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

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 anonymized 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 comorbidities, 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 4,945 (0.06%) in the control group, corresponding to an OR of 1.98 (CI 1.66-2.35; p < 0.001). The odds were 4-fold for the age groups between 60 and 79 years and 1.5-fold for cardiovascular diseases. Individuals with SMD without any of the risk factors under study had 3-fold odds of COVID-19 associated death.Conclusion: Our preliminary results identify individuals with SMD as a further group at increased risk of COVID-19 associated death. In regard to comorbidities, future studies should explore the potential confounding or mediation role in the relationship between SMD and COVID-19 associated deaths.

Mental disorders and risk of COVID-19-related mortality, hospitalisation, and intensive care unit admission: a systematic review and meta-analysis

“…Ten studies included in the systematic review were excluded from the meta-analysis: four reported overlapping samples; 23,40,42,43 two had no meta-analysable data; 19,20 three did not differentiate between death, hospitalisation, or ICU admission; 41,44,45 and one included a control group with unknown SARS-CoV-2 infection status 18 When stratifying mortality risk by psychiatric disorder type, the most robust associations were found for psychotic and mood disorders (figure 3; appendix 4 pp 27-30). Substance use disorders and intellectual disabilities and developmental disorders were associated with higher mortality only in crude estimates.…”

“…Our search identified 841 studies, 33 of which met the inclusion criteria for the systematic review ( figure 1 , Table 1 , Table 2 ; appendix 4 pp 14–20 ), 4 , 7 , 8 , 9 , 10 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 including data from 22 countries ( Table 1 , Table 2 ) with outcomes registered between Dec 1, 2019, and Nov 30, 2020.

Figure 1 Study selection *A full list of studies excluded after full-text screening is included in appendix 4 (pp 49–51 ).

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“…Ten studies included in the systematic review were excluded from the meta-analysis: four reported overlapping samples; 23 , 40 , 42 , 43 two had no meta-analysable data; 19 , 20 three did not differentiate between death, hospitalisation, or ICU admission; 41 , 44 , 45 and one included a control group with unknown SARS-CoV-2 infection status 18 ( table 2 ; appendix 4 p 23 ). Thus, 23 studies 4 , 7 , 8 , 9 , 10 , 21 , 22 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 were included in the meta-analyses.…”

Vitamin D in the time of the coronavirus (COVID-19) pandemic – a clinical review from a public health and public mental health perspective

“…Three large cohort studies have indicated an approximately two-fold increased risk of mortality. 1 – 3 It remains unclear whether this increased risk is due to the infection itself or due to a more adverse clinical course once infected. 1 Despite this higher mortality risk, individuals with SMD have been prioritised for vaccinations in only very few countries.…”

Neuropsychiatrische Aspekte von COVID-19 – Eine narrative Übersicht

“…Im Gegensatz dazu fand eine ähnliche Untersuchung in Südkorea[123] kein erhöhtes Infektionsrisiko von Personen mit psychiatrischen Erkrankungen und nur ein gering erhöhtes Risiko (OR 1,27) für einen schweren Krankheitsverlauf.Auch eine schwedische Registerstudie (die gesamte Bevölkerung mit rund 8 Millionen Einwohner umfassend) fand eine erhöhte Mortalität bei Personen, die an Psychosen und bipolaren Störungen litten, mit einer OR von 2, die in höherem Alter (60-79a) auf 4 anstieg. Komorbiditäten konnten den Unterschied nicht erklären[124]. Eine Kohortenstudie aus New York (N = 7348) an Patienten mit bestätigter COVID-19 Diagnose fand im Vergleich mit Patien-Dieses Dokument wurde zum persönlichen Gebrauch heruntergeladen.…”