Vaccinated people with mental health issues more likely to suffer a breakthrough COVID infection

SAN FRANCISCO, Calif. — Your mental health may determine how well the coronavirus vaccine protects you from COVID. A new study reveals vaccinated people who deal with mental health disorders have a significantly higher risk of suffering a breakthrough case of COVID-19.

Specifically, those with psychiatric conditions, a history of substance abuse, and those over the age of 65 have a 24-percent increased risk of a breakthrough infection. These problems include bipolar disorder, anxiety, psychosis, and depressive symptoms. Younger individuals with similar problems are 11 percent more prone.

The findings open the door to these groups receiving priority when it comes to booster shots and other preventive measures. The phenomenon may be due to impaired immune systems as well as risky behaviors associated with some disorders. Previous studies show those with weaker antibody responses to coronavirus jabs are more susceptible to breakthrough infections.

“Our research suggests that increased breakthrough infections in people with psychiatric disorders cannot be entirely explained by socio-demographic factors or pre-existing conditions,” says senior author Professor Aoife O’Donovan from the University of California-San Francisco (UCSF) in a release.

“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.”

What’s putting older people at higher risk?

The findings come from a study of over a quarter-million U.S. Army veterans, with over nine in 10 being men. They completed their vaccine regimen and had at least one test for SARS-CoV-2, the virus that causes COVID. Just over half received at least one psychiatric diagnosis within the last five years. One in seven also experienced a breakthrough COVID case.

The risk rose 24, 23, 16, 14, and 12 percent, respectively, for older adults with a history of substance abuse, psychotic disorders, bipolar disorders, adjustment disorders, and anxiety. Surprisingly, given the greater incidence among younger people, there was a significantly lower risk among young participants. Moreover, the risks were 10 percent lower in participants with psychotic disorders, possibly due to differences in socialization.

Older people “may be less socially isolated because of their greater burden of ill health and contacts with caregivers,” Prof. O’Donovan explains.

Breakthrough infections with a connection to substance abuse, adjustment disorders, anxiety, and PTSD (post-traumatic stress disorder) were 11, nine, four, and three percent more likely, respectively. The calculations took into account age, sex, race, ethnicity, vaccine type, smoking history, and underlying conditions linked to breakthrough cases. These include obesity, diabetes, sleep apnea, cardiovascular, lung, kidney and liver diseases, HIV, and cancer.

The mind plays a major role in immune health

Earlier this year, a study by the same team showed people with anxiety and PTSD (post-traumatic stress disorder) were more likely to engage in behaviors that put them at higher risk for COVID.

First author Dr. Kristen Nishimi believes higher incidence of breakthrough infection among older participants may be due to “decreased immunological response to vaccine that has been associated with some psychiatric disorders, which may be more substantial in older adults.”

It is also possible older adults with psychiatric disorders “may require more frequent in-person care, which could increase their interactions with the health care system.”

Breakthrough risks for other non-psychiatric conditions were also calculated and adjusted for factors like obesity and smoking status, as well as other underlying conditions. The researchers found patients with chronic kidney disease had an increased risk of 23 percent, compared with 20, 19, 18, and 13 percent, respectively for HIV, cardiovascular disease, COPD, and sleep apnea.

Certain psychiatric conditions, particularly in the 65-plus group, face risks that are on a par with other conditions, Prof. O’Donovan says.

Mental health is important to consider in conjunction with other risk factors,” the researcher concludes, “and some patients should be prioritized for boosters and other critical preventive efforts.”

The study is published in JAMA Network Open.

South West News Service writer Mark Waghorn contributed to this report.

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