Disparities in COVID-19 infection, hospitalisation and death in people with schizophrenia, bipolar disorder, and major depressive disorder: a cohort study of the UK Biobank

Abstract

People with severe mental illness (SMI; including schizophrenia/psychosis, bipolar disorder (BD), major depressive disorder (MDD)) experience large disparities in physical health. Emerging evidence suggests this group experiences higher risks of infection and death from COVID-19, although the full extent of these disparities are not yet established. We investigated COVID-19 related infection, hospitalisation and mortality among people with SMI in the UK Biobank (UKB) cohort study. Overall, 447,296 participants from UKB (schizophrenia/psychosis = 1925, BD = 1483 and MDD = 41,448, non-SMI = 402,440) were linked with healthcare and death records. Multivariable logistic regression analysis was used to examine differences in COVID-19 outcomes by diagnosis, controlling for sociodemographic factors and comorbidities. In unadjusted analyses, higher odds of COVID-19 mortality were seen among people with schizophrenia/psychosis (odds ratio [OR] 4.84, 95% confidence interval [CI] 3.00–7.34), BD (OR 3.76, 95% CI 2.00–6.35), and MDD (OR 1.99, 95% CI 1.69–2.33) compared to people with no SMI. Higher odds of infection and hospitalisation were also seen across all SMI groups, particularly among people with schizophrenia/psychosis (OR 1.61, 95% CI 1.32–1.96; OR 3.47, 95% CI 2.47–4.72) and BD (OR 1.48, 95% CI 1.16–1.85; OR 3.31, 95% CI 2.22–4.73). In fully adjusted models, mortality and hospitalisation odds remained significantly higher among all SMI groups, though infection odds remained significantly higher only for MDD. People with schizophrenia/psychosis, BD and MDD have higher risks of COVID-19 infection, hospitalisation and mortality. Only a proportion of these disparities were accounted for by pre-existing demographic characteristics or comorbidities. Vaccination and preventive measures should be prioritised in these particularly vulnerable groups.

Excess suicides in Brazil: Inequalities according to age groups and regions during the COVID-19 pandemic

“…One study that was performed in England suggests that patients with a history of severe mental disorder, therefore at high risk of suicide, had increased chances of dying due to COVID-19 when compared to those without these disorders (Hassan et al, 2021). Although the age group of 10 to 29 years was less susceptible to death due to COVID-19, when compared to those aged 60 years or older, for example, it should be noted that Brazil was the country with the second highest number of deaths from the disease during the pandemic (Bastos et al, 2021), which may have contributed to the decrease in the number of people susceptible to suicide in this age group.…”

Impact of the COVID-19 Pandemic on the Incidence and Characteristics of Patients with Psychiatric Illnesses Visiting Emergency Departments in Korea

“…Various risk factors can lead to worsening mental health during a pandemic. In particular, pre-existing mental disorders are a major risk factor for deteriorating mental health during the pandemic [17,18]. For vulnerable populations, mental health may worsen not only due to the pandemic itself, but also because of isolation due to social distancing policies, stress caused by the closure of schools and workplaces, and a decrease in income [13,[18][19][20].…”

Long COVID, neuropsychiatric disorders, psychotropics, present and future

“…Higher infection and mortality rate in schizophrenic patients and patients with severe mental disorders in other countries were also reported, including Israel (Tzur Bitan et al, 2021), Spain (Garcia-Ribera et al, 2021, Italy (Barlati et al, 2021), Canada (Zhand & Joober, 2021), the United Kingdom (Hassan et al, 2021) and USA (Teixeira et al, 2021;Wang et al, 2021b). Karaoulanis and Christodoulou (2021) reviewed the literature, with seven studies meeting their criteria.…”