Mood disorder diagnosis increases risk for COVID-19 mortality among hospitalized patients

Hospitalized individuals who had mood disorder history were at increased risk for greater COVID-19 morbidity and mortality, according to results of a retrospective cohort study published in American Journal of Psychiatry.

“Growing evidence that SARS-CoV-2 may affect brain function directly or indirectly likewise increases concern for interaction between preexisting disorders involving the [central nervous system], including mood disorders, and adverse outcomes,” Victor M. Castro, MS, of the department of psychiatry at Harvard Medical School, and colleagues wrote. “Whether [central nervous system] features represent a direct consequence of infection, a secondary effect of immune activation and cytokine release syndrome or some distinct mechanism secondary to COVID-19, they may complicate the management of acutely ill patients, particularly in resource-constrained environments.”

Castro and colleagues aimed to assess the link between prior mood disorder diagnosis and hospital outcomes among 2,988 individuals, of whom 717 had a prior mood disorder diagnosis, who were admitted with COVID-19 to two academic medical centers and four community hospitals in Eastern Massachusetts between Feb. 15, 2020, and May 24, 2020. They established the retrospective cohort using the institutions’ electronic health records and used regression models to assess associations between mood disorder history and in-hospital mortality and hospital discharge home among any hospitalized patients who tested positive for SARS-CoV-2.

Results of cox regression models adjusted for age, sex and hospital site showed mood disorder presence before admission was linked to greater in-hospital mortality risk beyond hospital day 12 (fully adjusted HR = 1.54; 95% CI, 1.054-2.25). Further, the researchers found diagnosis of mood disorder was linked to increased risk for discharge to a skilled nursing facility or other rehabilitation facility instead of home (fully adjusted OR = 1.504; 95% CI, 1.132-1.999).

“Psychiatric comorbidity, and mood disorders in particular, must be carefully considered in hospitalized COVID-19 patients,” Castro and colleagues wrote. “The mechanism by which a preexisting mood disorder may influence hospital course and outcome merits further investigation in large clinical cohorts, as well as at a neurobiological level.”