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  • CDC adds mental health conditions to its risk list for severe illness from COVID-19.
  • The decision was based on an ongoing review of literature and two recent meta-analyses.
  • Research shows an increased risk for mood disorders such as depression, bipolar disorder, and schizophrenia.
  • The American Psychological Association supports the CDC’s decision.

The Centers for Disease Control and Prevention (CDC) has added mental health conditions to its growing list of risk factors associated with severe illness from COVID-19.

The update, added in September 2021, was based on a review of new and accumulated data.

People with one or more medical conditions from the CDC’s high-risk list — which now includes depression and schizophrenia — are advised to get two initial doses of the COVID-19 vaccine, plus a booster shot.

The American Psychological Society (APA) supports the decision.

APA CEO Arthur C. Evans Jr., PhD, told Psych Central: “Adding [mental health conditions] to the list of medical conditions with heightened threat for severe illness is consistent with the American Psychological Association’s support and advocacy for a population health approach to behavioral health.”

The CDC added mental health conditions to its high-risk list based on “an ongoing review of the literature and the recent publication of two meta-analyses,” a CDC representative told Psych Central.

The first meta-analysis, published in July 2021, looked at 16 studies from 7 countries. The results suggested an increased risk of mortality from COVID-19 among those with mental health conditions, with severe mental health disorders presenting the highest risk.

The review covered a range of mental health conditions and disorders:

The second meta-analysis, also from July 2021, suggested that individuals with preexisting mood disorders face a greater risk of hospitalization and death from COVID-19.

“These studies noted increased risk across a broad range of mental health disorders but showed a possible greater risk for mortality from COVID-19 among individuals with schizophrenia, bipolar disorder, and severe depression.”

— A CDC representative in an interview with Psych Central

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In addition, a nationwide study published in October 2021 found that prior poor mental health — including depression, stress, and problems with emotions — was associated with higher COVID-19 infection rates in the United States.

According to the National Institute of Mental Health, around 21.4% of U.S. adults will experience a mood disorder in their lifetime. Mood disorders are a common cause of hospitalization for adults ages 18 to 45.

Research suggests that mood disorders are linked with lower immune system function and higher rates of conditions such as cardiovascular disease, which is also a risk factor for COVID-19.

Evans said: “Before the pandemic, we already had a host of medical and behavioral research indicating that people with a psychiatric diagnosis — especially those with severe mental illness — are more likely to experience adverse outcomes in health and overall well-being.”

Despite these greater health risks, research from 2010 shows that people with severe mental illness are more likely to receive lower-quality physical health care than the general population.

Compromised immunity

Sanam Hafeez, PhD, a neuropsychologist and director of Comprehend the Mind in New York City, explained that “someone who is severely depressed may not sleep sufficiently, eat well, or take optimum care of themselves […] This could put them at greater risk for contracting COVID-19 and fighting it off.”

Mood symptoms are also related to higher rates of inflammation, which could increase the risk of developing COVID-19, according to Evans.

Lifestyle factors

Higher rates of cigarette smoking and substance use disorders among individuals with mood disorders may also play a role, said Monica Gandhi, MD, MPH, an infectious diseases specialist with the University of California, San Francisco.

Also, research shows that stress and insomnia, common comorbidities among mood disorders, may also contribute to severe illness from COVID-19, Evans said.

Social determinants

Evans said public health measures associated with the pandemic, such as quarantine and lockdowns, have disproportionately affected those with severe mental illness — from disrupted support services to increased stress and isolation.

Ghandi explained that the following factors can also play a role:

  • economic insecurity
  • less access to preventive healthcare
  • lower health literacy
  • living in congregate facilities

The CDC specifies that mood disorders pose the greatest risk and acknowledges that individuals with other mental health conditions should also take precautions.

Those with mental health conditions that fall on a spectrum, such as attention deficit hyperactivity disorder (ADHD) or an anxiety disorder, may wish to consider a booster depending on the severity of their symptoms, Hafeez said.

“Those who are very anxious have neurological wiring that puts their body into frequent flight-or-fight scenarios that can wreak havoc on the mind and body,” Hafeez said.

While there isn’t much data to show that other mental health conditions are linked to higher rates or severity of COVID-19 disease, Evans said the APA will continue to advocate for the addition of other mental health conditions as the science indicates.

If you’ve been diagnosed with a mood disorder or have another health condition on the CDC’s high-risk list, two initial doses of the COVID-19 vaccine and a booster shot are recommended.

Also, keep in mind that recent CDC data has not shown waning vaccine effectiveness except for adults over 65 years old and immunocompromised people.

Getting a booster could help put your mind at ease. Still, because everyone’s situation and needs are unique, it’s best to check with your medical care team or mental health services professional first.