Major psychiatric disorders may worsen COVID-19 outcomes

Patients with major psychiatric disorders appeared to have higher rates of medical comorbidities linked to worse COVID-19 outcomes, according to results of a cross-sectional study published in JAMA Network Open.

However, the higher mortality rate was independent of comorbidities.

“The Optum COVID-19 Electronic Health Record database contained 3,614,884 patient records derived from a network of health care provider organizations across the United States, providing a unique opportunity to evaluate the effect of COVID-19 on patients with psychiatric disorders at a nationally representative level,” Antonio L. Teixeira, MD, PhD, of the department of psychiatry and behavioral sciences at University of Texas Health Science Center at Houston, and colleagues wrote. “Leveraging the access to this national COVID-19 EHR database, we aimed to explore whether people with major psychiatric disorders had higher rates of infection and mortality associated with COVID-19. Given that people with major psychiatric disorders have several factors associated with worse COVID-19 outcomes, we hypothesized they were more vulnerable to the infection.”

The researchers used EHR data collected from various national sources in the U.S. and licensed from Optum. They included current and historical data from patients tested for COVID-19 in 2020. They compared cohorts of patients with schizophrenia, mood disorders or anxiety disorders with a reference group without major psychiatric disorders. Lab-confirmed positivity for COVID-19, as well as mortality, served as the exposures. As main outcomes and measures, the researchers examined the risk for testing positive for COVID-19 in 2020 and risk for death from COVID-19.

Teixiera and colleagues analyzed data from 2,535,098 unique individuals, of whom 3,350 had schizophrenia, 26,610 had mood disorders and 18,550 had anxiety disorders. Mean patient age was 44 years, 233,519 were non-Hispanic African American, 1,583,440 were non-Hispanic Caucasian, and 1,580,703 were female.

Results showed a significantly lower positivity rate among than the schizophrenia cohort (9.86%; adjusted OR = 0.9; 95% CI, 0.84-0.97) and the mood disorder cohort (9.86; adjusted OR = 0.93; 95% CI, 0.87-0.99) compared with the anxiety disorder cohort (11.17%; adjusted OR = 1.05; 95% CI, 0.98-1.12), which was near the reference group’s (11.91%). Full adjustment for demographic factors and comorbid conditions revealed a near fourfold increased risk for death from the disease among patients with schizophrenia vs. the reference group (OR = 3.74; 95% CI, 2.66-5.24). Risk for mortality was 2.76 times higher among the mood disorders COVID-19 cohort than the reference group (OR = 2.76; 95% CI, 2-3.81), and the anxiety disorder cohort had a 2.39-fold greater risk for mortality than the reference group (OR = 2.39; 95% CI, 1.68-3.27).

“This study’s findings suggest the need to foster recognition of pandemic risks on specific groups of patients with psychiatric conditions and may drive alternative approaches to COVID-19 disease testing and interventions to improve clinical outcomes,” Teixeira and colleagues wrote.