Schizophrenia, Bipolar Disorder, and MDD Linked to Increased Risk for Developing Long COVID

New findings reported in JAMA Network Open from a longitudinal cohort study utilizing electronic health records (EHRs) show that individuals with a prior serious mental illness (SMI), including schizophrenia, face a significantly heightened risk of developing long COVID.

A clear understanding of long COVID and its prevalence has been hampered by differences in how long COVID is defined. Partly as a result, researchers have arrived at a wide range of estimates about how common it is, with some research putting it as high as 30%. Serious mental illness, which affects 5% of adults in the U.S., is defined by the American Psychological Association as a group of psychiatric disorders including recurrent major depressive disorder (MDD), bipolar disorder, and schizophrenia.

The heightened risks of COVID-19 infection and mortality observed among adults with SMI are attributed, in part, to several challenges, including limited access to general medical care, difficulties with treatment adherence and the existence of preexisting comorbidities, such as diabetes and cardiovascular disease.

Moreover, the clinical course and medical care received by adults with SMI may have been further complicated by stressors related to the pandemic, such as social isolation, anxiety and abrupt shifts in daily routines.

All of these factors underscore a need for health system leaders and managed care executives to integrate mental health and COVID-19 care strategies, according to lead author Veer Vekaria, B.S., from the Weill Cornell Medical Center in New York.

Vekaria and his colleagues identified 1,625,857 adult patients with confirmed COVID-19 infection between March 2020 and April 2023. SMI was defined as a diagnosis of schizophrenia, bipolar disorder, or recurrent MDD recorded before the COVID-19 infection; overall, 15.9% (258,523) of the COVID-19 cohort had a prior SMI diagnosis.

Of the total group of patients with a COVID-19 infection, 24.8% developed long COVID. Among those with prior SMI, 27.7% developed long COVID, Vekaria and his colleagues reported, and the higher risk was seen with current MDD, bipolar disorder and schizophrenia.

The consistency of these findings in each of the SMI categories “suggests transdiagnostic vulnerabilities to long-term adverse effects of COVID-19 among adults with severe mental illnesses,” the authors wrote in the discussion section of the paper.

This research was designed to answer questions about why people with SMI might be more vulnerable to developing long COVID, but Vekaria and his colleagues pointed to other research that has shown that chronic stress and immune dysregulation associated with an SMI may heighten long COVID risk. They said the heterogeneous distribution of long COVID subtypes “suggests overlapping symptoms affecting multiple systems with diverse underlying pathologies.” Their findings, they said, argue for proactive screening, surveillance, integrated care pathways, and socioeconomic determinants of health programs in health systems.