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Adults with schizophrenia, bipolar disorder, or recurrent major depressive disorder—especially those who are older, Black or Hispanic, have chronic conditions, have public health insurance, or were hospitalized during infection—are at elevated risk for long COVID, according to an analysis published yesterday in JAMA Network Open.

To determine whether adults with serious mental illness (SMI) are more vulnerable to long COVID (also called postacute sequelae of SARS-CoV-2 [PASC]) than those without SMI, a team led by a Weill Cornell Medicine researcher conducted a longitudinal cohort study from March 2020 to April 2023.

The study was based on the electronic health records of more than 1.6 million COVID-19 patients aged 21 years and older from 30 days to 6 months after infection. The average patient age was 52 years, 61.4% were women, 12.6% were Black, 13.5% were Hispanic, and 51.3% were White. 

Risk factors for persistent symptoms

A total of 15.9% of participants had an SMI, and 24.8% developed PASC. Those with an SMI were at a 10% higher risk for PASC (adjusted odds ratio [aOR], 1.10; 95% confidence interval, 1.08 to 1.11). 

These results suggest the need for coordinated approaches that simultaneously treat and seek to prevent PASC among adults with serious mental illnesses.

“The increased COVID-19 infection and mortality risks of adults with SMI are due in part to limited general medical care access, treatment adherence challenges, and the presence of comorbidities such as cardiovascular disease and diabetes,” the researchers wrote. 

A PASC risk factor was older age compared with ages 22 to 34 years (OR for 35 to 44 years, 1.04; OR for 45 to 64, 1.11; OR for 65 and older, 1.18).

Other contributing factors were Black or Hispanic versus White race (Black OR, 1.08; Hispanic OR, 1.12), chronic disease versus none (OR for Charlson Comorbidity Index [CCI] scores of 1 to 3, 1.13; OR for scores of 4 or higher, 1.23), hospitalization for infection versus none (OR, 1.80; hospitalization with ventilation, 2.17). Relative to public health insurance, commercial insurance was tied to lower odds of PASC (OR, 0.85).

“These results suggest the need for coordinated approaches that simultaneously treat and seek to prevent PASC among adults with serious mental illnesses,” the authors concluded.