People with preexisting mental disorders at increased risk for COVID-19-related mortality

Preexisting mental disorders, particularly psychotic and mood disorders, as well as exposure to antipsychotics and anxiolytics, increased risk for COVID-19-related mortality.

Researchers reported these results in a systematic review and meta-analysis published in The Lancet Psychiatry.

“Together with my co-authors and five major European psychiatric associations, we have strongly advocated to include patients with severe mental illness as a priority group in the national COVID-19 vaccination strategies,” Livia J. De Picker, MD, a psychiatrist and postdoctoral researcher at the University Psychiatric Hospital Duffel in Belgium, told Healio Psychiatry. “While several countries did change their policy in response to our campaign, policymakers in other countries discarded our pleas, stating that there was not sufficient evidence on which groups of patients were at risk for which particular outcomes. We felt compelled to provide them with that answer, and we knew the matter was urgent because vaccination plans were being rolled out all over the world.”

De Picker collaborated with colleagues from six countries, as well as the European College of Neuropsychopharmacology Immuno-NeuroPsychiatry Network, to evaluate whether COVID-19-related mortality, hospitalization and ICU admission were associated with any preexisting mental disorder, specific diagnostic categories of mental disorders and exposure to psychopharmacological drug classes. The researchers searched four databases between Jan. 1, 2020, and March 5, 2021, for original studies that reported data on COVID-19 outcomes among patients with psychiatric disorders vs. controls. They excluded studies with overlapping samples, those that were not peer-reviewed and those written in a language other than English, Danish, Dutch, French, German, Italian and Portuguese. Crude ORs for mortality following SARS-CoV-2 infection, estimated via modelled random-effects meta-analyses, served as the primary outcome. Hospitalization and ICU admission served as secondary outcomes. De Picker and colleagues also conducted subgroup analyses and meta-regressions to evaluate the effects of baseline COVID-19 treatment setting, patient age, country, pandemic phase, quality assessment score, sample sizes and adjustment for confounders.

The researchers included 33 studies in the systematic review and 23 studies in the meta-analysis. In total, they analyzed data of 1,469,731 patients with COVID-19, of whom 43,938 were diagnosed with a mental disorder. Results showed an association between the presence of any mental disorder and increased risk for COVID-19 mortality (OR = 2; 95% CI, 1.58-2.54). The researchers also reported this association for psychotic disorders (OR = 2.05; 95% CI, 1.37-3.06), mood disorders (OR = 1.99; 95% CI, 1.46-2.71), substance use disorders (OR = 1.76; 95% CI, 1.27-2.44) and intellectual disabilities and developmental disorders (OR = 1.73; 95% CI, 1.29-2.31) but not for anxiety disorders (OR = 1.07; 95% CI, 0.73-1.56). Further, they noted an association between COVID-19 mortality and exposure to antipsychotics (OR = 3.71; 95% CI, 1.74-7.91), anxiolytics (OR = 2.58; 95% CI, 1.22-5.44) and antidepressants (OR = 2.23; 95% CI, 1.06-4.71).

After adjusting for age, sex and other confounders, the association remained significant for psychotic disorders, mood disorders, antipsychotics and anxiolytics, according to the researchers. They also found an association between mental disorders and increased risk for hospitalization (OR = 2.24; 95% CI, 1.7-2.94) but no significant associations between mortality and ICU admission. According to results of subgroup analyses and meta-regressions, significant associations existed between mortality and COVID-19 treatment setting (P = .013) and country (P < .0001). For other covariates, the researchers identified no significant associations with mortality.

“We need to do everything in our power to make sure persons affected by psychotic disorders, mood disorders, substance use disorders or intellectual disability are getting vaccinated against COVID-19,” De Picker said. “If you are caring for a person with a mental disorder, either as family member or health care professional, make sure to ask them about vaccination and explain the importance. We know from other studies that people with severe mental illness have a lower vaccination uptake, and targeted interventions, including being able to discuss this with a professional they know and trust, can really save lives.”