Leo Sher, M.D.

A research report, “Association of a prior psychiatric diagnosis with mortality among hospitalized patients with Coronavirus Disease 2019 (COVID-19) infection” was published yesterday, on September 30, 2020 in the JAMA Network Open (1).

This cohort study was conducted at Yale New Haven Health System, a 5-hospital system in the Northeast of the United States. Data were obtained from electronic medical records and included all encounters of hospitalized COVID-19–positive patients between February 15 and April 25, 2020, and followed up to May 27, 2020, for mortality.

A total of 1685 patients were hospitalized with COVID-19 during the study period (mean [SD] age, 65.2 [18.4] years; 887 [52.6%] were male). Of the 1685 patients, 473 (28%) had psychiatric diagnoses prior to hospitalization. Overall, 318 patients (18.9%) died. Patients with a psychiatric diagnosis had a higher mortality rate compared with patients with no psychiatric diagnosis with 35.7% vs 14.7% of 2-week mortality, 40.9% vs 22.2% of 3-week mortality, and 44.8% vs 31.5% of 4-week mortality rate. The median follow-up time was 8 days (interquartile range, 4-16 days). In the unadjusted model, the risk for COVID-19–related hospital death was greater for those with any psychiatric diagnosis (hazard ratio, 2.3; 95% CI, 1.8-2.9; P < 0.001). After controlling for demographic characteristics, other medical comorbidities, and hospital location, the risk of death remained significantly greater among patients with a psychiatric condition (hazard ratio, 1.5; 95% CI, 1.1-1.9; P = 0.003).

The authors suggest that psychiatric symptoms may be a marker of systemic pathophysiologic processes that may, in turn, predispose to mortality. They propose that psychiatric disorders may augment systemic inflammation and compromise the function of the immune system. The authors also suggest that psychotropic medications may be associated with elevated risk of mortality.

Reference

1. Li L, Li F, Fortunati F, Krystal JH. Association of a prior psychiatric diagnosis with mortality among hospitalized patients with Coronavirus Disease 2019 (COVID-19) infection. JAMA Netw Open. 2020;3(9):e2023282. doi:10.1001/jamanetworkopen.2020.23282