Psychiatric inpatients at increased risk for COVID-19 infection, death

Patients in psychiatric inpatient setting who were admitted without known COVID-19 infection were at increased risk for subsequent infection vs. those in the community, according to study results published in The Lancet Psychiatry.

These patients also had a higher proportion of COVID-19-related deaths than those in the community.

“Although position papers have considered the increased risk [for] mental health problems, exacerbation of health inequalities and challenges of mental health inpatient settings posed by the pandemic, to our knowledge, no studies to date have reported details on COVID-19 prevalence, symptoms and outcomes in inpatients in mental health hospitals,” Gill Livingston, MD, of the division of psychiatry at University College London, and colleagues wrote.

“Two media reports have been published on this topic at the time of writing: China News Weekly reported 50 patients and 30 health care workers who developed COVID-19 in a psychiatric hospital in Wuhan, and suggested that this spread was related to insufficient supplies of protective clothing and called for adequate attention to patients in psychiatric units; and a South Korean newspaper reported that two nurses and 99 of 102 patients in a psychiatric ward developed COVID-19.”

In the current retrospective observational study, the investigators sought to outline the period prevalence, demographics, symptoms/asymptomatic cases, management and survival outcomes related to COVID-19 among 344 older inpatient psychiatric patients, as well as individuals with young-onset dementia, among five National Health Service Trusts in London between March 1 and April 30. They identified patients with COVID-19 according to a positive SARS-CoV-2 PCR test, or presence of relevant COVID-19 symptoms, as determined by patients’ treating physician.

Results showed 131 (38%) total inpatients received COVID-19 diagnoses during the study period. Among patients with COVID-19, the mean age was 75.3 years, 68 (52%) were women and 47 (36%) were from historically underrepresented groups. Further, 16 (12%) of those with COVID-19 were asymptomatic; 121 (92%) had at least one disease-related comorbidity; 108 (82%) were compulsorily detained; and 74 (56%) had dementia, of whom 13 (18%) had young-onset dementia. Livingston and colleagues reported that sites had an average receipt of COVID-19 testing kits of 4.5 days following the first clinical presentation of infection. During the study period, 19 (15%) patients diagnosed with COVID-19 died, and their deaths were considered related to COVID-19.

“Individuals with a severe mental illness have excess morbidity and mortality rates compared with those without severe mental illness, and therefore might be more susceptible to COVID-19-related health issues,” Livingston and colleagues wrote. Most (82%) patients in our study had no choice but to be in hospital because they were compulsorily detained. Since 2006 in the [United States], and since 2011 in the U.K., a policy of parity of esteem has been in place between mental and physical health, sometimes interpreted as treating patients with equal respect and hope. Implementation of the long-standing policy of parity of esteem for mental health is urgent.”