Abstract
People with severe mental illness (SMI; including schizophrenia/psychosis, bipolar disorder (BD), major depressive disorder (MDD)) experience large disparities in physical health. Emerging evidence suggests this group experiences higher risks of infection and death from COVID-19, although the full extent of these disparities are not yet established. We investigated COVID-19 related infection, hospitalisation and mortality among people with SMI in the UK Biobank (UKB) cohort study. Overall, 447,296 participants from UKB (schizophrenia/psychosis = 1925, BD = 1483 and MDD = 41,448, non-SMI = 402,440) were linked with healthcare and death records. Multivariable logistic regression analysis was used to examine differences in COVID-19 outcomes by diagnosis, controlling for sociodemographic factors and comorbidities. In unadjusted analyses, higher odds of COVID-19 mortality were seen among people with schizophrenia/psychosis (odds ratio [OR] 4.84, 95% confidence interval [CI] 3.00–7.34), BD (OR 3.76, 95% CI 2.00–6.35), and MDD (OR 1.99, 95% CI 1.69–2.33) compared to people with no SMI. Higher odds of infection and hospitalisation were also seen across all SMI groups, particularly among people with schizophrenia/psychosis (OR 1.61, 95% CI 1.32–1.96; OR 3.47, 95% CI 2.47–4.72) and BD (OR 1.48, 95% CI 1.16–1.85; OR 3.31, 95% CI 2.22–4.73). In fully adjusted models, mortality and hospitalisation odds remained significantly higher among all SMI groups, though infection odds remained significantly higher only for MDD. People with schizophrenia/psychosis, BD and MDD have higher risks of COVID-19 infection, hospitalisation and mortality. Only a proportion of these disparities were accounted for by pre-existing demographic characteristics or comorbidities. Vaccination and preventive measures should be prioritised in these particularly vulnerable groups.
Highlights
The health inequalities for people with severe mental illness (SMI) are regarded as a human rights issue [1, 2]
Individuals living with depression, schizophrenia/psychosis and other psychoses, or bipolar disorder (BD) - are at much heightened risk of physical diseases, which is the primary cause of the ~15 year gap in life expectancy between people with SMI and the general population [3]
Much of the attention on these physical health disparities has focused on the elevated rates of cardiovascular [4] and metabolic diseases in SMI [5, 6], as these account for notably higher proportions of premature mortality observed in this population other than suicide or accidental deaths [3, 7]
Summary
The health inequalities for people with severe mental illness (SMI) are regarded as a human rights issue [1, 2]. There has been considerable evidence, from low and middle income countries, which has already indicated the heightened morbidity and mortality associated with SMI due to various infectious diseases [8,9,10]. Studies in high-income settings have shown that infectious diseases are more prevalent in people with SMI [11,12,13], and have been the leading cause of preventable hospitalisations in this population even prior to the pandemic [14]. Until recently, this topic has received relatively little attention
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