Socioeconomic deprivation, older age, and several medical conditions are associated with an increased risk of severe illness from COVID-19.
Mental disorders are estimated to affect 20-25% of the adult population (450 million worldwide, 47 million in the US) and their incidence has likely increased during the pandemic due to a variety of factors. Concerns have been raised that people with a pre-existing mental disorder may represent a population at higher risk for COVID-19 infection and in which infection outcomes are worse.
Multiple factors have been described that could increase the risk of people with mental disorders contracting COVID infection or worsen the outcomes of the infection. These include challenges in evaluating health information and adherence to preventive behaviors, limitations in access to health care, homelessness or living in environments where the risk of contagion is higher, and the higher prevalence of comorbid medical conditions. which are associated with an increased risk of COVID -19 as a serious illness (cardiovascular diseases, cancers and chronic obstructive pulmonary disease).
Despite the recognition of these multiple vulnerability factors, the risk of COVID-19 infection and its outcomes among patients with mental disorders have not been systematically investigated.
Concerns have been raised that people with a pre-existing mental disorder may represent a population at higher risk for COVID-19 infection and with a higher likelihood of adverse outcomes from infection, but there is no systematic research evidence of this.
This study evaluated the impact of a recent diagnosis (within the last year) of a mental disorder, including attention-deficit/hyperactivity disorder (ADHD), bipolar disorder, depression, and schizophrenia, on the risk of COVID infection. -19 and related mortality and hospitalization.
| Methods |
We conducted a case-control study using population-level anonymized electronic health record data collected by IBM Watson Health Explorys from 360 hospitals and 317,000 providers across 50 US states, representing 20%. of the US population
We examined the impact of mental disorders on the risk of COVID-19 infection, adjusted for age, gender, ethnicity, and common medical comorbidities. The exposure groups were patients diagnosed with a mental disorder; the unexposed groups were patients without the mental disorder; and the outcome measure was the diagnosis of COVID-19.
We then explored how demographic factors affected the risk of COVID-19 infection among patients with mental disorders. Case groups were patients with a mental disorder and one of the following factors: female, older (i.e., >65 years), African American. Comparison groups were patients with a mental disorder and one of the following corresponding factors: male, adult (i.e., 18 to 65 years), Caucasian. The outcome measure was the diagnosis of COVID-19.
Finally, we investigated death and hospitalization rates among patients with COVID-19 infection and a mental disorder, compared with patients with COVID-19 infection but without mental disorder and with patients with mental disorder but without COVID-19 infection.
| Results |
Patients with a recent diagnosis of a mental disorder had a significantly increased risk of COVID-19 infection , with a stronger effect for depression (adjusted odds ratio, AOR=7.64, 95% CI: 7.45-7 .83, p<0.001) and schizophrenia (AOR=7.34, 95% CI: 6.65-8.10, p<0.001).
Among patients with a recent diagnosis of a mental disorder, African Americans had higher odds of COVID-19 infection than Caucasians, with the largest ethnic disparity for depression (AOR=3.78, 95% CI: 3.58 -3.98, p<0.001).
Women with mental disorders had higher odds of COVID-19 infection than men, with the largest gender disparity for ADHD (AOR=2.03, 95% CI: 1.73-2.39, p<0.001 ).
Patients with a recent diagnosis of a mental disorder and COVID-19 infection had a mortality rate of 8.5% (vs. 4.7% among COVID-19 patients without mental disorder, p<0.001) and a hospitalization rate of 27.4% (vs. .18.6% among COVID-19 patients without mental disorder, p<0.001).
| Discussion |
Based on an analysis of a national database of electronic health records in the US, we document that patients with a recent diagnosis (within the last year) of a mental disorder are at significantly increased risk of COVID infection -19 compared to patients without mental disorders, and also have a worse outcome as demonstrated by higher rates of hospitalization and death.
The risk of COVID-19 infection among people with a recent diagnosis of a mental disorder increases further among African Americans and women, although death and hospitalization rates are higher in men. These findings identify people with mental disorders as a highly vulnerable population to COVID-19 infection and its adverse outcomes, and confirm ethnic and gender disparities already observed in the general population.
A variety of factors are likely to contribute to a higher risk of COVID-19 infection and worse infection outcomes in people with mental disorders. These people may have problems evaluating health information and complying with preventive behaviors. Their living circumstances put them at greater risk of living in crowded hospitals or care homes, or even prisons, and these are environments where infections can spread quickly.
