Too Risky? Mental Illness and Risky Behaviors During the COVID-19 Pandemic

Patients with bipolar I disorder and other mental illnesses may be at increased risk for COVID-19 infection.

A new cross-sectional observational study evaluated the risk perception of the COVID-19 pandemic in Italian patients with a mental health diagnosis to better understand how they faced the pandemic. Results showed that individuals with a mental illness may be more likely to engage in risky behavior.

Investigators conducted their research during the second wave of the COVID-19 pandemic and the lockdown in Italy, assessing risk perception and risk-related variables in a sample of 150 participants with a previous diagnosis of major depression, bipolar I disorder, and schizophrenia. Results showed that participants were more concerned about economic, psychological, and interpersonal consequences of COVID-19 than about physical health.

“Our study highlights the need to provide more support to psychiatric patients during emergency events to prevent them from engaging in risky behaviors,” wrote the authors.1

Findings showed no difference in the perception of risk among patients with major depression, schizophrenia, and bipolar disorder. This may indicate that mental illness might influence risk perception independently from the diagnosis, as is indicated by previous studies that demonstrated mental illness influences patient’s well-being and daily living.2,3 Furthermore, patients with severe mental illness have higher risk of developing COVID-19, perhaps due to a lack of a sense of self-preservation.4

Participants reported a higher perceived risk of work and of economic consequences due to COVID-19 pandemic. Data on mortality risk showed that patients considered the risk of dying for heart attack, cancer, and stroke higher than the risk of dying for COVID-19, perhaps due to participants’ high perception of control, self-efficacy, and positive emotions toward the COVID-19 pandemic. Participants were more concerned about the negative impact of the pandemic on psychological well-being and interpersonal relationships.

“Our results showed that psychiatric patients perceived the economic and social long-term consequences of COVID-19 much more dangerous than the short-term ones (contagion, death, and health risk). In addition, the increase in knowledge about the virus accentuates these concerns. We believe that it is necessary to develop new interventions to implement coping strategies aimed to reduce the impact of emergency situations on the psychiatric population,” said the authors.1


1. Natale A, Concerto C, Rodolico A, et al. Risk perception among psychiatric patients during the COVID-19 pandemic. Int J Environ Res Public Health. 2022;19(5):2620.

2. Momen NC, Plana-Ripoll O, Agerbo E, et al. Association between mental disorders and subsequent medical conditions. N Engl J Med. 2020;382(18):1721-1731.

3. Yao H, Chen JH, Xu YF. Patients with mental health disorders in the COVID-19 epidemic. Lancet Psychiatry. 2020;7(4):e21.

4. Zhu Y, Chen L, Ji H, et al. The risk and prevention of novel coronavirus pneumonia infections among inpatients in psychiatric hospitals. Neurosci Bull. 2020;36(3):299-302.