Psychiatric Disorders Linked to Higher Breakthrough Covid Risk, Study Finds

A study published in JAMA Network Open this week found that people living with psychiatric disorders face a measurably higher chance of catching Covid-19 even after being fully vaccinated. The research, conducted by scientists at the San Francisco Veterans Affairs Health Care System and UC San Francisco's Department of Psychiatry, analyzed medical records from nearly 264,000 fully vaccinated patients who received care through the Department of Veterans Affairs between early 2020 and late 2021. None of these patients had tested positive for the virus before vaccination. The findings suggest that mental health conditions may compromise immune response or vaccine effectiveness in ways that public health campaigns have not yet adequately addressed.

The overall risk increase was modest but consistent: people with any psychiatric disorder diagnosis were about 3.7% more likely to experience a breakthrough infection than those without such diagnoses. But the risk varied sharply depending on the specific condition. Substance use disorder emerged as the strongest predictor, associated with a 16% higher risk of breakthrough infection. Adjustment disorder—a condition that can develop after a stressful life event and may include symptoms like trembling, tension, or feelings of hopelessness—was linked to a 13% higher risk. Anxiety disorders carried an 8% increased risk. The researchers controlled for factors known to complicate Covid outcomes, including age, sex, obesity, smoking status, and chronic conditions like diabetes, suggesting that the psychiatric diagnoses themselves, rather than lifestyle factors alone, were driving the elevated vulnerability.

The vulnerability was not evenly distributed across age groups. The association between psychiatric disorders and breakthrough infection risk was strongest among patients 65 and older, a finding that reflects the generally higher susceptibility to severe Covid outcomes in older populations. Notably, the study uncovered one counterintuitive result: among people under 65, those with psychotic disorder diagnoses showed a 10% lower risk of breakthrough infection—the only psychiatric condition associated with reduced rather than increased risk in that age group. Researchers have not yet explained this anomaly.

The question of why psychiatric conditions might increase breakthrough infection risk remains incompletely understood. Some research published in the Lancet and elsewhere suggests that people with certain psychiatric disorders may have diminished immune function or produce weaker responses to vaccines, leaving them with reduced immunity even after vaccination. A separate 2022 study by the American Psychological Association found that certain post-traumatic stress disorder symptoms correlated with riskier Covid behaviors—like traveling by air for leisure or attending large gatherings—which could increase exposure opportunities. Before vaccines became widely available, people with psychiatric disorders were already known to face higher rates of Covid infection and more severe outcomes including hospitalization and death.

The authors of the JAMA study argue that these findings point toward a gap in public health strategy. If people with psychiatric conditions are genuinely at elevated risk despite vaccination, they may need targeted interventions—booster shot campaigns designed specifically for them, prevention messaging tailored to their circumstances, and perhaps additional support to reduce risky behaviors. The research suggests that mental health should be considered a factor in Covid vulnerability planning, not an afterthought. As vaccination campaigns shift focus and pandemic restrictions ease, the question of how to protect vulnerable populations, including those with psychiatric diagnoses, remains unresolved.