New studies show mood disorders heighten risk of severe COVID illness and death

It has been well documented internationally that the COVID-19 pandemic has led to an unprecedented impact on the mental health of broad layers of the world’s population. This includes people with existing mental health problems as well as those previously unaffected prior to the coronavirus crisis.

A new study published this month in The Lancet attempted to quantify the global prevalence and burden of depressive and anxiety disorders, finding substantial increases worldwide. The study was a systematic review of published data that reported the prevalence of depression and anxiety before the pandemic, then compared this using 48 papers published during the first 12 months of the pandemic in 2020.

Health care workers transport a COVID-19 patient from an intensive care unit (ICU) at a hospital in Kyjov to hospital in Brno, Czech Republic late last year (AP Photo/Petr David Josek)

The study, performed by investigators from the Queensland Centre for Mental Health Research and the University of Queensland in Australia, presented data compiled from 204 countries and territories. If the pandemic did not occur, model estimates suggest there would have been 193 million cases of major depressive disorder (2,471 cases per 100,000 population) globally in 2020.

However, the study's findings show there were 246 million cases (3,153 per 100,000), an increase of 28 percent, an increase of 53 million cases. More than 35 million of the additional cases were in women, compared with close to 18 million in men. Similarly, cases of anxiety increased by 76 million, 26 percent above what was expected had there not been a pandemic.

The study also found younger people were more affected by major depressive and anxiety disorders in 2020 than older age groups. The additional prevalence of both disorders peaked among those aged 20-24 years, translating into 1,118 additional cases of major depressive disorder per 100,000 and 1,331 additional cases of anxiety disorders per 100,000. This was found to decline with increasing age.

Further, the study indicated that some regions of the world fared worse than others, particularly those experiencing military conflict such as North Africa and the Middle East. The latter registered the largest rise in depression of 37 percent. South Asia saw the biggest increase in anxiety of 35%.

The heightened prevalence was associated with increasing COVID-19 infection rates as well as decreasing human mobility. The authors cited “the combined effects of the spread of the virus, lockdowns, stay-at-home orders, decreased public transport, school and business closures, and decreased social interactions, among other factors.” Further, it was estimated that countries more negatively impacted by the pandemic during 2020 were those with the greatest increases of these disorders.

The lead author of the study, Dr Damian Santomauro said in a press release “Our findings highlight an urgent need to strengthen mental health systems in order to address the growing burden of major depressive disorder and anxiety disorders worldwide.”

The authors noted that mental health disorders are among the leading causes of the global health-related burden, with the two most disabling conditions, depressive and anxiety disorders, both ranking among the 25 leading causes of burden worldwide in 2019. This was the case internationally, and across gender lines, a trend that had held since 1990.

Dr Santomauro stated: “Even before the pandemic, mental health-care systems in most countries have historically been under-resourced and disorganised in their service delivery. Meeting the added demand for mental health services due to COVID-19 will be challenging, but taking no action should not be an option.”

The implications of this were highlighted by a study earlier this year which found that sufferers of the mood-related conditions were twice as likely to suffer severe adverse consequences from COVID infection, including serious illness, hospitalisation and death.

Published in July in JAMA Psychiatry, a Journal of the American Medical Association, it was a review and meta-analysis of 21 published studies that included more than 91 million people worldwide.

In an interview with the Australian Broadcasting Corporation’s (ABC) Health Report, senior author Dr Roger McIntyre stated, “we've all been familiar with the risk that is afforded if you have cardiovascular disease and obesity, and what we've learned is that the risk with these well-known pre-existing conditions … having a depression or bipolar disorder is in many cases doubling the risk, if not more than doubling the risk. So it is an extraordinary risk.”

While it is as yet unclear the relationship between mood disorders and risk from COVID-19, the authors state that sufferers can show immune dysfunction that may lead to deficiencies in coping with viral infections. Further, people with mood disorders can be at greater risk of cardiovascular disease and obesity which are known to increase the dangers of COVID.

In addition, there are social factors that exacerbate adverse outcomes for those with mood disorders. These patients are increasingly poor, and have limited timely access to preventative health care.

The study authors note that “many individuals with mood disorders reside in congregate facilities, such as psychiatric inpatient units, homeless shelters, community housing, and prisons, where risk of COVID-19 transmission is increased because of the inability to effectively socially distance and/or quarantine.”

Professor Iain Hickie of the Brain Mind Institute at the University of Sydney, added: “One of the mistakes about depression is to think of it as just a psychological response. It's a physiological perturbation. The body is perturbed, in the immune system, in the neuroendocrine or cortisol or stress response system, in the sympathetic nervous system, and in its metabolic system. So, depression is much, much more than just in your head, it's in your body, and your body is perturbed and has trouble then coping with things like infection, with viral illnesses.”

Youth are particularly vulnerable. Professor Hickie explained that mood disorders start in young people, with most before the age of 25 years.

The findings of the report are supported by a similar study design in May 2021 in the journal Psychiatry Research. In over 60,000 COVID-19 patients, investigators from the University of Jordan found that a pre-diagnosis of mental health disorders increased the risk of COVI19 mortality and disease severity. Higher mortality occurred in patients with disorders such as schizophrenia.

This is exacerbated by the fear of contracting the virus, becoming seriously ill, the impact of lockdown and decreased social interaction. An earlier study in December 2020 of over 90,000 people from eight countries in the Journal of Affective Disorders revealed substantial increases in the rates of; anxiety (6 to 51%), depression (15 to 48%), post-traumatic stress disorder (7 to 54%), psychological distress (34 to 38%), and stress (8% to 82%).

The situation facing those with mental illness is not the result of the pandemic. The coronavirus has instead exacerbated what was an already existing crisis. This is due to the slashing of mental health care budgets in virtually every country, including the closure of care institutions, the cutting of staffing and beds in hospitals and the increased cost for private mental health treatment.

The World Health Organisation's Mental Health Atlas 2017 report found in a survey of 169 countries that spending on mental health on average was less than 2 percent of health budgets. Development assistance for mental health has never been more than 1 percent of global development assistance for health.

These research findings suggest that the crisis triggered by COVID will see a drastic increase in morbidity and mortality for those suffering from mental health disorders globally, not only during the pandemic, but for many years to come.

In addition to the toll taken by cuts to mental health services, the criminal response of governments to the pandemic has greatly exacerbated the pressures facing working people. While bailing out the banks, and forcing the working class to pay, capitalist governments have lifted lockdowns and other essential safety measures, allowing the virus to circulate, and millions to die, to ensure that corporate profit-making and capitalist exploitation can continue.