Psychiatric Disorders and COVID-19 Mortality Rates, Outcomes

Psychiatric disorders have a documented association with lower life expectancy – in some cases shortening lifespan by as much as 10 years – as well as increased risk of comorbid medical conditions. In light of the persisting COVID-19 public health crisis, experts are concerned that psychiatric comorbidity may increase virus-related mortality and predispose patients to poorer outcomes.

Ongoing and emerging research efforts aim to investigate the implications of prior psychiatric diagnoses on COVID-19-related mortality and health outcomes. According to data from a recent Yale University study, patients suffering from mental illnesses may face a higher risk for severe COVID-19 outcomes including death.

Psychiatric Comorbidity and COVID-19 Mortality

Researchers from the Yale University School of Medicine evaluated data obtained from the Yale New Haven Health System. Overall, the study included clinical data from 1,685 patients hospitalized with COVID-19 infection between February 15 and April 25, 2020.

Within that cohort, those who had been diagnosed with prior psychiatric disorders had a significantly elevated mortality risk compared with patients without a diagnosis after controlling for demographic characteristics, comorbidities, and hospital location. Of the 1,685 total participants, 473 (28%) received psychiatric diagnoses prior to hospitalization. This group was significantly older and more likely to be female, non-Hispanic white, and to have medical comorbidities. Overall, 318 patients or nearly 19% of the cohort died. The highest risk for COVID-19 mortality was reported among patients with a psychiatric diagnoses at 2 weeks after their index hospitalization, as well as at 3 and 4 weeks.

South Korean Cohort Study

In a similar study conducted by South Korean researchers, a cohort of patients with mental illness did not have an increased risk for testing positive for COVID-19 compared with the general population. However, the findings, published in Lancet Psychiatry, reveal that patients with a severe mental illness diagnosis had a greater risk of severe COVID-19 outcomes – including death, intensive care unit admission, and use of mechanical ventilation.

In this study cohort, groups with and without mental illness were matched demographically and by the presence of comorbid conditions.

Association Between Psychiatric Diagnosis and COVID-19 Outcomes

The latest studies are the first to characterize the association of psychiatric diagnosis with COVID-19 mortality. Their findings are similar to previous scientific results, confirming that individuals with comorbid psychiatric and medical diagnoses had poorer outcomes and higher mortality rates. However, the reasons underlying this association remain unclear at this time.

“Psychiatric symptoms may arise as a marker of systemic pathophysiologic processes, such as inflammation, that may, in turn, predispose to mortality,” the U.S. study’s authors wrote in the research letter. “Similarly, psychiatric disorders may augment systemic inflammation and compromise the function of the immune system, while psychotropic medications may also be associated with mortality risk.”

The Yale University study’s authors acknowledged their trial’s limitations, including the fact that individuals not hospitalized for COVID-19 as well as those who died outside of the hospital were not included in the dataset. Furthermore, diagnosis codes were used to determine psychiatric diagnosis, which do not account for the status of treatment or whether the patient had an active, in-remission, or recovered psychiatric disorder in both of the studies.

Neither study took obesity or cigarette smoking into account, nor socioeconomic status or patient education level, which may be confounding factors.

Medical experts believe that an underlying biological mechanism related to the immune system may provide an explanation for this association although, further research is needed to confirm.

The author’s stress the importance of the consequences of mental illness as related to poorer health and decreased life expectancy, which may be in part due to reduced access to medical care and treatment adherenceMany individuals with psychiatric disorders lack health insurance or adequate coverage which may delay them seeking medical care; these patients may present at the hospital with more advanced stages of COVID-19. Clinicians should take these factors into consideration when treating patients with COVID-19 and remain aware of the multifactorial risks associated with pre-existing mental illness. 

Most Effective Strategies for Optimizing Patient Engagement

There is a growing recognition of the importance of patient engagement as the key component of high-performing, cost-efficient healthcare systems which increase treatment adherence and self-monitoring as well as improve population health outcomes. Healthcare organizations who prioritize a strong team-based care infrastructure are better positioned to optimize patient engagement programming – broadly defined as the process of actively involving patients in their care and treatment decisions.

New research reveals that it is a relationship-based approach that builds trust and promotes patient autonomy, while organizational and administrative factors provide the foundation for such patient engagement. Organizations and health systems with provider champions, clear-cut staff duties, team performance improvement meetings, and staff dedicated to patient engagement tend to be more successful, according to findings published in the Annals of Family Medicine.

Optimizing Patient Engagement 

The recent study aimed to identify specific organizational factors that were associated with a greater adoption of patient engagement care practices within Veterans Health Administration (VA) primary care clinics. At these locations, patient engagement efforts were centered on the Patient-Aligned Care Team (PACT) initiative, which leverages aspects of the patient-centered medical home model to deliver comprehensive and continuous team-based care to veterans.

Investigators evaluated the adoption of PACT protocols across the VA primary care clinic system by analyzing responses from a survey completed by 2,500 clinicians at over 600 locations across the nation. Their results revealed that respondents at high-performing clinics were more likely to report regular team meetings aimed at discussing performance improvement and dedicated leadership responsible for the implementation of PACT best practices. High performance was also associated with fully-staffed PACT teams and clearly defined staff roles.

