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Excess deaths among those with mental health conditions and intellectual disabilities has increased during the COVID-19 pandemic.

A UK study of more than 160 thousand patients found that deaths from COVID-19 among people with learning disabilities were nine times higher than among the general population during the first UK lockdown and were five times higher among those with eating disorders. 

“Prior to the pandemic we knew that people with severe mental illnesses and with intellectual disabilities were at an increased risk of death, mostly from preventable physical causes. When the pandemic started we were very concerned that people with serious mental health problems and intellectual disabilities might be more vulnerable to contracting and dying from COVID-19. We did the study using large scale health records linked to information on deaths, which enabled us to assess our concerns using real-time data,” Dr Jayati Das-Munshi, lead author of the study and Reader in Social and Psychiatric Epidemiology at King's College London told Theravive.

“Our study found that during the pandemic the excess risk of mortality rose further- across all nine mental health conditions surveyed, deaths from COVID19 were more than the general population, and in addition excess mortality from all other causes continued to be a concern too.”   

In undertaking the research, Das-Munshi and colleagues examined data from 167, 122 patients between 2019 and 2020. They looked at the ratio of mortality spanning across nine mental health conditions as well as intellectual disabilities. 

They also assessed the data by ethnicity.   

They found those living with personality disorders and those with dementia had a death rate from COVID-19 that was four times higher than the general population. For people with schizophrenia, the death rate was three times higher.

Part of this increase in deaths, Das-Munshi says, could be attributed to people with mental health conditions or intellectual disabilities living in care facilities or group homes. 

“Early on in the pandemic in the UK and elsewhere, when testing was not yet widely available and there were shortages in PPE, there were concerns that people living in residential or group home situations were at an increased risk of contracting COVID-19,” she told Theravive. 

“It is possible that this may have partially accounted for the findings in this study since we know that a larger proportion of people with learning disabilities would have been in these living situations.” 

Even before the days of the COVID-19 pandemic, those with intellectual disabilities or mental health conditions already had a higher death rate than the general population. Das-Munshi says this is likely due to a number of factors. 

“Underlying health conditions like type 2 diabetes mellitus, respiratory conditions and cancers may occur in excess in people living with severe mental illnesses. We know that these groups also experience high levels of mental health related stigma which can have an adverse impact when people may try to access care,” she said. 

“Our previous work has indicated that service users find it challenging to access care when they are receiving this from multiple providers and the care is not well integrated. Although most causes of death are from preventable physical causes, mortality from suicide may be also more likely, compared to the general population, for some groups, and this will also play a role.” 

The number of deaths among those with intellectual disabilities and mental health conditions declined between July 2020 and September 2020 as case numbers in the UK fell and lockdown restrictions were eased.

But the death rate among the intellectually disabled or those with mental health conditions was still double that of the general population.

The researchers say their work is an important reminder those living with intellectual disabilities or mental health conditions are vulnerable and at risk of mortality from COVID-19. Given this, these people should be prioritized for vaccination as well as given optimal physical care and suicide reduction interventions. 

“More can be done. Prior to the pandemic there were already longstanding concerns around a lack of parity of esteem between mental health and physical health. The pandemic has shone a light on this and unfortunately has made things worse,” Das-Munshi said. 

“Similar findings to ours from the UK have also been reported globally. We really do need to ensure that people living with a range of severe mental health conditions and intellectual disabilities are prioritised for equitable healthcare access, the COVID-19 public health emergency has made things worse.”