psychological well-being existed long before the COVID-19 pandemic began. As shown by the early research efforts that we discuss in this article, the pandemic may provide greater insights into the ways that mental and physical health can impact each other.

In the interim, it’s important to remember that most mental illnesses are treatable conditions. This includes complex disorders characterized by severe symptoms.

If someone in your life experiences acute distress as a result of one or more mental health concerns, Crownview Psychiatric Institute may be able to help. At our treatment center in San Diego, California, adults benefit from a dynamic combination of evidence-based therapies, focused educational opportunities, beneficial adjunct services, and an innovative community-like environment.

To learn more about our programs and services, or for answers to specific questions about how CPI can help your loved one, please visit our Contact Us page or call us today.