Excess deaths in people with mental health conditions increased during the COVID-19 pandemic

Before the pandemic the rates of mortality in those with severe mental health conditions were already higher than the general population. New research published in The Lancet Regional Health -- Europe shows that between March and June 2020, during the first wave of COVID-19, mortality further increased in people with mental health conditions and intellectual disabilities compared with the general population.

The study was published in the run up to World Mental Health Day on 10 October 2021 which this year has the theme 'Mental Health in an Unequal World'.

Deaths from COVID-19 among those with learning disabilities were nine times higher than the general population during the first lockdown period, according to the study, and for those with eating disorders almost five times higher. For those with personality disorders and those with dementia, deaths from COVID-19 were about four times higher than the general population and more than three times higher in people with schizophrenia.

The research was part-funded by the National Institute for Health Research (NIHR) Maudsley Biomedical Research Centre (BRC) and used the Clinical Record Interactive Search (CRIS) system to analyse anonymised data from clinical e-records of patients from South London.

Lead author Dr Jayati Das-Munshi, Reader in Social and Psychiatric Epidemiology at King's College London and Honorary Consultant Psychiatrist with South London and Maudsley NHS Foundation Trust, said: "The results from our study paint a stark picture of how the existing vulnerability of those with mental health conditions and intellectual disabilities have worsened during the COVID-19 pandemic. The higher death rates compared to the general population were associated with more deaths from COVID-19 infection itself, as well as deaths from other causes.

"People living with severe mental health conditions and intellectual disabilities should be considered a vulnerable group at risk of COVID-19 mortality, as well as deaths from other causes, throughout the pandemic. We suggest a need to prioritise vaccination and optimise physical health care and suicide risk reduction, before, during and after peaks of COVID-19 infection in people living with mental health conditions."

Through the NIHR Maudsley BRC's Clinical Records Interactive System (CRIS) researchers analysed anonymised data from 167,122 patients at South London and Maudsley NHS Foundation Trust on deaths between 2019 and 2020. They assessed mortality ratios across nine mental health conditions and intellectual disabilities and by ethnicity. These were standardised by age and gender and were also compared with five-year average weekly deaths (from 2015 to 2019) from England and Wales. These were then standardised against population data from London, to assess whether estimates were accounted for by local area-level effects.

Senior author Rob Stewart, Professor of Psychiatric Epidemiology & Clinical Informatics at the Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King's College London, said: "These findings and their implications illustrate the importance of being able to learn from the information contained in health records. We have worked with the Maudsley's CRIS platform for nearly 15 years now and a key focus has been to highlight inequalities in mortality and general health. Because CRIS information is updated on a weekly basis, this has allowed us to track the progress of the COVID-19 pandemic and its impact on mental health services."

Deaths in those with mental health conditions and intellectual disabilities fell from July 2020 to September 2020 as COVID-19 cases fell and lockdowns eased, however remained double that of the general population which was similar to the figures before the pandemic.

Similar mortality trends were observed across minority ethnic groups within the sample, with South Asian and Black Caribbean people with severe mental health conditions and intellectual disabilities being 2.5 times more likely to die in the pandemic period compared to the year prior to the pandemic. Elevated mortality risks were also evident for White British and Black African people with severe mental health conditions and intellectual disabilities.

Researchers were from the Institute of Psychiatry, Psychology & Neuroscience, the Centre for Implementation Science, and the ESRC Centre for Society and Mental Health, all based at King's College London.

The study was funded by the NIHR Maudsley Biomedical Research Centre and the Academy of Medical Sciences.

The paper 'All-cause and cause-specific mortality in people with mental disorders and intellectual disabilities, before and during the COVID-19 pandemic: cohort study' was published in The Lancet Regional Health -- Europe.