People with psychosis, anxiety at high risk of breakthrough Covid

People with a history of certain psychiatric conditions, such as psychosis and anxiety, have a heightened risk of breakthrough Covid-19, a finding that may be related to impaired immune response as well as risky behaviours associated with some disorders.

The finding was consistent even with people who are vaccinated against SARS-CoV-2, said researchers at the University of California-San Francisco.

The team found that patients over 65, with substance abuse, psychotic disorders, bipolar disorder, adjustment disorder, and anxiety, faced increased risks of up to 24 per cent for breakthrough Covid.

For those under 65, risks were up to 11 per cent higher than for those without psychiatric history.

"Our research suggests that increased breakthrough infections in people with psychiatric disorders cannot be entirely explained by socio-demographic factors or pre-existing conditions," said Aoife O'Donovan, from the UCSF Weill Institute for Neurosciences.

"It's possible that immunity following vaccination wanes more quickly or more strongly for people with psychiatric disorders and/or they could have less protection to newer variants."

In the study, published in JAMA Network Open, the researchers tracked data from 263,697 US patients, who had completed their vaccine regimen and had at least one test for SARS-CoV-2.A

Surprisingly, given the greater incidence of breakthrough infections among younger people, this study showed significantly smaller effects in the under-65s group.

Moreover, risks were 10 per cent lower in participants with psychotic disorders compared to those without a psychiatric diagnosis a" a decrease that O'Donovan attributes to possible lower socialisation among younger people with psychotic disorders compared with older people who "may be less socially isolated because of their greater burden of ill health and contacts with caregivers".

However, risks for breakthrough infections associated with substance abuse, adjustment disorder, anxiety and post-traumatic stress disorder were all higher in the younger cohort than their peers without a psychiatric diagnosis - 11 per cent, 9 per cent, 4 per cent and 3 per cent, respectively.

According to Kristen Nishimi, from the UCSF Weill Institute, the higher incidence of breakthrough infection among older participants may be due to "decreased immunological response to vaccines that has been associated with some psychiatric disorders, which may be more substantial in older adults".

It's also possible that older adults with psychiatric disorders "may require more frequent in-person care, which could increase their interactions with the health care system", she noted.

"Mental health is important to consider in conjunction with other risk factors, and some patients should be prioritised for boosters and other critical preventive efforts," said O'Donovan.