Tag Archives: mental health

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. 

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Impact of COVID-19 Isolation and Social Distancing on Mental Health

As a method of novel coronavirus disease transmission suppression and an attempt to reduce the risk of infection, social restrictions – such as social distancing and sheltering in place – have been put into place and remain active in the majority of the United States. Such measures have isolated many older adults at home, leaving them with limited contact and social interaction for the duration of the outbreak. As evidenced by global statistics revealing higher death rates among this demographic, the COVID-19 pandemic has been disproportionately affecting older adults.

Current literature suggests that social interaction is an integral component of mental health and wellbeing, while loneliness has been associated with morbidity and mortality in prior research. While the isolating effects of social distancing measures have been felt acutely by the entire population and may be especially profound in older demographics, relatively little scientific evidence on the subject is currently available. A recent study published in the Pan American Journal of Public Health aimed to provide further information on the implications of social distancing measures on patient mental health.

Coping with Coronavirus Isolation

A team of researchers aimed to examine the impact of isolation and social distancing among adults aged 60 and above during the COVID-19 outbreak in the United States. To conduct this analysis, the study’s authors asked convenience sampling respondents to complete a web-administered survey exploring the effects of social distancing on mental health factors, including loneliness, stress, and behavioral changes. In total, data from 833 responses from participants aged 60 and above were included in the sample.

Effects of Social Distancing on Older Patients

Of the total survey respondents, 36% reported being stressed while nearly 43% reported feelings of loneliness. Approximately one-third of participants reported feelings of increased loneliness during the social distancing period specifically. Respondents also reported engaging in more solitary activities and fewer in-person activities, using email and text messages more than usual, and spending more time using technology than before.

The study’s authors noted significant differences between younger patients aged 60-70 and those above the age of 71; changes in physical activity, drinking, recreational drug use, and sleeping pattern were found to differ by age. Participants over the age of 71 showed more resiliency with 74% experiencing little to no stress, according to the authors.

“That’s where older adults have a strength,” lead researcher and clinical associate professor at the University of Georgia’s Institute of Gerontology Kerstin Emerson told HealthDay. “They have life experience and coping mechanisms that we don’t often give them credit for, but that’s part of their wisdom. We can really turn to older adults as examples of how to manage and live through bad periods of history.”

Furthermore, two-thirds of survey respondents reported using more social media than they would before the pandemic began revealing that older adults are actively engaging in other forms of social connection and becoming increasingly comfortable online. However, for some older individuals remote connections may be more difficult to achieve due to a lack of internet or smart device access; Emerson noted that her team’s results don’t reflect the most vulnerable populations socially isolated in rural areas or those without sufficient economic resources.

As social distancing regulations and isolation measures persist across the globe, it is important to consider the effects of these strategies on mental health – especially among older adults in the United States. The latest findings indicate the potential adverse psychiatric effects associated with continued shelter-in-place practices and highlight the need for increased mental health screening among vulnerable populations at this time.

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Self-Care Strategies For Medical Practitioners

As the population enters another month of social distancing and self-isolation in an effort to combat the COVID-19 outbreak, it is becoming increasingly important for individuals to prioritize their physical, mental, and emotional health. The so-called “new normal” many find themselves living in has been characterized by heightened stress levels, long work hours, increased feelings of loneliness and hopelessness, as well as a persisting need to support and care for loved ones. During such an overwhelming time, it is important to take the necessary self-care measures that can work to mitigate negative emotional and physical responses to the pandemic – many of which may be happening subconsciously.

Both deteriorating physical and mental health can impede the ability to provide much-needed medical and home care, give and receive support, and to fulfill the needs of a growing number of patients. Whether you are one of the healthcare providers braving the crisis and fighting the virus on the front lines, a first-time telemedicine practitioner, or a medical professional with a practice currently closed, it is essential to take the time to incorporate some of the self-care strategies listed below when possible.

Self-Care Strategies

Boosting both physical and mental health requires regular check-ins throughout the day. Make sure to check in not only with your family and friends, but equally as importantly with yourself – how are you feeling physically, mentally, and emotionally? Paying attention to your current state will help identify what you may need at that moment, whether that is a walk around the neighborhood, a nutritious meal, or some physical exercise. The recommendations below are simple to incorporate into a daily routine yet may prove tremendously effective in improving overall wellbeing.

Physical Health

Supporting physical health is vital to ensure a well-functioning immune system and to protect it from the risk of COVID-19 infection. Several ways to maintain a healthy lifestyle despite the circumstances – inclusive of regular physical activity and a well-balanced diet – are listed below:

•   Maintain a sleeping schedule and get enough rest; aim to sleep for around 7 to 8 hours per night.

•   Engage in physical activity every day – this can include walks around the block, jogging, or exercising at home.

•   Spend time outside (following social distancing guidelines) and in nature; studies have found that being outdoors is one of the quickest methods of improving health and wellbeing.

•   Eat regularly and fuel your body with a healthy, nutritious diet.

•   Make sure to hydrate as dehydration can have noxious effects on physical health; aim for about 2 liters of water per day.

•   Avoid substance use and destructive behaviors; abusing alcohol or drugs at this time may worsen both physical and mental health, take a toll on the immune system, and lead to other repercussions.

Mental Health 

Taking care of your mental health is equally as important; the heightened stress levels and rising feelings of loneliness can contribute to declines in immune system functioning as a result of related hormonal changes.

•   Find ways to connect with yourself and those around you – this can include regular phone or video calls, communicating throughout the day, and mindful personal check-ins.

•   Set a routine and try to maintain it; devoting specific times of the day to work, chores, home life, and self-care can help provide much-needed structure.

•   Instead of worrying about the public health crisis at hand, focus on things you can control, including work-related tasks, healthy lifestyle habits, and time spent connecting with the people around you.

•   Consider introducing relaxation techniques throughout the day, such as deep breathing, stretching, meditation, and yoga practice.

•   Use technology mindfully; many individuals are increasingly turning to social media, television, and their computers as a way of spending idle time. While it is needed to maintain social interactions and continue business operations, the amount of unnecessary time spent in front of a screen should be minimized.

•   Listen to music, read books, and pursue other stimulating activities instead.

•   Explore online resources and applications for managing anxiety and other mental health concerns at this time; the CDC has compiled a list of helpful coping strategies, accessible here. 

To be best equipped to provide health care and other support services, medical practitioners must prioritize their physical health and emotional wellbeing, which can be extremely difficult for those working within the healthcare system. While the consistent efforts of healthcare practitioners of all backgrounds are invaluable, the demands of the oft-dysfunctional healthcare system can take a significant toll on their physical and mental health. Many are struggling with traumatic stress responses or battling the infection themselves. As integral members of our shared communities, medical workers are encouraged to remember that they are not alone and to seek the therapeutic support and medical care they need.

Regardless of specialty, finding the time to practice self-care is now more important than ever; introducing some of the above strategies into your daily routine can significantly improve overall health and wellbeing. Additional recommendations, including specific tips for first responders and health care providers, have been made available by the CDC and can be found here.

If you or someone you know is considering suicide please contact the National Suicide Prevention Hotline at 1-800-273-8255 or through chat on https://suicidepreventionlifeline.org/

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