Preexisting Neuropsychiatric Conditions and Associated Risk of Severe COVID-19 Infection and Other Acute Respiratory Infections

Abstract

ImportanceEvidence indicates that preexisting neuropsychiatric conditions confer increased risks of severe outcomes from COVID-19 infection. It is unclear how this increased risk compares with risks associated with other severe acute respiratory infections (SARIs).ObjectiveTo determine whether preexisting diagnosis of and/or treatment for a neuropsychiatric condition is associated with severe outcomes from COVID-19 infection and other SARIs and whether any observed association is similar between the 2 outcomes.Design, Setting, and ParticipantsPrepandemic (2015-2020) and contemporary (2020-2021) longitudinal cohorts were derived from the QResearch database of English primary care records. Adjusted hazard ratios (HRs) with 99% CIs were estimated in April 2022 using flexible parametric survival models clustered by primary care clinic. This study included a population-based sample, including all adults in the database who had been registered with a primary care clinic for at least 1 year. Analysis of routinely collected primary care electronic medical records was performed.ExposuresDiagnosis of and/or medication for anxiety, mood, or psychotic disorders and diagnosis of dementia, depression, schizophrenia, or bipolar disorder.Main Outcomes and MeasuresCOVID-19–related mortality, or hospital or intensive care unit admission; SARI-related mortality, or hospital or intensive care unit admission.ResultsThe prepandemic cohort comprised 11 134 789 adults (223 569 SARI cases [2.0%]) with a median (IQR) age of 42 (29-58) years, of which 5 644 525 (50.7%) were female. The contemporary cohort comprised 8 388 956 adults (58 203 severe COVID-19 cases [0.7%]) with a median (IQR) age of 48 (34-63) years, of which 4 207 192 were male (50.2%). Diagnosis and/or treatment for neuropsychiatric conditions other than dementia was associated with an increased likelihood of a severe outcome from SARI (anxiety diagnosis: HR, 1.16; 99% CI, 1.13-1.18; psychotic disorder diagnosis and treatment: HR, 2.56; 99% CI, 2.40-2.72) and COVID-19 (anxiety diagnosis: HR, 1.16; 99% CI, 1.12-1.20; psychotic disorder treatment: HR, 2.37; 99% CI, 2.20-2.55). The effect estimate for severe outcome with dementia was higher for those with COVID-19 than SARI (HR, 2.85; 99% CI, 2.71-3.00 vs HR, 2.13; 99% CI, 2.07-2.19).Conclusions and RelevanceIn this longitudinal cohort study, UK patients with preexisting neuropsychiatric conditions and treatments were associated with similarly increased risks of severe outcome from COVID-19 infection and SARIs, except for dementia.

Effects of COVID-19 on cognition and brain health

“…Hospitalisation with evidence of acute infection has long been known to be associated with higher rates of dementia diagnosis, beyond SARS-CoV-2 infection [ 139 ]. Pre-existing dementia People with pre-existing dementia have a higher likelihood of experiencing severe COVID-19 (indexed by increased rates of hospitalisation, ICU admission, or death) [ 140. , 141.…”

“…People with pre-existing dementia have a higher likelihood of experiencing severe COVID-19 (indexed by increased rates of hospitalisation, ICU admission, or death) [ 140. , 141.…”

Antibody prevalence after 3 or more COVID-19 vaccine doses in 23,000 immunosuppressed individuals: a cross-sectional study from MELODY

“…Interestingly, there are recognised mechanisms whereby psychological status may impact on adaptive immune responses, although this has not been studied in the setting of co-existing immunotherapy 25,26 . However, irrespective of causation, assessment of distress is important as observational data has shown an association between neuropsychiatric diagnoses and poorer outcome to COVID-19 infection 27 . Our data suggest there remains a significant prevalence of distress in the immunocompromised population which warrants recognition and consideration.…”

Long COVID as a functional somatic symptom disorder caused by abnormally precise prior expectations during Bayesian perceptual processing: A new hypothesis and implications for pandemic response

“… 76 Anxiety and depression have been found to be associated with more severe acute respiratory infections, including COVID-19 (i.e., hospitalization, intensive care, and mortality), and it is possible this is mediated by the associated immune abnormalities. 130 Psychosocial stress is a strong modifiable risk factor for stroke (with higher locus of control at home or at work being an effect modifier lowering this risk), also possibly mediated by neuroinflammation. 131 Compatible with this is that social disconnection (e.g., social isolation and loneliness) is “a key determinant of health” with an effect on all-cause mortality “comparable in magnitude with that of smoking (15 cigarettes/day) and high levels of alcohol consumption (6 drinks/day).” 132 Another systematic review that found social isolation and/or loneliness associated with increased all-cause mortality suggested a mechanism may be that they “lead to activation of the hypothalamic-pituitary-adrenocortical axis .…”