Understanding the Impact of Mental Health on COVID-19 Diagnosis

In 2002, Trajectory Healthcare was founded to evaluate, improve and design population health management programs. Working with their evidence based and patented analytical tools, Trajectory provides epidemiologic consulting services to a variety of health organizations, including the non-profit Population Health Impact Institute (PHII).

In the fall of 2020, Trajectory reached out to Center for Improving Value in Health Care (CIVHC) for claims data from the Colorado All Payer Claims Database (CO APCD) that could assist with examining the “trajectory” of common diseases. The Trajectory team received a data set to better understand the resource use of common diseases, as well as who may or may not be more susceptible based on specific pre-existing conditions.

With the current COVID-19 pandemic in full effect, Trajectory initially focused their research on understanding whether or not people affected by a mental health condition are at higher risk of contracting the COVID-19 virus. Their results, published in a pre-print in the journal SSRN in March 2021 and then presented in collaboration with PHII in a public forum in April, were groundbreaking.





“We believe this study was among the first to discover that mental/behavioral health conditions, including depression and anxiety, interact with physical diseases (i.e., hypertension, diabetes, COPD, asthma, and chronic kidney diseases) in such a way to become a strong predictor of COVID-19 diagnosis,” notes Thomas Wilson, PhD, DrPH Founder and Chief Science Officer Trajectory Healthcare, LLC and PHII Board Chair. He and his co-author, Jessie Sullivan, MD, revised the paper in June 2021 to assess the role of social determinants of health (SDOH) on COVID-19 diagnosis using Medicaid status from the CO APCD as a proxy.

Dr. Sullivan noted that SDOH “…attenuated the role of mental health but did not eliminate it. It was an additional independent predictor comparable to other diseases in the model. This fact alone highlights the need to include SDOH in any population health study.” The revised pre-print of this study is now ranked in the top 15% all SDOH pre-prints in the journal (ranked #30 of 190).

Already proving to be an invaluable resource, this project will continue to assist in determining what factors create higher risks for common diseases such as COVID-19 as well as pinpointing areas for appropriate intervention measures. Additionally, they intend to utilize the data to determine which comorbidities may have a higher likelihood of “subsequent events” such as, rehospitalizations, ER visits, PCP visits, etc. The project team has applied for funding from the National Science Foundation to allow for additional data and even more robust analyses of all the COVID-19 waves subsequent to the first one in 2020.

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