Leo Sher, M.D.

A research paper, “Severe mental illness is associated with increased mortality and severe course of COVID-19” has recently been published in Acta Psychiatrica Scandinavica online ahead of print (1).

In Denmark, nationwide administrative registries contain information on various healthcare-related and administrative variables. The unique and permanent civil registration number allows cross-linkage of the registries at an individual level. The authors of this study identified all patients with a positive real-time reverse transcription-polymerase chain reaction test for COVID-19 in Denmark up to and including 2 January 2021. Multivariable cox regression was used to calculate 30-day absolute risk and average risk ratio (ARR) for the composite end point of death from any cause and severe COVID-19 associated with psychiatric disorders, defined using both hospital diagnoses and redemption of psychotropic drugs.

In all, 144,321 individuals with COVID-19 were included in the study. Of these, 984 (0.7%) had a schizophrenia spectrum disorder, 485 (0.3%) bipolar disorder, 3764 (2.6%) unipolar depression, 7328 (5.1%) other psychiatric disorders and 4479 (3.1%) were in treatment with psychotropic drugs without having a hospital psychiatric diagnosis.

Compared with patients without psychiatric disorders, the standardized ARR of the composite outcome was significantly increased for patients with severe mental illness including schizophrenia spectrum disorders 2.43 (95% confidence interval [CI], 1.79-3.07), bipolar disorder 2.11 (95% CI, 1.25-2.97), unipolar depression 1.70 (95% CI, 1.38-2.02), and for patients who redeemed psychotropic drugs 1.70 (95% CI, 1.48-1.92). No association was found for patients with other psychiatric disorders 1.13 (95% CI, 0.86-1.38). Similar results were seen with the outcomes of death or severe COVID-19. Among the different psychiatric subgroups, patients with schizophrenia spectrum disorders had the highest 30-day absolute risk for the composite outcome 3.1% (95% CI, 2.3-3.9%), death 1.2% (95% CI, 0.4-2.0%) and severe COVID-19 2.7% (95% CI, 1.9-3.6%).

The authors concluded that a medical history of schizophrenia spectrum disorders, bipolar disorder or unipolar depression or a psychiatric disorder requiring active medical treatment may represent a substantial risk factor for an unfavourable outcome in patients with COVID-19.

Reference

1. Barcella CA, Polcwiartek C, Mohr GH, Hodges G, Søndergaard K, Niels Bang C, Andersen MP, Fosbøl E, Køber L, Schou M, Torp-Pedersen C, Kessing LV, Gislason G, Kragholm K. Severe mental illness is associated with increased mortality and severe course of COVID-19. Acta Psychiatr Scand. 2021 Apr 24. doi: 10.1111/acps.13309. Epub ahead of print.