Risk of Death in Individuals Hospitalized for COVID-19 With and Without Psychiatric Disorders: An Observational Multicenter Study in France

Nicolas Hoertel,Arnaud Sandrin,Marie Frank,Guillaume Airagnes,Léo Lebouter,Antoine Rozes,Katrin Anne Becker,Ivan Lerner,Martin Hilka,Bastien Rance,Eric Zapletal,Patricia Serre,Judith Leblanc,Juan José Herrera-Morueco,Raphaël Vernet,Charlotte Caucheteux,Hélène Ravera,Mélodie Bernaux,Pedro De La Muela,Aurélien Maire,Alain Bauchet,Christel Daniel,Alexandre Gramfort,Catherine Ducloas,Alexander Carpinteiro,Aurélie Bourmaud,Thomas Moreau,Johannes Kornhuber,Sylvie Cormont,Richard Layese,Nina Orlova,Marion Leboyer,Nicolas Griffon,Ali Bellamine,Olivier Grisel,Xavier Tannier,Anne Sophie Jannot,Nicolas Garcelon,Céline Cougoule,Damien Leprovost,Maxime Wack,Martin Guilbaud,Arthur Mensch,Antoine Neuraz,Patricia Martel,Nathanaël Beeker,Romain Bey,Frédéric Limosin,Anita Burgun,Damien Van Gysel,Carlos Blanco,Gaël Varoquaux,Julien Dubiel,Jill Jen Vie,Jesús M Alvarado,Erich Gulbins,Elisa Salamanca,Julien Champ,Fabrice Carrat,Cédric Lemogne,Kankoé Sallah ,Loïc Estève ,Claire Hassen‐Khodja ,Marie‐France Mamzer ,Stéphane Bréant ,François Hémery ,Pierre–Yves Ancel ,Demián Wassermann ,M Lopez Abellan ,Nicolás Paris ,Perceval Wajsbürt ,Jean‐Marc Tréluyer ,G Lemaître ,Vincent Benoît ,Jérôme Lambert ,Marina Sánchez‐Rico

doi:10.1016/j.bpsgos.2021.12.007

Abstract

BackgroundPrior research suggests that psychiatric disorders could be linked to increased mortality among patients with COVID-19. However, whether all or specific psychiatric disorders are intrinsic risk factors of death in COVID-19 or whether these associations reflect the greater prevalence of medical risk factors in people with psychiatric disorders has yet to be evaluated. MethodsWe performed an observational, multicenter, retrospective cohort study to examine the association between psychiatric disorders and mortality among patients hospitalized for laboratory-confirmed COVID-19 at 36 Greater Paris University hospitals. ResultsOf 15,168 adult patients, 857 (5.7%) had an ICD-10 diagnosis of psychiatric disorder. Over a mean follow-up period of 14.6 days (SD = 17.9), 326 of 857 (38.0%) patients with a diagnosis of psychiatric disorder died compared with 1276 of 14,311 (8.9%) patients without such a diagnosis (odds ratio 6.27, 95% CI 5.40–7.28, p < .01). When adjusting for age, sex, hospital, current smoking status, and medications according to compassionate use or as part of a clinical trial, this association remained significant (adjusted odds ratio 3.27, 95% CI 2.78–3.85, p < .01). However, additional adjustments for obesity and number of medical conditions resulted in a nonsignificant association (adjusted odds ratio 1.02, 95% CI 0.84–1.23, p = .86). Exploratory analyses after the same adjustments suggested that a diagnosis of mood disorders was significantly associated with reduced mortality, which might be explained by the use of antidepressants. ConclusionsThese findings suggest that the increased risk of COVID-19–related mortality in individuals with psychiatric disorders hospitalized for COVID-19 might be explained by the greater number of medical conditions and the higher prevalence of obesity in this population and not by the underlying psychiatric disease.

Highlights

In this multicenter retrospective observational study involving 15,168 patients hospitalized for laboratory-confirmed COVID-19, we found that individuals with a diagnosis of psychiatric disorder had a 6-fold increased risk of mortality than those without this diagnosis
All individual psychiatric diagnoses were significantly associated with increased mortality when adjusting for age, sex, hospital, current smoking status, and medications according to compassionate use or as part of a clinical trial
Our analyses suggest that increased mortality in patients diagnosed with a psychiatric disorder compared to those without this diagnosis was mainly explained by the higher rates of medical risk factors, including greater number of medical conditions and higher prevalence of obesity, in this population

Summary

Introduction

Prior studies [1,2,3,4,5,6,7,8,9,10] suggest that psychiatric disorders, including schizophrenia spectrum disorders [1,2,3,4,7], mood disorders [1,2,3,8], anxiety disorders [1], intellectual and developmental disabilities [9], substance-induced psychiatric disorders [1,2], and dementia [5] are associated with higher COVID-19-related mortality. Because these comorbidities are associated with increased COVID-19-related mortality [13], it is important to determine whether psychiatric disorders are independent risk factors for death due to COVID-19, or whether this association is explained by the greater rates of medical risk factors for severe COVID-19 in this population This issue is key in the context of worldwide infectious disease crisis [14,15,16], where limited resources, including vaccine distribution, are allocated based on vulnerability to develop severe COVID-19. Conclusions: These findings suggest that the increased risk of COVID-19-related mortality in individuals with psychiatric disorders hospitalized for COVID-19 might be explained by the greater number of medical conditions and the higher prevalence of obesity in this population, but not by the underlying psychiatric disease

Methods

Results

Conclusion