COVID-19 vaccination for people with severe mental illness: why, what, and how?

Mazereel, Victor; Assche, Kristof Van; Detraux, Johan; Hert, Marc De

doi:10.1016/s2215-0366(20)30564-2

Cited by 140 publications

(177 citation statements)

References 104 publications

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“…4,5 The risks of poor COVID-19 outcomes might differ between psychiatric disorders, and patients with severe mental illness (usually including psychotic and mood disorders) have been suggested to be particularly susceptible. 6 Increased risks of COVID-19 mortality and intensive care unit (ICU) admission have also been associated with psycho pharmacological treatments. 7,8 Although some studies have demonstrated higher COVID-19 mortality in patients with mental disorders, the studies did not identify higher risk of hospital admission or ICU admission.…”

Section: Introductionmentioning

confidence: 99%

Mental disorders and risk of COVID-19-related mortality, hospitalisation, and intensive care unit admission: a systematic review and meta-analysis

Vai

Mazza

Colli

et al. 2021

The Lancet Psychiatry

253

214

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Background Mental disorders might be a risk factor for severe COVID-19. We aimed to assess the specific risks of COVID-19-related mortality, hospitalisation, and intensive care unit (ICU) admission associated with any pre-existing mental disorder, and specific diagnostic categories of mental disorders, and exposure to psychopharmacological drug classes.Methods In this systematic review and meta-analysis, we searched Web of Science, Cochrane, PubMed, and PsycINFO databases between Jan 1, 2020, and March 5, 2021, for original studies reporting data on COVID-19 outcomes in patients with psychiatric disorders compared with controls. We excluded studies with overlapping samples, studies that were not peer-reviewed, and studies written in languages other than English, Danish, Dutch, French, German, Italian, and Portuguese. We modelled random-effects meta-analyses to estimate crude odds ratios (OR) for mortality after SARS-CoV-2 infection as the primary outcome, and hospitalisation and ICU admission as secondary outcomes. We calculated adjusted ORs for available data. Heterogeneity was assessed using the I² statistic, and publication bias was tested with Egger regression and visual inspection of funnel plots. We used the GRADE approach to assess the overall strength of the evidence and the Newcastle Ottawa Scale to assess study quality. We also did subgroup analyses and meta-regressions to assess the effects of baseline COVID-19 treatment setting, patient age, country, pandemic phase, quality assessment score, sample sizes, and adjustment for confounders. This study is registered with PROSPERO, CRD42021233984. Findings 841 studies were identified by the systematic search, of which 33 studies were included in the systematic review and 23 studies in the meta-analysis, comprising 1 469 731 patients with COVID-19, of whom 43 938 had mental disorders. The sample included 130 807 females (8•9% of the whole sample) and 130 373 males (8•8%). Nine studies provided data on patient race and ethnicity, and 22 studies were rated as high quality. The presence of any mental disorder was associated with an increased risk of COVID-19 mortality (OR 2•00 [95% CI 1•58-2•54]; I²=92•66%). This association was also observed for psychotic disorders (2•05 [1•37-3•06]; I²=80•81%), mood disorders (1•99 [1•46-2•71]; I²=68•32%), substance use disorders (1•76 [1•27-2•44]; I²=47•90%), and intellectual disabilities and developmental disorders (1•73 [1•29-2•31]; I²=90•15%) but not for anxiety disorders (1•07 [0•73-1•56]; I²=11•05%). COVID-19 mortality was associated with exposure to antipsychotics (3•71 [1•74-7•91]; I²=90•31%), anxiolytics (2•58 [1•22-5•44]; I²=96•42%), and antidepressants (2•23 [1•06-4•71]; I²=95•45%). For psychotic disorders, mood disorders, antipsychotics, and anxiolytics, the association remained significant after adjustment for age, sex, and other confounders. Mental disorders were associated with increased risk of hospitalisation (2•24 [1•70-2•94]; I²=88•80%). No significant associations with mortality were identified for ICU adm...