People with serious mental illness are likely to be at a socioeconomic disadvantage, which could force them to work and live in unsafe environments. Homelessness and unstable housing can impact your ability to quarantine. Stigma can result in barriers to accessing healthcare for patients infected with COVID-19, or make them reluctant to seek healthcare for fear of discrimination.
Specific manifestations of individual mental disorders may influence risk differently. For example, for patients with ADHD, their lack of attention could put them at greater risk of forgetting to wear face masks or maintain social distancing, while for people suffering from depression, their lack of motivation could lead them to neglecting their protection or seeking medical attention when indicated, and in a patient with schizophrenia, delusional thinking can lead them to reject the use of a mask.
On the other hand, increased sensitivity to stress , which is common among patients with mental disorders, will make it difficult for them to cope with the uncertainties, isolation and economic challenges related to the COVID-19 pandemic, increasing their risk of relapse and exacerbation. of the illness.
People with mental disorders are also at higher risk of using drugs and suffering from a substance use disorder than the general population. In particular, smoking is highly prevalent among people with schizophrenia, bipolar disorder, and depression compared to the general population.
Furthermore, patients with mental disorders who are smokers smoke more than those who do not have a mental disorder, which increases their risk of lung pathology, making them more vulnerable to severe illness from COVID-19. In fact, an increased risk of adverse outcomes related to the association of COVID-19 and smoking has been reported.
People with severe mental disorders are more likely to have comorbid medical conditions associated with an increased risk of severe illness from COVID-19. Indeed, our analyzes showed that medical comorbidities (cancers, cardiovascular diseases, obesity, chronic kidney diseases, asthma, chronic obstructive pulmonary disease, type 2 diabetes, and substance use disorders) contributed to the increased risk of COVID-19 infection in patients with a recent illness and mental disorder, as demonstrated by the reduced risk after adjusting for these comorbidities.
However, even after this adjustment, the risk of COVID-19 infection in patients with recent mental disorders still increased, indicating that these disorders directly affect susceptibility to COVID-19.
Overlapping biological factors between mental disorders and COVID-19 infection could also be involved. An example of a common biological factor contributing to several mental disorders and COVID-19 pathology is inflammation , which is reported to play a role in the pathogenesis of depression, schizophrenia, and bipolar disorder, as well as in the systemic manifestations of COVID-19 infection.
Our analyzes revealed that African Americans with depression, bipolar disorder, schizophrenia, and ADHD were at higher risk of COVID-19 infection than Caucasians, even after controlling for medical comorbidities, indicating that social, behavioral, and lifestyle factors life also contribute to this deep ethnic inequality.
Women with ADHD, bipolar disorder, depression, and schizophrenia had a higher risk of COVID-19 infection, although lower rates of death and hospitalizations than men, which could reflect a higher risk of infection or a greater likelihood of getting tested. proof.
However, socioeconomic factors contribute to gender disparities in health and are likely to have also influenced gender disparities in COVID-19 infection rates. The much higher risk of death for men than women overall, but mainly for patients with depression and COVID-19 infection, could similarly reflect biological and socioeconomic factors.
Patients with COVID-19 infection and a recent diagnosis of a mental disorder had a higher risk of death (8.5% vs. 5.7% for all patients with COVID-19 and 4.7% for patients with COVID-19 without a recent mental disorder), which again may be due to delays in obtaining medical care, medical comorbidities, and a variety of socioeconomic and disease-related factors.
The difference in the mortality rate of COVID-19 patients with mental disorders compared to all COVID patients (48% higher) is similar in magnitude to the difference we recently reported for COVID-19 patients with mental disorders due to substance use (45% higher) 26.
However, in that previous study, using electronic health record data through June 15, 2020, we reported a higher mortality rate from COVID-19 infection than in the current study, which used data through July 29. of 2020 (6.6% vs. 5.7%), which likely reflects the decrease in COVID-19 mortality attributed in part to better management of the disease, greater
These findings identify people with a recent diagnosis of a mental disorder who are at increased risk for COVID-19 infection, which is further exacerbated among African Americans and women, and who have a higher frequency of some adverse outcomes of the disease. infection. This evidence highlights the need to identify and address modifiable vulnerability factors for COVID-19 infection and prevent delays in healthcare delivery in this population.
