People with mental health problems at increased risk for severe COVID-19 outcomes

In a recent study published on the CDC Emerging infectious diseases magazine, Researchers evaluated associations between mental health conditions (MHC) and severe coronavirus disease 2019 (COVID-19) outcomes.

Individuals with MHC may be at high risk for severe post-hospital COVID-19 outcomes. Most previous studies were limited by the small sample size or aggregation of MHC which masked the differences in risk. Additionally, previous studies have not assessed readmissions and length of hospital stay (LOS).

Study: Mental health conditions and severe COVID-19 outcomes after hospitalization, United States. Image Credit: lumezia.com/Shutterstock

About the study

In the present study, researchers investigated associations of selected MHCs with severe COVID-19, LOS, and readmission outcomes. They analyzed a large database of patient medical records based in the United States. Patients admitted to hospital with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and discharged between March 1, 2020 and July 31, 2021 were identified. Anxiety, bipolar disorder, depression and schizophrenia were MHC selected. Outcomes of interest were intensive care unit (ICU) admissions, LOS, invasive mechanical ventilation, all-cause readmission to the same hospital within 30 days, and all-cause mortality during the hospital stay.

The association between each MHC with each outcome was examined using mixed-effect models. The reference cohort included patients without MHC diagnosis. Adjusted odds ratios and corresponding 95% confidence intervals (CI) were estimated using logistic models. 95% CIs and percentage differences for LOS were calculated using Poisson models. Models were adjusted for age, race, sex, ethnicity, month of hospitalization, type of insurance, Elixhauser comorbidity index, and hospital characteristics.

Results

The study sample included 664,956 hospitalized patients with COVID-19. Most patients (77.1%) were 50 years of age or older and 55% of male patients had no diagnosis of MHC compared with 45% of females. More male patients (53.8%) than females (46.2%) had schizophrenia. In contrast, most female patients suffered from depression (61.7%), anxiety (61%), or bipolar disorder (58.8%), outnumbering male patients.

Outcomes of Hospitalized COVID-19 Patients (n = 664,956), for Diagnosed Mental Health Conditions, versus Patients Undiagnosed with Mental Health Conditions in Premier Healthcare Database COVID-19 Special Release, United States, March 2020-July 2021 For each condition, the odds ratios represent the odds of outcome given for patients with the condition versus patients without mental health conditions.  For length of stay, the percentages represent the percentage difference in length of stay for patients with the condition versus patients without mental health conditions.  Covariates were selected based on factors known or plausibly associated with both the mental health condition and the given outcome.  Values ​​in bold indicate statistical significance (2-sided α = 0.05), adjusted for multiple comparisons using the Bonferroni-Holm method.

Outcomes of Hospitalized COVID-19 Patients (n = 664,956), for Diagnosed Mental Health Conditions, versus Patients Undiagnosed with Mental Health Conditions in Premier Healthcare Database COVID-19 Special Release, United States, March 2020-July 2021 For each condition, the odds ratios represent the odds of outcome given for patients with the condition versus patients without mental health conditions. For length of stay, the percentages represent the percentage difference in length of stay for patients with the condition versus patients without mental health conditions. Covariates were selected based on factors known or plausibly associated with both the mental health condition and the given outcome. Values ​​in bold indicate statistical significance (2-sided α = 0.05), adjusted for multiple comparisons using the Bonferroni-Holm method.

Greater chances of ICU admission, mechanical ventilation, and death were noted for patients with anxiety than for those without MHC. Patients with any of the selected MHCs had significantly high chances of readmission. All selected MHCs were significantly associated with a longer mean LOS. Patients with anxiety, on average, had the longest hospital stay of 34.8 days, followed by those with schizophrenia (25.6 days), bipolar disorder (20.6 days), and depression (19.5 days).

Conclusions

The authors found that anxiety was strongly associated with the outcomes of serious illness. Each of the selected MHCs was independently associated with an increased risk of all-cause readmission within 30 days and a longer mean LOS. These results cannot be compared with the results of previous studies because they presented substantial heterogeneity in the data / results, in the aggregation of MHC and in populations with variable risk profiles, among others.

Additionally, previous studies have found no significant relationship between anxiety and increased risk of mechanical ventilation, ICU admission, or hospital mortality. Conversely, most others did not evaluate outcomes such as LOS and readmission. In summary, MHCs could aggravate respiratory diseases, increasing the risk of readmission or prolonged hospital stay in non-psychiatric admissions. The study showed differences in the risks of each selected MHC and provided evidence that MHCs could be considered high-risk factors for COVID-19 patients.

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