Overall, healthcare organizations only modestly implemented the recommended patient engagement tactics as results indicated a significantly lowered adoption of motivational interviewing and self-management programming.

“Lower use of these practices may be related to clinicians’ perceptions that some elements of the patient-centered medical home may not be entirely relevant (or may be difficult to use) for particular groups of patients during visits,” the researchers explained.

Organizational Factors

Revealing the importance of organizational elements, the study emphasizes the need to create new patient-centered relationships – that were found most effective for promoting patient engagement among high-performing clinics.

“Team-based care is a key driver of the use of patient engagement care processes and may directly affect patients’ level of engagement,” the study’s authors wrote. “Factors related to patients, team members, and workload may moderate the influence of team-based care on use of patient engagement care processes.”

Clear staffing roles were tied to better adherence to PACT, including motivational interviewing and organizational programming. Team-based huddles were essential for communicating quality improvement data: “Improved team collaboration and coordination are necessary for practices to manage the increasing complexity and unpredictability of clinical care and to become more accountable for patient-centered outcomes,” the authors concluded.

Next Steps

The latest findings emphasize the need to prioritize organizational elements of healthcare practices  and organizations in order to deliver care and achieve optimized patient engagement. Promoting fully-staffed facilities, identifying clearly defined roles of team members, more effective leadership, and a practice culture of performance improvement all may increase the efficacy of patient engagement initiatives and subsequently patient health outcomes.

While the team of researchers continues to examine the specific aspects of the patient-centered medical home model that most effectively improve engagement, the outlined organizational elements can be improved to better the functionality of primary care teams and enhance patient engagement in the medical care process.

Investigating the Clinical Uses of Peptides

In recent years, peptides and peptide derivatives have gained recognition within the scientific community for their many potential therapeutic benefits. Burgeoning evidence indicates that some types of peptides may play a beneficial role in slowing down the aging process by reducing inflammation and destroying microbes. These compounds are easier to absorb by the body than proteins because they are smaller and thus quickly broken down; they can easily penetrate the skin and intestines thereby entering the bloodstream faster. Currently, many health and cosmetic products contain peptides for various uses – including their potential anti-aging, anti-inflammatory, or muscle building properties.

Many of the supplements currently available on the market contain peptides derived from food sources or synthetically created ones, however, the scientific community is most focused on bioactive peptides – those that have a positive effect on the body and overall health. Some of the most popular bioactive peptides include collagen peptides, often used for anti-aging benefits and skin health, as well as creatine peptide supplements consumed for muscle-building, performance enhancement, and strength improving effects.

Peptides for Performance

Increasingly, peptides are being used by professional and amateur athletes as they can stimulate the release of human growth hormone while remaining hard to detect in lab results due to fast rates of bodily absorption. As a result of their muscle-building and performance-boosting qualities, certain types of peptides have been considered performance and image enhancing drugs (PIEDs) although, many have been banned by the World Anti-Doping Agency.

Their muscular benefits have proven significant in overcoming physical injury as part of regular exercise, muscle soreness, or the repercussions of overtraining. Soft tissue injuries such as those of the muscles, tendons, and ligaments are common in both amateur and professional athletes; preventing them from occurring can be done with a combination of supplements, recovery time, and healthy nutrition patterns.

In addition, current research implicates that bioactive peptides can have a beneficial impact on overall physical health by lowering high blood pressure, destroying microbes, reducing inflammation, preventing the formation of blood clots, improving immune function, and even acting as antioxidants.

Bioactive Collagen Peptides for Anti-Aging Benefits

Bioactive collagen peptides comprised of collagen, the main structural component of connective tissues in mammals, can help prevent joint damage, provide protein and other nutrients for metabolic processes, and can be easily incorporated into sports nutrition products without affecting taste profiles. Previous trials have found that specific bioactive collagen peptides can stimulate RNA-expression and biosynthesis of collagen, proteoglycans, and elastin in Achilles tendons; participants of an Australian study showed significant improvement of chronic Achilles tendinopathy and were able to return to running within three months of supplement use.

As collagen plays an essential role in skin, hair, and nail health, these peptides are often consumed to slow down the aging process with some studies suggesting that collagen-infused products can mitigate skin wrinkles, improve skin elasticity, and boost hydration. Furthermore, bioactive peptides can improve the body’s healing abilities by reducing inflammatory activity and potentially acting as antimicrobial agents.

Immunoregulatory Peptides

In addition to anti-aging and regenerative properties, bioactive peptides are gaining increased attention for their immunoregulatory potential. Peptides and peptide derivatives may be able to suppress autoimmune responses, organ transplantation rejection responses, or neoplastic cell growth, as evidenced by past research. Their ability to suppress the proliferation of disease, reduce autoimmune disease-associated lesions, and better the therapeutic benefits of certain treatments have significant implications for the anti-aging medicine.

For a more in-depth understanding of peptides and their therapeutic properties, clinicians are encouraged to attend our virtual educational experience Peptide Certification: The Evolving Trends and Applications of Peptides Therapies between November 13-15 led by world-renowned experts in the field.