Preexisting neuropsychiatric conditions linked to higher risk for respiratory infections

For adults in the U.K., preexisting neuropsychiatric conditions and having a prescription for a related treatment carried a significantly increased risk of severe outcomes from COVID-19 and other severe acute respiratory infections.

“Recent evidence indicates that the risk of developing an incident neuropsychiatric condition after severe COVID-19 infection and a severe acute respiratory infection (SARI) is similar,” Tom Alan Ranger, PhD, of the Nuffield Department of Primary Care Health Sciences at the University of Oxford in England, and colleagues wrote in JAMA Psychiatry.

Ranger and fellow researchers sought to determine whether preexisting diagnosis of or treatment for a neuropsychiatric condition is associated with severe outcomes from COVID-19 infection and other SARIs and whether any observed association is similar between each of the two outcomes.

They utilized the QResearch database of English primary care records and created two separate longitudinal cohorts, one prepandemic (2015 to 2020) group of 11,134,789 adults (median age 42.0 years; 50.7% female) and one contemporary (2020 to 2021) group of 8,388,956 adults (mean age 48.0 years; 50.2% male). Participants were included if they had a diagnosis of or were prescribed medication for anxiety, mood or psychotic disorders and diagnosis of dementia, depression, schizophrenia or bipolar disorder. The main outcomes were COVID-19–related mortality or hospital or ICU admission; SARI-related mortality; or hospital or intensive care unit admission.

Adjusted HRs were estimated using flexible parametric survival models clustered by primary care clinic. This study included a population-based sample, including all adults in the database who had been registered with a primary care clinic for at least 1 year.

Results showed that diagnosis or treatment for neuropsychiatric conditions other than dementia was associated with an increased likelihood of a severe outcome from SARI (anxiety: aHR, 1.16; 99% CI, 1.13-1.18; psychotic disorder diagnosis and treatment: aHR, 2.56; 99% CI, 2.40-2.72) and COVID-19 (anxiety: aHR, 1.16; 99% CI, 1.12-1.20; psychotic disorder treatment: aHR, 2.37; 99% CI, 2.20-2.55). The effect estimate for severe outcome with dementia was higher for those with COVID-19 than SARI (aHR, 2.85; 99% CI, 2.71-3.00 vs. aHR, 2.13; 99% CI, 2.07-2.19).

“We found that people diagnosed with a neuropsychiatric condition or those prescribed corresponding psychotropic medications had a similarly associated increased risk of severe disease from COVID-19 and other SARIs,” Ranger and colleagues wrote, “suggesting that these associations are not specific to COVID-19 infection.”