Leo Sher, M.D.

A research report, “Bidirectional associations between COVID-19 and psychiatric disorder: retrospective cohort studies of 62 354 COVID-19 cases in the USA” was published in Lancet Psychiatry online ahead of print on November 9, 2020 and included in the February 01, 2021 issue of the Journal (1).

The authors used the TriNetX Analytics Network, a global federated network that captures anonymized data from electronic health records in 54 health-care organizations in the USA, totaling 69.8 million patients. TriNetX included 62,354 patients diagnosed with COVID-19 between Jan 20, and Aug 1, 2020. To examine the psychiatric consequences of COVID-19, the authors created propensity score-matched cohorts of patients who had received a diagnosis of other illnesses that represented a range of frequent presentations.

In patients with no previous psychiatric history, a diagnosis of COVID-19 was associated with increased incidence of a first psychiatric diagnosis in the following 14 to 90 days compared with six other health events (HR 2.1, 95% CI 1.8-2.5 vs influenza; 1.7, 1.5-1.9 vs other respiratory tract infections; 1.6, 1.4-1.9 vs skin infection; 1.6, 1.3-1.9 vs cholelithiasis; 2.2, 1.9-2.6 vs urolithiasis, and 2.1, 1.9-2.5 vs fracture of a large bone; all p<0.0001). The incidence of any psychiatric diagnosis in the 14 to 90 days after COVID-19 diagnosis was 18.1% (95% CI 17.6-18.6), including 5.8% (5.2-6.4) that were a first diagnosis. Having a diagnosis of psychiatric disorder in the year before the COVID-19 outbreak was associated with a 65% increased risk of COVID-19 (RR 1.65, 95% CI 1.59–1.71; p<0.0001) compared with a cohort matched for established physical risk factors for COVID-19 but without a psychiatric diagnosis

COVID-19 survivors appear to be at increased risk of psychiatric sequelae, and a psychiatric diagnosis might be an independent risk factor for COVID-19. The authors suggest that COVID-19 has an impact on psychiatric health above and beyond that which occurs after other acute health events. The authors also suggest that vulnerability to COVID-19 may be elevated by the pro-inflammatory state postulated to take place in some forms of psychiatric conditions or be related to psychotropic medications.

Reference

1. Taquet M, Luciano S, Geddes JR, Harrison PJ. Bidirectional associations between COVID-19 and psychiatric disorder: retrospective cohort studies of 62 354 COVID-19 cases in the USA. Lancet Psychiatry. 2021 Feb;8(2):130-140. doi: 10.1016/S2215-0366(20)30462-4. Epub 2020 Nov 9.