Increased risk of <scp>COVID</scp>‐19 infection and mortality in people with mental disorders: analysis from electronic health records in the United States

Wang, QuanQiu; Xu, Rong; Volkow, Nora D.

doi:10.1002/wps.20806

Cited by 564 publications

(723 citation statements)

References 38 publications

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“…Several large population-based have investigated associations between positive testing for COVID-19 on the one hand and psychiatric disorders on the other [1][2][3] . Positive test result likelihoods for psychiatric disorders are inconsistent between those studies: while two of those cohort studies (from the UK and South Korea) do not report positive associations between COVID-19 testing and psychiatric disorders 1, 4 , others (from the UK and the US) mention odds ratios of 1.5 to 10 for associations between mental disorders and a COVID-19 diagnosis 2,3,5 . For a recent diagnosis of a mental disorder in the US, odds ratios for COVID-19 were reported to be around 7.6, with evidence for relatively severe COVID-19 outcomes in those with a diagnosis of mental disorder 5 .…”

Section: Introductionmentioning

confidence: 98%

Are psychiatric disorders risk factors for COVID-19 susceptibility and severity? a two-sample, bidirectional, univariable and multivariable Mendelian Randomization study

Luykx

Lin

2020

Preprint

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ImportanceObservational studies have suggested bidirectional associations between psychiatric disorders and COVID-19 phenotypes, but results of such studies are inconsistent. Mendelian Randomization (MR) may overcome limitations of observational studies, e.g. unmeasured confounding and uncertainties about cause and effect.ObjectiveTo elucidate associations between neuropsychiatric disorders and COVID-19 susceptibility and severity.MethodIn November, 2020, we applied a two-sample, bidirectional, univariable and multivariable MR design to genetic data from genome-wide association studies (GWASs) of neuropsychiatric disorders and COVID-19 phenotypes (released on 20 Oct. 2020). Our study population consisted of almost 2 million participants with either a (neuro)psychiatric disorder or data on COVID-19 status. Outcomes and exposures were anxiety, anxiety-and-stress related disorders, major depressive disorder, schizophrenia, bipolar disorder, schizophrenia-bipolar disorder combined (BIP-SCZ), and Alzheimer’s dementia on the one hand; and self-reported, confirmed, hospitalized, and very severe COVID-19 on the other.ResultsIn single-variable MR analysis the most significant and only Bonferroni-corrected significant result was found for BIP-SCZ (a combined anxiety of bipolar disorder and schizophrenia as cases vs. controls): the effect estimate was consistent with increased risk of COVID-19 (OR = 1.17, 95% CI, 1.06-1.28; p = 0.0012). Nominally significant univariable results were in line with slightly elevated risks of COVID-19 for genetic liabilities to bipolar disorder and schizophrenia. No COVID-19 phenotype consistently increased risk of (neuro)psychiatric disorders. In multivariable MR, bipolar disorder was the only phenotype showing a Bonferroni-corrected significant effect on a COVID-19 phenotype, namely severe COVID-19 (OR = 1.293; 95% CI, 1.095-1.527; p = 0.003). All sensitivity analyses confirmed the results.ConclusionsGenetic liability to bipolar disorder slightly increases COVID-19 susceptibility and severity. The contribution of bipolar disorder to these COVID-19 phenotypes was smaller than the odds ratios estimated by observational studies. Strength of association and direction of effect for genetic liability to schizophrenia were similar, albeit less significant. We found no consistent evidence of reverse effects, i.e. of genetic liability to COVID-19 on psychiatric disorders.

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Section: Introductionmentioning

confidence: 98%

Are psychiatric disorders risk factors for COVID-19 susceptibility and severity? a two-sample, bidirectional, univariable and multivariable Mendelian Randomization study

Luykx

Lin

2020

Preprint

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“…Further, SMI in itself is associated with an increased risk of COVID-19 6,7 . There is therefore a clear need for continued monitoring of the health in vulnerable populations, such as patients with SMI, as the COVID-19 pandemic continues.…”

Section: Discussionmentioning

confidence: 99%

Subjective mental health and need for care among psychiatric outpatients during the COVID-19 pandemic: results from an outreach initiative in Sweden