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Section: Introductionmentioning

confidence: 99%

Mental disorders and risk of COVID-19-related mortality, hospitalisation, and intensive care unit admission: a systematic review and meta-analysis

Vai

Mazza

Colli

et al. 2021

The Lancet Psychiatry

253

214

View full text Add to dashboard Cite

show abstract

“…As we have discussed in the previous section, studies have shown bidirectional associations between pre-existing psychiatric disorder and severity of SARS-CoV-2 infection as well as illness-related hospitalization, morbidity and mortality (Yang et al, 2020;Taquet et al, 2021b;Wang et al, 2021b). Dysregulated immunity, chronic stress and sleep disturbances are a few other additional vulnerabilities for SMI-COVID-19 interactions (Mazereel et al, 2021). Social factors such as poverty, homelessness, stigmatization, discrimination, and social stereotypes not only contribute to the COVID-19-related stress, but also to the access to healthcare and vaccination (Torales et al, 2020).…”

Section: Unique Roles and Opportunitiesmentioning

confidence: 92%

“…1. Prioritizing vaccinations in individuals with SMI and substance use disorders (SUD) in public health: Literature mentions people with SMI and SUD to be vulnerable groups besides their propensity for physical comorbidity, and recommends urgent vaccination in them (Mazereel et al, 2021). As we have discussed in the previous section, studies have shown bidirectional associations between pre-existing psychiatric disorder and severity of SARS-CoV-2 infection as well as illness-related hospitalization, morbidity and mortality (Yang et al, 2020;Taquet et al, 2021b;Wang et al, 2021b).…”

Section: Unique Roles and Opportunitiesmentioning

confidence: 99%

COVID-19 Vaccination: crucial roles and opportunities for the mental health professionals

et al. 2021

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Besides addressing the increased prevalence of psychiatric disorders, social challenges, and building community resilience during the crisis, mental health professionals (MHPs) are in a unique position to assist the vaccination drive against coronavirus disease-2019 (COVID-19) in various nations. Vaccination programs are adversely affected by misinformation, fake news and vaccine hesitancy fuelled by social media. MHPs can enable this vital public health strategy by prioritizing vaccination for individuals with severe mental illness (SMI) and substance use disorders, promote awareness and public education, debunk misinformation and integrate psychosocial care into the vaccination drives. In order to target the health inequity and discrimination faced by people with SMI coupled with their additional risks, the authors urge the global mental health fraternity to tailor these crucial roles with respect to COVID-19 vaccination based on the regional needs and contexts.

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“…The issues related to this greater risk include medications used to treat severe mental illness, poorer levels of physical health than the general public, reduced access to medical care, as well as environmental and socioeconomic factors (Chen et al 2020;Warren et al 2020). In addition, people with severe mental illness are less likely to avail themselves of vaccines when they have been available for infectious disease outbreaks in the past (Mazereel et al 2021) but our understanding of vaccine uptake for seasonal flu in people with severe mental illness remains limited (Williams et al 2016). One study of seasonal vaccination uptake by people with severe mental illness demonstrated that a specialized clinic held in an easily accessible environment was an effective way to increase vaccination uptake (from 58.4% to 93.8%) (Miles et al 2020).…”

mentioning

confidence: 99%

“…People with severe mental illness are at greater risk of being infected with COVID-19 and have increased risk of subsequent rates of hospitalization, mortality, and morbidity as a result of being infected (Huang et al 2020;Mazereel et al 2021;Wang et al 2020). The issues related to this greater risk include medications used to treat severe mental illness, poorer levels of physical health than the general public, reduced access to medical care, as well as environmental and socioeconomic factors (Chen et al 2020;Warren et al 2020).…”

mentioning

confidence: 99%

Ensuring COVID‐19 vaccine uptake by people with severe mental illness: A mental health nursing priority

Usher

2021

Int J Mental Health Nurs

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COVID-19 vaccination for people with severe mental illness: why, what, and how?

Cited by 140 publications

References 104 publications

Mental disorders and risk of COVID-19-related mortality, hospitalisation, and intensive care unit admission: a systematic review and meta-analysis

Mental disorders and risk of COVID-19-related mortality, hospitalisation, and intensive care unit admission: a systematic review and meta-analysis

COVID-19 Vaccination: crucial roles and opportunities for the mental health professionals

Ensuring COVID‐19 vaccine uptake by people with severe mental illness: A mental health nursing priority

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