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New research from the University of Oxford has shown an increased risk of severe illness and death from both COVID-19 and other severe respiratory infections, such as influenza and pneumonia, among people with a pre-existing mental health condition.

The new study, published in JAMA Psychology, and led by researchers in the Nuffield Department of Primary Care Health Sciences, Nuffield Department of Clinical Neurosciences at Oxford University, and from the Intensive Care National Audit and Research Centre, examined over 11 million electronic medical records and built on previous research by investigating both COVID-19 and other SARI. 

As COVID-19 becomes an endemic (regularly found in the population) disease, it is important to know who is at most risk for serious illness or death so that they can be prioritised for preventive measures, such as vaccination. Furthermore, it is important to understand whether such risk is unique to COVID-19, or whether it is seen in other severe respiratory illnesses as well. 

These findings are important for health professionals treating people with these conditions and for public health policy, as people with these conditions may need to be prioritised for preventive measures, such as vaccination, and treatments
Professor Julia Hippisley-Cox, co-lead author on the paper, GP and Professor at the Nuffield Department of Primary Care Health Sciences

Several major studies have found that people with a pre-existing neuropsychiatric condition are at increased risk of death from COVID-19 compared to people without such a diagnosisSimilar findings have been reported from before the COVID-19 pandemic in other acute respiratory infections. In addition to this, some medications prescribed for neuropsychiatric conditions have also been associated with worse outcomes from respiratory illnesses, although this evidence is not as certain.  

To investigate whether people with a prior diagnosis of a neuropsychiatric condition were more likely to go to hospital, ICU or die from COVID-19 or other severe, acute respiratory illnesses the researchers used a major database of routinely collected, anonymised, electronic medical records called Q-ResearchThey were also careful to account for multiple factors, such as age, BMI, socio-economic status, or other medical conditions which could affect the findings. 

The study builds on previous research by investigating the implications of not only COVID-19 but also other respiratory illnesses in people with neuropsychiatric conditions, including anxiety, mood disorders, psychotic disorders, dementia, depression, bipolar disorder, and schizophrenia, or taking associated medications. The researchers found having a diagnosed neuropsychiatric condition led to an increased risk of between 1.16 and 2.85 times for being admitted to hospital, intensive care, or death from COVID-19 and SARI compare to that in the general population. In addition, people taking medications associated with these conditions were at increased risk whether or not they had a diagnosis for the relevant condition. This increase was present even after accounting for confounding factors.  

Professor Peter Watkinson, co-lead author on the paper, ICU physician and Professor at the Nuffield Department of Clinical Neurosciences, said: 

'This research also suggests that the reported epidemic of mental health conditions has implications beyond mental health itself, as it seems to predispose to more serious outcomes from respiratory infectious disease. This has major ramifications for both individuals with these conditions and the health care system'. 

Better understanding of the relationship between mental health conditions, their associated medications, and respiratory illness has the potential to improve the wellbeing of people with these conditions by providing advice to reduce their likelihood of contracting respiratory illness and by improving management for them when they do develop these illnesses.  

Furthermore, this research demonstrates that there may be broader benefits to individuals and health services from reducing the prevalence of mental health conditions in the community. 

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