People with mental disorder diagnosis at increased risk for COVID-19 infection

Individuals who were recently diagnosed with a mental disorder were at increased risk for COVID-19 infection, especially African Americans and women, according to study results published in World Psychiatry.

“Multiple factors have been described that could increase the risk [for] persons with mental disorders to get COVID infection, or make the outcomes of the infection worse,” QuanQiu Wang, of the School of Medicine at Case Western Reserve University in Ohio, and colleagues wrote. “These include challenges in appraising health information and complying with preventive behaviors, limitations in access to health care, homelessness or living in settings where the risk for contagion is higher, and the higher prevalence of comorbid medical conditions that are associated with increased risk for COVID-19 severe illness (such as cardiovascular diseases, cancers and chronic obstructive pulmonary disease). Despite the recognition of these multiple vulnerability factors, the risk for COVID-19 infection and its outcomes among patients with mental disorders have not been investigated systematically.”

To address this research gap, Wang and colleagues aimed to determine the effects of a past-year diagnosis of a mental disorder, such as ADHD, bipolar disorder, depression and schizophrenia, on the risk for COVID-19 infections, as well as related rates of mortality and hospitalization. They analyzed EHR data of 61 million adults from 360 hospitals and 317,000 providers across the U.S. up to July 29, 2020.

Results showed a significantly increased risk for COVID-19 infection among those with a recent mental disorder diagnosis, with the effect strongest for depression (adjusted OR [aOR] = 7.64; 95% CI, 7.45-7.83) and schizophrenia (aOR = 7.34; 95% CI, 6.65-8.1). Among individuals recently diagnosed with a mental disorder, African Americans were at increased risk for COVID-19 infection vs. Caucasians. The strongest ethnic disparity was for depression (aOR = 3.78; 95% CI, 3.58-3.98). Women with mental disorders were at increased risk for COVID-19 infection vs. men. The strongest gender disparity was for ADHD (aOR = 2.03; 95% CI, 1.73-2.39). Individuals who had both a recent mental disorder diagnosis and COVID-19 infection had a death rate of 8.5% and a hospitalization rate of 27.4% compared with 4.7% and 18.6%, respectively, among individuals with COVID-19 and no mental disorder.

“Our analysis of a large nation-wide database provided evidence of an increased COVID-19 infection risk among patients with mental disorders, exacerbated by ethnic and gender disparities, and of higher mortality and hospitalization rates in COVID-19 patients with a recent diagnosis of a mental disorder,” Wang and colleagues wrote. “Our results identify mental disorders as a health risk factor for COVID-19 infection and its adverse outcomes, emphasizing the need to recognize and address modifiable vulnerability factors and to prevent delays in health care provision in this population.”