Risk of adverse outcome of COVID-19 among patients in secure psychiatric services: observational cohort study

Abstract

Background Secure forensic mental health services treat patients with high rates of treatment-resistant psychoses. High rates of obesity and medical comorbidities are common. Population-based studies have identified high-risk groups in the event of SARS-CoV-2 infection, including those with problems such as obesity, lung disease and immune-compromising conditions. Structured assessment tools exist to ascertain the risk of adverse outcome in the event of SARS-CoV-2 infection. Aims To assess risk of adverse outcome in the event of SARS-CoV-2 infection in a complete population of forensic psychiatry patients using structured assessment tools. Method All patients of a national forensic mental health service (n = 141) were rated for risk of adverse outcome in the event of SARS-CoV-2 infection, using two structured tools, the COVID-Age tool and the COVID-Risk tool. Results We found high rates of relevant physical comorbidities. Mean chronological age was 45.5 years (s.d. = 11.4, median 44.1), mean score on the COVID-Age tool was 59.1 years (s.d. = 19.4, median 58.0), mean difference was 13.6 years (s.d. = 15.6), paired t = 10.9, d.f. = 140, P < 0.001. Three patients (2.1%) were chronologically over 70 years of age, compared with 43 (30.5%) with a COVID-Age over 70 (χ2 = 6.99, d.f. = 1, P = 0.008, Fisher's exact test P = 0.027). Conclusions Patients in secure forensic psychiatric services represent a high-risk group for adverse outcomes in the event of SARS-COV-2 infection. Population-based guidance on self-isolation and other precautions based on chronological age may not be sufficient. There is an urgent need for better physical health research and treatment in this group.

Public perceptions of psychiatric, justice-involved, and elderly populations during the COVID-19 pandemic

“…Forensic psychiatric patients have been met with similar challenges ( Kennedy et al, 2020 ). In a recent study, almost a third of forensic patients were found to be at high risk for adverse outcomes if infected with COVID-19 ( Basrak et al, 2021 ). Moreover, when restricted to hospital units, physical distancing becomes difficult, and patients are deprived of previous liberties, access to the community, and communication with friends and family ( Simpson et al, 2020 ).…”

Substance use, mental disorders and COVID-19: a volatile mix

“…There is clear evidence demonstrating the association between psychiatric and substance use disorders and poor physical health across a number of domains [ 13 ▪ , 15 , 22 , 23 ▪ , 24 ], all of which increase the risk of contracting COVID-19 and experiencing more severe COVID-19-related complications if infected [ 22 , 23 ▪ , 25 – 27 ]. High rates of smoking, overweight and obesity, metabolic syndrome, hypertension and cardiovascular disease, alongside confinement in forensic, residential and in-patient facilities, can increase susceptibility to infection and disease [ 28 ▪▪ , 29 ]. Preexisting psychiatric symptoms may be exacerbated due to fear and worry about being infected, social isolation and the lack of connectivity, distressing medical symptoms and death [ 28 ▪▪ , 30 ▪▪ ].…”

The Impact of the COVID-19 Pandemic on Forensic Mental Health Services and Clinical Outcomes: A Longitudinal Study

“…Forensic mental health service users are highly vulnerable to adverse COVID-19 outcomes due to risk factors such as obesity, hypertension, metabolic syndrome, and neurocognitive impairments ( 11 ), and the nature of these services means that positive cases can spread quickly if not isolated ( 12 ). Almost one-third of service users within a forensic mental health service meet high risk age criteria, perhaps suggesting a greater than expected risk of adverse outcomes in the event COVID-19 infection ( 11 ).…”