ADHD as a Risk Factor for Infection With Covid-19

New study shows that people infected with COVID-19 have a higher risk of having ADHD, ASD, or Schizophrenia. If you add the person having a LOW Social Economic Status (SES), then the risk is significantly higher. We look at the data from this study, and try to spot the risk factors.

It was found that in contrast to all the other mental health disorders that were assessed, only the rate of ADHD was significantly higher among the Covid-19-P subjects, irrespective of age, gender, SES and the presence of other chronic mental and physical disorders.

Merzon, E., Manor, I., Rotem, A., Schneider, T., Vinker, S., Golan Cohen, A., Lauden, A., Weizman, A., & Green, I. (2020). ADHD as a Risk Factor for Infection With Covid-19. Journal of attention disorders, 1087054720943271. Advance online publication. https://doi.org/10.1177/1087054720943271

[…] This study included 14,022 subjects, aged from 2 months old to 103 years old, who were tested for Covid-19. Among them 1,416 (10.1%) had at least one positive result, and 12,606 (89.9%) had only negative results. In a primary univariate analysis, Covid-19-positive (Covid-19-P) subjects were younger, more likely to be males, and belonged to a lower SES than Covid-19-negative (Covid-19-N) subjects (Table 1). […]

[…] The medical conditions of the sample exhibited several significant differences between the Covid-19-P and the Covid-19-N subjects (Table 2). The most prominent ones were the presence of ADHD (p<.001), dementia (p<.001), hypertension (p<.001), and chronic lung disease (p<.001) (Table 2). […]

[…] In the univariate analysis, the likelihood of Covid-19 infection was positively associated with having a diagnosis of ADHD [crude OR of 1.47 (95% CI 1.26–1.71, p<.001)], being younger than 20 years old [crude OR of 1.78 (95% CI 1.57–2.03, p<.001)], being male [crude OR of 1.16 (95% CI 1.04–1.29, p<.05)] and being part of the low-medium SES group [crude OR of 2.41 (95% CI 2.06–2.83, p<.001)]. […]

[…] The likelihood of Covid-19 infection was negatively associated with having a diagnosis of depression/anxiety [crude OR of 0.77 (95% CI 0.62–0.96, p<.001)], dementia [crude OR of 0.55 (95% CI 0.38–0.79, p<.001)], diabetes mellitus [crude OR of 0.83 (95% CI 0.71–0.98, p<.001)], hypertension [crude OR of 0.83 (95% CI 0.71–0.98, p<.001)] and chronic lung disease [crude OR of 0.61 (95% CI 0.49; 0.75, p<.001)] (Table 3). […]

[…] After controlling the demographic and the medical variables in a multivariate analysis, the adjusted odds ratio of ADHD increased to 1.58 (95% CI 1.27–1.96, p<.001), emphasizing the significance of the association between ADHD and Covid-19. […]

[…] The positive association of Covid-19 infection with male gender, age below 20 years and low-medium SES group remained significant, adjusted OR of 1.18 [(95% CI 1.01–1.37, p<.05)] 2.08 [(95% CI 1.61–2.68, p<.001)], and 1.96 [(95% CI 1.63–2.36, p<.001)], respectively. […]

[…] The negative association of Covid-19 infection remained significant only with having a chronic lung disease [adjusted OR of 0.58 (95% CI 0.45–0.76, p<.001] (Table 3). […]

[…] Among the 1,699 subjects with a diagnosed ADHD, 418 (24.6%) have purchased during the last 12 months at least three prescriptions of ADHD medications and were defined as treated. […]

[…] About 92% of the medications were stimulants. In order to clarify the effect of ADHD pharmacotherapy, the sample was stratified to three strata: non-ADHD, treated ADHD, and untreated ADHD. […]

[…] The subjects with treated ADHD had no additional risk of Covid-19 [crude OR of 1.07 (95% CI 0.78; 1.48, p=.65)], compared to non-ADHD subjects (a reference group), while the risk of subjects with untreated ADHD was significantly increased [crude OR of 1.61 (95% CI 1.36–1.89, p<.001)] (Table 4). […]

[…] After an adjustment for possible confounders, the association between ADHD treatment and the risk of infection with Covid-19 became more prominent for untreated ADHD versus treated ADHD [adjusted OR 1.68 (95% CI 1.37–2.10, p<.001 vs. adjusted OR 0.85 (95% CI 0.54– 1.34, p=.707), respectively] (Table 4, Figure 1). […]

Discussion

[…] Vulnerability to Covid-19 infection is still not well understood and the information about it is scarce, thus the best way to tackle it is through a focus on high-risk groups. […]

[…] This study examined the possible risk factors, from demographic ones, as age and gender, to the medical ones. The studied population included all the suspected subjects of an Israeli HMO in the first 2 months of the epidemic, who were tested for Covid-19, and the infection rate was found to be 10.1%. […]