Flygare

Ivanov

Säll

et al. 2020

Preprint

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ImportanceThe ongoing COVID-19 pandemic restricts access to care for psychiatric patients. The physical and mental well-being of patients with severe mental illness in the current circumstances is unknown.ObjectiveTo evaluate physical and mental well-being, subjective mental health, and need for updated psychiatric management plans in a sample of patients with severe mental illness during the early stages of the COVID-19 pandemic.DesignCross-sectional study of structured telephone assessments conducted between April 23 and June 30, 2020.SettingRegional psychiatric outpatient care centre in Stockholm, Sweden.ParticipantsPatients who had not been in contact with their psychiatric clinic between April 9 and April 23, 2020. A total of 1071 patients were contacted by phone.ExposuresOccurrence of respiratory symptoms, changes in psychiatric symptoms, and the need for updated psychiatric management plans, as determined by the telephone assessors. Subjective mental health rated 0-100 by patients.Main Outcomes and MeasuresSelf-rated physical, respiratory and psychiatric symptoms according to a semi-structured interview. Subjective mental health rated on a scale from 0-100.ResultsPatients (n = 1071) were on average 45 years old (SD = 16.9), of which 570 (53%) were female. Neurodevelopmental disorders, psychotic disorders, and bipolar disorder were the most common diagnostic categories. The majority of respondents reported no respiratory symptoms (86%), and few reported light (10%) or severe (4%) respiratory symptoms. Similarly, most patients reported no worsening in psychiatric symptoms (81%). For those who reported a worsening of psychiatric symptoms (19%), the psychiatric management plans that were already in place were deemed appropriate in most cases (16.5%), whereas 22 patients (2.5%) reported a worsening of psychiatric symptoms that warranted an earlier or immediate follow-up by their psychiatric clinic. Patients rated their subjective mental health on a 0-100 scale as 70.5 [95% CI 69 - 71.9] on average (n = 841). Response rates to the questions of the structured assessment varied from 79% - 82%.Conclusions and RelevanceThe majority of patients reported no respiratory symptoms, no change in psychiatric symptoms and a rather high subjective well-being. Patients in psychiatric care with a mental health care plan experienced stability in the management of their psychiatric symptoms and general well-being, and only a minority were in need of acute support during the early pandemic phase in Stockholm, Sweden.Key PointsQuestionWhat is the physical and mental health of patients with severe mental illness during the early phase of the COVID-19 pandemic?FindingsIn this cross-sectional study that included 1071 patients at a psychiatric outpatient clinic, the proportion of patients reporting respiratory symptoms were 4%. In addition, 19% of patients reported a worsening of psychiatric symptoms, with 2.5% needing an earlier follow-up than was planned.MeaningPatients with severe mental illness experienced stability in the management of their psychiatric symptoms during the early pandemic phase in Sweden.

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“… 2 Conversely, individuals with a mental disorder are also purported to be at increased risk for COVID-19 infection. 3 …”

Section: Introductionmentioning

confidence: 99%

Case series associated with COVID-19 pandemic in causing psychiatric morbidity

Mahapatra

Sharma

2021

Gen Psych

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The COVID-19 has emerged as a public health emergency across the globe. Countries all over the world have been forced to enforce nationwide lockdowns to curb the transmission of this illness, affecting millions of people. The disorder and the lockdowns enforced have resulted in a complex set of psychosocial stressors in the lives of people, affecting their resilience and causing psychological stress and mental health issues. In this case series, we aim to highlight the role of such psychosocial stressors in causing mental health problems, especially in a vulnerable individual. The first case reports the onset of first-episode mania in a healthy individual with a family history of mental illness, after the sudden demise of the patient’s mother due to COVID-19. The second case highlights the onset of psychosis in an adolescent girl following academic stress due to the inability to carry on her education through online classes. The third case demonstrates the exacerbation of dissociative episodes in a child following the financial crisis in the family during the lockdown period. In low-income to middle-income countries such as India, there is a complex interplay of the psychosocial stressors due to the COVID-19 pandemic with pre-existing issues such as poverty, socioeconomic disparity and inequity of resources leading to a ‘double hit’ for people from disadvantaged sections of the society and individuals with pre-existing mental illness or vulnerability for mental illness.

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Increased risk of COVID‐19 infection and mortality in people with mental disorders: analysis from electronic health records in the United States

Cited by 564 publications

References 38 publications

Are psychiatric disorders risk factors for COVID-19 susceptibility and severity? a two-sample, bidirectional, univariable and multivariable Mendelian Randomization study

Are psychiatric disorders risk factors for COVID-19 susceptibility and severity? a two-sample, bidirectional, univariable and multivariable Mendelian Randomization study

Subjective mental health and need for care among psychiatric outpatients during the COVID-19 pandemic: results from an outreach initiative in Sweden

Case series associated with COVID-19 pandemic in causing psychiatric morbidity

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