Joint European policy on the COVID-19 risks for people with mental disorders: An umbrella review and evidence- and consensus-based recommendations for mental and public health

Abstract

As COVID-19 becomes endemic, identifying vulnerable population groups for severe infection outcomes and defining rapid and effective preventive and therapeutic strategies remains a public health priority. We performed an umbrella review, including comprehensive studies (meta-analyses and systematic reviews) investigating COVID-19 risk for infection, hospitalization, Intensive Care Unit (ICU) admission, and mortality in people with psychiatric disorders, and outlined evidence-and consensus-based recommendations for overcoming potential barriers that psychiatric patients may experience in preventing and managing COVID-19, and defining optimal therapeutic options and current research priorities in psychiatry. We searched Web of Science, PubMed, and Ovid/PsycINFO databases up to 17 January 2022 for the umbrella review. We synthesized evidence, extracting when available pooled odd ratio estimates for the categories 'any mental disorder' and 'severe mental disorders'. The quality of each study was assessed using the AMSTAR-2 approach and ranking evidence quality. We identified four systematic review/meta-analysis combinations, one metaanalysis, and three systematic reviews, each including up to 28 original studies. Although we rated the quality of studies from moderate to low and the evidence ranged from highly suggestive to nonsignificant, we found consistent evidence that people with mental illness are at increased risk of COVID-19 infection, hospitalization and most importantly mortality, but not of ICU admission. The risk and the burden of COVID-19 in people with mental disorders, in particular those with severe mental illness, can no longer be ignored but demands urgent targeted and persistent action. Twentytwo recommendations are proposed to facilitate this process.

COVID-19 mortality among selective serotonin reuptake inhibitor users—results from a nationwide cohort

“…Mental illness has previously been associated with an increased risk of poor COVID-19 outcomes. [ 23 ] We include schizophrenia, schizotypal and delusional disorders in our analysis, but psychiatric diseases not accounted for could affect our risk assessment. As with all study designs, not including direct drug intake observation, study participants' compliance to drug prescriptions is a limitation.…”

Post-COVID condition: dispensation of drugs and diagnostic tests as proxies of healthcare impact

“…There is no evidence of an increase during COVID-19 of psychiatric conditions needing pharmacological intervention [ 24 , 25 ], even though in the frame of the hospital setting antipsychotics (N05A) may be needed to control agitation. However, it is not clear why the risk to be prescribed with these medications was still high 18 months after recovery.…”

“…However, it is not clear why the risk to be prescribed with these medications was still high 18 months after recovery. Perhaps, even in the absence of psychotic or psychotic-like manifestations, there was reluctance to stop drugs prescribed during the acute disease phase, notwithstanding that in a meta-analysis antipsychotics have been associated with an increased risk of mortality from COVID-19 [ 24 ]. At variance, a few studies claimed that the anti-inflammatory activity of antipsychotics may play a beneficial role in the treatment [ 26 ].…”

Impact of mental disorders on clinical outcomes of physical diseases: an umbrella review assessing population attributable fraction and generalized impact fraction

“…For example, depressive and anxiety disorders are associated with a higher mortality risk in people with cancer 19,20 , cardiovascular diseases 21,22 , chronic obstructive pulmonary disease 23 , and diabetes mellitus 24,25 . The recent COVID-19 pandemic has also indicated that mental disorders are associated with higher disease severity and mortality [26][27][28] .…”