Patients with mental illness at high risk of death from COVID-19

A large hospital system study shows that patients with mental illness are at higher risk of serious COVID-19 results than the general population.

Of the 1,685 patients admitted with COVID-19, those previously diagnosed with psychiatry were those who had not been diagnosed after managing demographic characteristics, comorbidities, and hospital locations. The risk of death was significantly higher in comparison (HR 1.5, 95% CI 1.1-1.9, P= 0.003), reported by Luming Li, MD of Yale University School of Medicine in New Haven, Connecticut.

The risk was higher in patients who received a psychiatric diagnosis 2 weeks (35.7% vs 14.7%), 3 weeks (40.9% vs 22.2%) and 4 weeks (44.8% vs 31.5%) after index admission.The team wrote in a research letter published in JAMA network open..

“Psychiatric symptoms can occur as markers of systemic pathophysiological processes such as inflammation, which in turn can predispose to death,” the researchers write. “Similarly, mental illness can increase systemic inflammation and impair the functioning of the immune system, but psychotropic drugs can also be associated with mortality risk.”

Another recent study published in Lancet Psychiatry A cohort of Korean mental illness patients was found to be less likely to test positive for SARS-CoV-2 than the general population (odds ratio). [OR] 1.00, 95% CI 0.93-1.08).

However, in that study, patients with more severe psychiatric disorders, including non-emotional or affective disorders with psychotic features, were found to be dying, admitted to the intensive care unit, or using mechanical artificial respiration. The risk of COVID-19 outcome was high (adjusted OR 1.27, 95% CI 1.01-1.66), reported by Dr. Dong Kong Young, MD of the South Korean Army in Jonan.

The underlying biological mechanisms associated with the immune system may be behind this association, but mental illness worsens health and shortens lifespan, in part due to reduced access to health care. It is important not to overlook the fact that it is related to Paul Appelbaum, MD of Columbia University in New York City, who was not involved in either study, commented that he was in compliance with treatment recommendations.

“Similar factors here may mean that patients with COVID-19 with mental illness have already come to these hospitals in poor health,” Appelbaum said. Today’s MedPage on mail. “Researchers have controlled the existence of some conditions, but may not have been able to fully control the patient’s existing physical condition.”

Patients with mental illness may have been hospitalized at a more advanced stage of COVID-19, according to Appelbaum, but neither study considered it.

“In a US study, the reality that many people with mental illness are either uninsured or insured may have been a key factor in such delays,” he said. Said.

In the Yale cohort-average age 65.2 years. 52.6% were male and 18.9% died. Overall, 473 patients (28%) had previously had a psychiatric diagnosis.

The researchers reported that the group with a psychiatric diagnosis was considerably older and more likely to be female and white. Comorbidities such as cancer, diabetes, kidney disease, liver disease, congestive heart failure, and HIV were also fairly common in patients with mental illness.

In contrast, the Korean cohort with and without mental illness was demographically consistent in the presence of comorbidities, Yon and co-authors reported.

Both studies relied on diagnostic codes to identify mental illness and did not consider the use of restricted psychiatric treatment, the authors said. Neither study describes obesity or smoking, but many other medical diagnoses. Finally, socioeconomic status or patient education levels were not measured in these analyzes, which can confuse the results.

Last updated: September 30, 2020