Risk of COVID-19 diagnosis and death in patients with mental illness: a cohort study.

Jeon-Yeon Seon,In-Hwan Oh,Min Kyoung Lim,Minha Hong,Sunjea Kim

doi:10.1017/s2045796021000597

Abstract

Patients with mental illness are vulnerable to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection because of behavioural changes associated with cognitive deterioration, especially without their caregivers. While studies have reported that SARS-CoV-2 infection risk and severe clinical outcomes are high among patients with mental illness, there is a lack of quantitative research supporting this claim. This study investigates if SARS-CoV-2 infection and coronavirus disease 2019 (COVID-19)-related death are higher in patients with mental illness than among those without a mental disorder. A cohort study was conducted using the COVID-19 database of the National Health Insurance Service in South Korea. A total of 123 480 patients aged ⩾20 years who visited a hospital between 1 January 2020 and 30 May 2020 were analysed. Mental disorder diagnoses and types were determined based on 2019 medical records, and a multivariate logistic regression model was used to calculate the odds ratios (ORs) for SARS-CoV-2 infection and deaths. The ORs for SARS-CoV-2 infection (OR 1.58; 95% CI 1.45-1.71) and COVID-19-related death (OR 2.18; 95% CI 1.57-3.04) were high among patients with mental illness. The OR of SARS-CoV-2 infection was higher among patients with severe mental illness (OR 2.60; 95% CI 2.21-3.06), dementia (OR 1.90; 95% CI 1.62-2.22) and substance use disorder (OR 4.98, 95% CI 3.60-6.88). The OR for COVID-19-related death was high among patients with severe mental illness (OR 3.53; 95% CI 1.82-6.83) and dementia (OR 2.12; 95% CI 1.39-3.22). Patients with mental illness are at high risk for SARS-CoV-2 infection and COVID-19-related death. Behavioural changes associated with cognitive deterioration and long-term care facility residence increase SARS-CoV-2 infection risk, and severe medical conditions and delayed treatment increase the COVID-19-related mortality risk in patients with mental illness. Patients with mental illness are a priority target population for COVID-19 prevention and treatment, and it is important to plan prevention measures that address their needs.

Highlights

Coronavirus disease 2019 (COVID-19) is a novel infection caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Wiersinga et al, 2020)
To compare the risks of SARS-CoV-2 infection and COVID-19-related death according to patient characteristics, a χ2 test was performed with sex, age, the region of residence, health insurance premium, Charlson Comorbidity Index (CCI) score and mental illness as the independent variables (Table 1)
A χ2 test was used to assessthe statistical significance of differences in COVID-19-related death rates according to sex, age, region of residence, health insurance premiums, CCI scores and mental illness ( p < 0.001)

Summary

Introduction

Coronavirus disease 2019 (COVID-19) is a novel infection caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Wiersinga et al, 2020). After the World Health Organization (WHO) declared COVID-19 a pandemic on March 2020, 81 658 440 confirmed cases were reported worldwide in December 2020, and 1 802 206 of those led to death (WHO, 2020a). Patients with mental illness are vulnerable to SARS-CoV-2 infection because of behavioural changes associated with cognitive deterioration (Yao et al, 2020), especially without their caregivers. Some experts have proposed that patients with mental illness are at high risk of SARS-CoV-2 infection due to a lack of awareness of infection risk and a lack of commitment to personal prevention activities (Druss, 2020; Shinn and Viron, 2020; Yao et al, 2020)

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