Death associated with coronavirus (COVID-19) infection in individuals with severe mental disorders in Sweden during the early months of the outbreak – a exploratory cross-sectional analysis of a population-based register study

Abstract

Background: Individuals with severe mental disorder (SMD) have a higher risk of somatic comorbidity and mortality than the rest of the population. We set up a population-based study to assess whether individuals with SMD had a higher risk of death associated with a COVID-19 infection (COVID-19 associated death) than individuals without SMD. Methods: Exploratory analysis with a cross-sectional design in the framework of a population-based register study covering the entire Swedish population. The Swedish Board for Health and Welfare (Socialstyrelsen) provided anonymised tabulated summary data for further analysis. We compared numbers of COVID-19 associated death in individuals with SMD (cases) and without SMD (controls). We calculated the odds ratio (OR) for the whole sample and by age group and four potential risk factors, namely diabetes, cardiovascular disease, hypertension, chronic lung disease. Results: The sample comprised of 7,923,859 individuals, 103,999 with SMD and 7,819,860 controls. There were 130 (0.1%) COVID-19 associated deaths in the SMD group and 4945 (0.06%) in the control group, corresponding to an OR of 1.98 (CI 1.66-2.35; p < 0.001). The odds were fourfold in the age group between 60 and 79 years. Cardiovascular diseases increased the odds by 50%. Individuals with SMD without any of the risk factors under study had three-folds odds of COVID-19 associated death. Conclusion: Our preliminary results suggest that individuals with SMD are a further group at increased risk of COVID-19 associated death. The factors contributing to this increased mortality risk require clarification.

COVID-19 vaccination for people with severe mental illness: why, what, and how?

“…38 Arguably, the increased risk of worse COVID-19-related outcomes in people with psychiatric disorders, and especially in those with severe mental illness, is due to frequent comorbidity with physical diseases related to poor COVID-19 outcomes. However, the aforementioned Personal View studies [17][18][19][20][21][22][23] showed a risk greater than that of physical diseases by correcting for them in the analyses. Therefore, psychiatric disorders confer an additional risk for SARS-CoV-2 infection and COVID-19-related morbidity and mortality.…”

“…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.…”

Death Associated With Coronavirus (COVID-19) Infection in Individuals With Severe Mental Disorders in Sweden During the Early Months of the Outbreak—An Exploratory Cross-Sectional Analysis of a Population-Based Register Study

“…We gratefully acknowledge Olga Filson for her assistance with the data analysis. This manuscript has been released as a pre-print at medRxiv ( 73 ).…”

Risk of adverse outcome of COVID-19 among patients in secure psychiatric services: observational cohort study

“…[27][28][29][30] People with major mental illnesses are more likely to become infected with COVID-19 in the community and are more than twice as likely to have a severe outcome from COVID-19 infection than the general population. [31][32][33] Outbreaks have occurred worldwide in psychiatric centres, including forensic hospitals, with fatal results. 1,2 High transmission rates have been found within psychiatric units despite implementation of Centers for Disease Control and Prevention (CDC) guidelines.…”