Comorbid psychiatric, substance use disorders increase odds of COVID-19 hospitalization

Among patients with COVID-19 who visited EDs, those with both psychiatric and substance use disorders had greater odds of hospitalization compared with those with one or neither type of disorder, according to a study in JAMA Psychiatry.

Previous studies have shown that people with preexisting psychiatric disorders were more likely to have COVID-19 disease, and about 6% of those who had COVID-19 during the beginning of the pandemic had a new psychiatric diagnosis later on, Lyna Z. Schieber, MD, DPhil, a senior scientist at the CDC, and colleagues, wrote. Thus, substance use disorders may be associated with greater risk for and greater severity of COVID-19, the researchers hypothesized.

Schieber and colleagues retrospectively analyzed discharge data for adults with COVID-19 at 873 hospitals with EDs and inpatient facilities in 48 states from April 2020 to August 2021. They also assessed incidence of substance use and psychiatric disorders using records from previous hospital visits or the first visit for COVID-19.

The primary outcome was hospitalization, which comprised inpatient encounter, inpatient indicator, ED admission and ED billing charge for a stay less than 24 hours.

In total, 1,274,219 patients met inclusion criteria, 567,766 (44.6%) of whom were hospitalized from an ED. Among all patients, 79.3% had a primary discharge diagnosis of COVID-19.

A total of 237,186 (18.6%) patients had psychiatric disorders, with 81,577 (6.4%) patients having more than one. Fewer patients had any substance use disorder (n = 58,876; 4.6%), with 11,725 (0.9%) having more than one. Of patients with any psychiatric disorder, 12.3% also had a substance use disorder.

Patients who had both psychiatric and substance use disorders had the greatest probability of hospitalization (mean, 61%) compared with patients who only had a substance use disorder (mean, 59%), those who only had a psychiatric disorder (mean, 51%) and those who had neither (mean, 41%).

Evaluation of specific psychiatric and substance use disorder pairs revealed differences in the probability of hospitalization between patients with both disorders and other patients. For instance, patients with schizophrenia and sedative use disorder had a 36% higher probability of being hospitalized compared with patients who had no psychiatric or substance use disorder.

“Overlooking possible coexisting psychiatric disorder and substance use disorder in ED patients with COVID-19 can underestimate the likelihood of hospitalization,” Schieber and colleagues wrote. “Screening and assessment of both conditions are needed because the likelihood of both being present is particularly high.”