Association of Psychiatric Disorders With Mortality Among Patients With COVID-19

Abstract

IMPORTANCE To date, the association of psychiatric diagnoses with mortality in patients infected with coronavirus disease 2019 (COVID-19) has not been evaluated.OBJECTIVE To assess whether a diagnosis of a schizophrenia spectrum disorder, mood disorder, or anxiety disorder is associated with mortality in patients with COVID-19. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study assessed 7348 consecutive adult patients for 45 days following laboratory-confirmed COVID-19 between March 3 and May 31, 2020, in a large academic medical system in New York. The final date of follow-up was July 15, 2020. Patients without available medical records before testing were excluded. EXPOSURES Patients were categorized based on the following International Statistical Classification of Diseases, Tenth Revision, Clinical Modification diagnoses before their testing date: (1) schizophrenia spectrum disorders, (2) mood disorders, and (3) anxiety disorders. Patients with these diagnoses were compared with a reference group without psychiatric disorders. MAIN OUTCOMES AND MEASURES Mortality, defined as death or discharge to hospice within 45 days following a positive severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) test result. RESULTS Of the 26 540 patients tested, 7348 tested positive for SARS-CoV-2 (mean [SD] age, 54 [18.6] years; 3891 [53.0%] women). Of eligible patients with positive test results, 75 patients (1.0%) had a history of a schizophrenia spectrum illness, 564 (7.7%) had a history of a mood disorder, and 360 (4.9%) had a history of an anxiety disorder. After adjusting for demographic and medical risk factors, a premorbid diagnosis of a schizophrenia spectrum disorder was significantly associated with mortality (odds ratio [OR], 2.67; 95% CI, 1.48-4.80). Diagnoses of mood disorders (OR, 1.14; 95% CI, 0.87-1.49) and anxiety disorders (OR, 0.96; 95% CI, 0.65-1.41) were not associated with mortality after adjustment. In comparison with other risk factors, a diagnosis of schizophrenia ranked behind only age in strength of an association with mortality. CONCLUSIONS AND RELEVANCEIn this cohort study of adults with SARS-CoV-2-positive test results in a large New York medical system, adults with a schizophrenia spectrum disorder diagnosis were associated with an increased risk for mortality, but those with mood and anxiety disorders were not associated with a risk of mortality. These results suggest that schizophrenia spectrum disorders may be a risk factor for mortality in patients with COVID-19.

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“…It is of worth to pinpoint that Wang and colleagues (2021) reported that chronic schizophrenia patients have a lower association compared with recent diagnosis of schizophrenia (less than 1 year) (AOR 1.48, 95% CI: 1.33-1.65 vs. AOR 9.89, 95% CI: 8.68-11.26), giving place to the speculation that antipsychotic treatment may exert a protective effect. Nemani et al, (2021) recently described that schizophrenia spectrum diagnosis was associated with an increase of death or discharge to hospice outcome at 45 days following testing and highlighted the relevance of evaluating the potential protective effects of psychotropic medications. Our data retrospectively exploring an epidemiological sample of people with severe mental disorders who are on long-acting injectable antipsychotics revealed a lower risk of SARS-CoV2 infection and a better outcome after infection in this group of antipsychotic treated individuals compared to overall COVID-19 people (Canal-Rivero et al, 2021).…”

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“…7 Several studies have found an association between an existing psychiatric disorder and increased risk for SARS-CoV-2 infection and COVID-19-related hospitalisation, morbidity, and mortality. [17][18][19][20][21][22][23][24] Some of these studies also specifically examined the difference between risks associated with severe mental illness, as described by diagnosis, severity, or previous hospitalisation for a mental disorder, and other psychiatric disorders. These studies point to a higher risk for worse COVID-19-related outcomes for people with severe mental illness than for people with less severe mental illness.…”

“…These studies point to a higher risk for worse COVID-19-related outcomes for people with severe mental illness than for people with less severe mental illness. 17,19,23,24 Individuals with severe mental illness have a two to three times higher mortality rate than do the general population. 7,25 Compared with the general population, people with severe mental illness are more likely to be obese or have physical diseases, such as cardiovascular diseases, type 2 diabetes, and respiratory tract diseases, all risk factors for worse COVID-19-related outcomes.…”

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“…The risk of infection was comparable or even higher than the risk of other chronic conditions such as heart disease and diabetes. Another study from the USA demonstrated that the risk of mortality is increased in patients with schizophrenia spectrum disorder, even after controlling for age and other chronic medical conditions [ 11 ▪▪ ]. Patients with a schizophrenia spectrum disorder had a 2.7-fold higher odds of mortality, which was found to be higher than diabetes, heart failure, or hypertension.…”