[…] It is interesting to note that the Covid-19 positive patients tended to be younger, to be males and from a lower SES group. The tendency toward a lower SES group could be explained by the higher density of the population in this strata. These findings are consistent with other urban reports such as in New York City where there was a higher likelihood for a positive test amongst those who live in lower SES neighborhoods and those who live in larger households (Borjas, 2020). […]

[…] The independent association between young age and increased likelihood of Covid-19 infection early in Israel’s Covid-19 outbreak has been poorly reported elsewhere due to lack of early widespread testing. However, a similar distribution amongst young adults has been reported in South Korea, a country who also applied early vigorous testing (Shim et al., 2020). Similarly, the initial low case fatality rate in England may have been a reflection of the relatively young age structure of early infections (Dowd et al., 2020). […]

[…] This association may be related to risky behaviors such as the attendance of mass gatherings as well as the tendency of this age group to cling together, remaining non-compliant with social distancing measures. […]

[…] For instance, in Korea’s recent Covid-19 “second wave,” hundreds of infections have been linked to nightclubs and other entertainment venues, which saw large crowds in early May after officials relaxed social distancing guidelines (Gang-lip, 2020). […]

[…] Moreover, an adjustment for age younger than 20 years old in a multivariate logistic regression analysis increased the odds ratio of association between the previous diagnosis of ADHD and the risk of being infected with Covid 19. […]

[…] Medical conditions, like diabetes, hypertension, and chronic lung diseases that were considered to be associated with increased rate of fatality (Docherty et al., 2020) were not linked to an elevated rate of infection in this study. […]

[…] This is most probably due to the strict “stay at home” restrictions that were particularly stressed in this vulnerable population (Centers for Disease Control and Prevention, 2020b; Israel Ministry of Health, 2020b). […]

[…] On the other hand, mental health problems were not identified as possible risk factors for Covid-19 infection. It was found that in contrast to all the other mental health disorders that were assessed, only the rate of ADHD was significantly higher among the Covid-19-P subjects, irrespective of age, gender, SES and the presence of other chronic mental and physical disorders. […]

[…] This finding is especially robust, since most of the diagnosed ADHD patients are children (Ginsberg et al., 2014a, 2014b), and that the pediatric population accounted for less than 2% of Covid-19 identified cases during the same time period (Centers for Disease Control and Prevention, 2020c; Lu et al., 2020). Thus, it seems that ADHD by itself is a plausible risk factor for this infection. […]

[…] One possible explanation of the significant vulnerability of ADHD subjects to be infected by Covid-19 may be ascribed to the inattentive, hyperactive, and impulsive characteristics of ADHD. These characteristics of ADHD interfere with the ability to comply with WHO demands for the prevention of Covid-19 infection. Interestingly, other tested psychiatric disorders did not have the same effect on the rate of Covid-19 infection. […]

[…] Noteworthy, schizophrenia that shares some of the clinical characteristics of ADHD such as distractibility, inattention in addition to impaired judgment, was not associated with significant elevated risk for infection with Covid-19 (Table 3). […]

[…] Another characteristic of people with ADHD is their difficulty in taking orders and to be disciplined. Thus, it may be that their compliance to the restrictions that were imposed on the population was lower, thus increasing their vulnerability to be infected. […]

[…] In addition, the rate of Covid-19-P tests was significantly higher in untreated ADHD subjects, while in ADHD subjects treated with pharmacotherapy the rate was even lower than that of non-ADHD subjects. This finding indicates the possible protective role of pharmacotherapy in the attenuation of Covid-19 transmission. […]

[…] The notion of dysregulated behavior as a cause for increased risk for infection with Covid-19 is supported by the reduced rate of infection in ADHD treated patients, as compared to the higher rate of infection in the untreated ones. […]

[…] Therefore, it is suggested that physicians will educate parents, as well as young and adult ADHD patients on the potential for increased risk, as well as risk amelioration through medication. […]

Conclusion

[…] In conclusion, this study found that ADHD may be a risk factor for Covid-19 infection, independently of other risk factors. […]

[…] The pharmacotherapy of ADHD (mostly stimulants) appeared to moderate the risk of infection. […]

[…] This is an important finding, since it could encourage healthcare systems to identify this population at risk, to increase their awareness to the necessary preventive actions, and to guide their parents, teachers, or personal caretakers to monitor carefully their behavior and the Covid-19 status. […]

[…] Adherence to anti-ADHD treatment should be encouraged in an attempt to reduce the spread of Covid-19 infection (Cortese et al., 2020). […]

/ADDspeaker

References

Merzon, E., Manor, I., Rotem, A., Schneider, T., Vinker, S., Golan Cohen, A., Lauden, A., Weizman, A., & Green, I. (2020). ADHD as a Risk Factor for Infection With Covid-19. Journal of attention disorders, 1087054720943271. Advance online publication. https://doi.org/10.1177/1087054720943271