Association of Psychiatric Disorders With Mortality Among Patients With COVID-19
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Design
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Retrospective, observational, cohort study
N=7,348
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Objective
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To assess whether a diagnosis of a schizophrenia spectrum disorder, mood disorder, or anxiety disorder is associated with mortality in patients with COVID-19
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Study Groups
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Schizophrenia spectrum (n=75)
Mood disorders (n=564)
Anxiety disorders (n=360)
Control (n=6,349)
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Inclusion Criteria
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Aged ≥18 years, confirmed SARS-CoV-2 test, data available in the health system |
Exclusion Criteria
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Patients without available medical records before testing |
Methods
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This was a retrospective, observational study from a health system in New York. Patients with a positive SARS-CoV-2 test were stratified based on ICD-10 diagnoses for schizophrenia spectrum disorders, mood disorders, and anxiety disorders. Due to certain nonspecific diagnosis codes, medical reviews were performed for all schizophrenia diagnoses.
These patients were compared to a control group without psychiatric diagnoses. The control group excluded patients with other psychiatric disorders (e.g., OCD, somatoform disorders, dissociative disorders, etc.); however, organic mental disorders, substance use disorders, mental retardation, and psychological development disorders were included in the reference group.
Odds ratios were conducted unadjusted, adjusted based on demographics (age, race, and sex), and adjusted for medical risk factors plus demographics.
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Duration
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Positive test: March 3 to May 31, 2020
Follow-up: 45-days after positive test or up to July 15, 2020
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Outcome Measures
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Mortality 45-days after positive SARS-CoV-2 test |
Baseline Characteristics
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Schizophrenia spectrum (n=75)
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Mood disorders (n=564)
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Anxiety disorders (n=360)
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Control (n=6,349) |
Age, years
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59.7 ± 15.0 |
62.3 ± 18.7 |
54.9 ± 19.3 |
53.6 ± 18.4 |
Female
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44% |
60.1% |
60.3% |
52% |
White
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62.7% |
57.8% |
61.1% |
38.2% |
Comorbidities
Hypertension
Heart failure
MI
Diabetes
COPD
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77.3%
24%
42.7%
37.3%
52%
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68.8%
21.5%
37.2%
41.1%
47.9%
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52.8%
12.2%
24.7%
25.3%
37.5%
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42.5%
5.3%
13.2%
24.3%
20.8%
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MI=myocardial infarction; COPD=chronic obstructive pulmonary disease |
Results
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Schizophrenia spectrum (n=75)
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Mood disorders (n=564)
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Anxiety disorders (n=360)
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Control (n=6,349)
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45-day mortality
aOR (95% CI)
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20 (26.7%)
aOR 2.67 (1.48-4.80)
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104 (18.4%)
aOR 1.14 (0.87-1.49)
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39 (10.8%)
aOR 0.96 (0.65-1.40)
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701 (11%)
Reference
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aOR=adjusted odds ratio; CI=confidence interval |
Adverse Events
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Not studied |
Study Author Conclusions
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In this cohort study of adults with SARS-CoV-2–positive test results in a large New York medical system, adults with a schizophrenia spectrum disorder diagnosis were associated with an increased risk for mortality, but those with mood and anxiety disorders were not associated with a risk of mortality.
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InpharmD Researcher Critique
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This study has several limitations. The study period during a time when the pandemic was peaking in New York, with testing restricted to symptomatic and high-risk persons. The was also prior to the results of RECOVERY-dexamethasone were published and during a time when inappropriate therapies were being used (i.e., hydroxychloroquine, lopinavir/ritonavir) by inpatients and outpatients.
The data set was unbalanced did not match psychiatric patients with controls. As such, the patients with schizophrenia disorders had a higher prevalence of risk factors for severe COVID-19 (e.g., COPD, hypertension, diabetes). This degree of confounding could have lead to the results seen in this study, regardless of underlying schizophrenia.
This study may also be at risk of selection bias. Patients with psychiatric disorders may be less likely to seek medical attention; however, all patients included in this study had previous treatment and established access to healthcare.
The severity of COVID-19, the incidence of hospitalization, or if the patients were asymptomatic were not reported. This study also failed to report the status of psychological disorders (i.e., if they are managed or trying new therapies).
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