With the pandemic now some 9 months old and going strong, substantial data are appearing on the association of mental health and COVID in the United States, although these data are primarily in adults. Two major reports in the last couple of months are telling.
In the first, scientists examined a database of 61 million health records from 360 hospitals across the United States. The striking finding was that having a recent diagnosis of a mental health condition (i.e., ADHD, depression, manic depression, or psychosis) greatly increased the chances of getting COVID-19, of being hospitalized, and even of dying from the illness. Even though adults with these mental health conditions are also likely to have more pre-existing health conditions, the conclusion was still true even after taking a wide range of other health conditions into account. The risk effect was amplified for women versus men, and for African Americans versus Caucasians.
The reasons for this association are not clear, but they could include a tendency for people with ADHD and other mental health conditions to have fewer social and economic resources, or to be less efficient or responsive to the need for health care. Biologically, it is possible that inflammation is a common influence on each of these mental health conditions just as it is a major factor in the morbidity associated with COVID-19 infection.
The second major study reported the opposite effect. In that study, scientists examined a database of nearly 70 million patients across 54 health care organizations. They confirmed from the prior study that having a mental health condition increased the chances of getting a COVID-19 infection. But they further followed up with patients and found that COVID-19 diagnosis predicted notably increased risk of subsequent new psychiatric diagnosis during the next 90 days.
The notable findings pertained to mood disorder, anxiety disorders, insomnia, and dementia (ADHD was not examined). The increased rates were reliably larger than those seen after infection with influenza (flu), other respiratory infections, or bone fracture, suggesting particular risks associated with COVID infection.
Part of the effect was because any health condition after April 1, 2020, led to more psychiatric diagnosis than any health condition prior to that date. This may be because of the general stress in the population or pressure on health care systems. However, the effect was not entirely explained by that fact. The researchers suggested based on their data checks that the explanation was probably biological—some common factor linking COVID and mental disorder (again, systemic inflammation is one salient candidate).
These studies, in combination, provide concerning evidence of a bi-directional relationship between mental health conditions (ADHD, anxiety, and depression), and COVID-19 infection/severity.
Overall, though, they underscore the importance for those with ADHD and other conditions like depression, to pay special attention to their COVID risk, and to seek help swiftly if they become ill. They also should alert clinicians to attend to prior and subsequent mental health risk in patients with COVID-19, and to pay special attention to COVID-19 precautions in their clients with mental health conditions.
Vaccinations are expected to begin in the United States this coming week, and to be available across the nation as we move into 2021 spring and summer. There is light at the end of the tunnel. Hang on a little longer with social distancing, masks, and frequent handwashing, limit travel, and stay the course. Resources to help those with ADHD cope with the pandemic and the isolation recommendations are available online. Two reputable sources are the following.
- Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD)
- The National Child Traumatic Stress Network
Highlights include the advice to:
- Create structure (for example: schedule the day, set aside a particular space for work or homework)
- Build resilience (for example: eat and sleep healthy, self-care, social contact within the limits allowed by safe social distancing)
If you or your loved ones have already suffered from this pandemic or its consequences like unemployment, I extend my sympathy and hopes for a better tomorrow.
Stay healthy and have a safe and peaceful holiday season.
Please note: Dr. Nigg cannot advise on individual cases for ethical, legal, and logistical reasons.
Taquet M, Luciano S, Geddes JR, Harrison PJ. Bidirectional associations between COVID-19 and psychiatric disorder: retrospective cohort studies of 62 354 COVID-19 cases in the USA. The Lancet Psychiatry. 2020 Nov.
Wang Q, Xu R, Volkow ND. Increased risk of COVID-19 infection and mortality in people with mental disorders: analysis from electronic health records in the United States. World Psychiatry. 2020 Oct.