Summary: Veterans with post-traumatic stress disorder (PTSD) who contracted COVID-19 faced a modest but measurable increase in the risk of hospitalization and death compared with veterans without psychiatric diagnoses. Other mental health disorders showed substantially larger increases in risk: psychosis, bipolar disorder, and major depression were all associated with higher rates of severe COVID-19 outcomes.
Source: UCSF
A large veteran cohort study from UC San Francisco and the San Francisco VA Health Care System found that psychiatric disorders—including PTSD, psychosis, bipolar disorder, major depression, and substance use disorders—are linked to greater risk of hospitalization and death after a COVID-19 infection.
The researchers analyzed electronic health records for 228,367 U.S. Department of Veterans Affairs patients who tested positive for SARS‑CoV‑2 between February 2020 and August 2021. The average age in the sample was about 60 years, roughly 90% were men, and 25.6% had a diagnosis of PTSD while 28.2% had another psychiatric diagnosis. Overall, 15% of the cohort were hospitalized and 6% died within 60 days of a positive test.
After adjusting for demographic factors, medical conditions, and health behaviors, the study found that PTSD was associated with a modest but statistically significant increase in severe COVID-19 outcomes. In models that adjusted only for socio‑demographic variables (age, sex, race and ethnicity), PTSD was associated with an approximately 18% higher risk of hospitalization and a 13% higher risk of death. When the models additionally controlled for medical comorbidities, smoking and obesity, the increased risks were reduced but remained significant—about a 9% higher risk of hospitalization and an 8% higher risk of death for veterans with PTSD compared with those without any psychiatric diagnosis.
Other psychiatric conditions showed larger increases in risk. Veterans with psychotic disorders experienced substantially worse outcomes: a roughly 66% higher risk of hospitalization and a 58% higher risk of death compared with veterans without psychiatric diagnoses. Bipolar disorder was linked to an estimated 46% higher hospitalization risk and a 29% higher mortality risk, while major depressive disorder was associated with about a 21% higher hospitalization risk and a 13% higher risk of death.
Substance-related diagnoses produced a different pattern. Veterans with substance use disorder or alcohol use disorder were markedly more likely to be hospitalized (about 62% and 45% higher hospitalization risk, respectively), but their mortality rates were similar to those without psychiatric diagnoses. The investigators suggest that factors such as lower social support, homelessness, or limited caregiver networks may contribute to higher hospitalization rates for people with substance use disorders, even if mortality is not increased to the same degree.
Why the risks differ
The study explored several mechanisms that may help explain why psychiatric disorders increase the risk of adverse COVID-19 outcomes. Co‑occurring medical conditions—such as diabetes, cardiovascular disease, lung disease, kidney or liver disease, cancer, and HIV—plus health behaviors like smoking, physical inactivity and poor diet, account for part of the elevated risk. When those factors are included in statistical models, the estimated effects of psychiatric diagnoses are reduced but generally remain statistically significant.
Biological pathways may also play a role. The study’s senior author notes that mental health disorders can be associated with elevated inflammation, dysregulated immune function, and signs of accelerated cellular aging, all of which could increase vulnerability to severe infectious disease. PTSD in particular is sometimes associated with lower cortisol levels, which could alter inflammatory regulation in ways that affect COVID‑19 outcomes.
The researchers also observed age differences. PTSD appeared to be associated with worse outcomes in younger veterans (under 65) than in older veterans, possibly reflecting differences in how PTSD is diagnosed, treated, or managed over time. The team suggests that routine screening and long-term treatment access in the VA system may mean that older veterans have better-managed PTSD, which could blunt some of the risk.
Implications
These findings indicate that people with PTSD and other psychiatric disorders represent a vulnerable group with respect to COVID‑19. The authors recommend considering individuals with psychiatric conditions—especially those with psychosis, bipolar disorder, and major depression—for prioritized COVID‑19 prevention efforts, including vaccination outreach, screening, early antiviral treatment, and measures to address comorbid medical conditions and health behaviors.
The study is led by Kristen Nishimi, Ph.D., with senior author Aoife O’Donovan, Ph.D., and co‑authors from the UCSF Department of Psychiatry and Behavioral Sciences and the San Francisco VA Health Care System. Results were published in Translational Psychiatry on Nov. 22, 2022.
About this mental health, PTSD, and COVID-19 research news
Author: Press Office
Source: UCSF
Contact: Press Office – UCSF
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Original Research: Post‑traumatic stress disorder and risk for hospitalization and death following COVID‑19 infection, by Kristen Nishimi et al., Translational Psychiatry (open access).