People with mental health problems are at higher risk of severe COVID-19 results

In a recent study published in the CDC Emerging infectious diseases diary, the researchers assessed the links between mental health conditions (MHCs) and severe outcomes of coronavirus disease 2019 (COVID-19).

People with MHC may be at increased risk of severe COVID-19 results after hospitalization. Most previous studies have been limited by the small sample size or aggregation of MHCs that mask risk differences. In addition, earlier studies did not assess readmission and length of hospital stay (LOS).

Study: Mental health conditions and severe outcomes of COVID-19 after hospitalization, United States. Image credit: lumezia.com/Shutterstock

About the study

In the present study, the researchers examined the associations of selected MHCs with severe results from COVID-19, LOS and readmission. They analyzed a large US-based patient file database. Patients hospitalized with severe acute coronavirus 2 infection (SARS-CoV-2) and discharged between 1 March 2020 and 31 July 2021 have been identified. Anxiety, bipolar disorder, depression and schizophrenia have been selected by the ICC. Outcomes of interest are ICU admission, LOS, invasive mechanical ventilation, readmission of all causes to the same hospital within 30 days, and all-cause mortality during hospital stay.

The relationship between each MHC with each result was investigated using mixed effect models. The reference group includes patients without a diagnosis of MHC. Adjusted odds ratios and corresponding 95% confidence intervals (CIs) were estimated with logistic models. 95% CI and percentage differences for LOS were calculated using Poisson models. The models were adjusted for age, race, gender, ethnicity, month of admission, type of insurance, Elixhauser comorbidity index, and hospital characteristics.

Results

The study sample included 664,956 patients hospitalized with COVID-19. Most patients (77.1%) were 50 years of age or older, and 55% of male patients had no diagnosis of MHC compared to 45% of women. More male patients (53.8%) than women (46.2%) had schizophrenia. Conversely, most female patients had depression (61.7%), anxiety (61%) or bipolar disorder (58.8%), which is more than male patients.

Results of hospitalized patients with COVID-19 (n = 664,956) by diagnosing mental health, compared with patients without diagnoses of mental health in the special version for COVID-19 based on data from Premier Healthcare, USA, March 2020. - July 2021. For each condition, the odds represent the odds of the outcome for patients with illness compared to patients without mental illness.  For the length of stay, the percentages represent the percentage difference in the length of stay for patients with illness compared to patients without mental illness.  The covariates were selected on the basis of factors known or plausible in relation to both the state of mental health and the outcome.  The bold values ​​show statistical significance (2-sided α = 0.05), corrected for multiple comparisons using the Bonferroni-Holm method.

Results of hospitalized patients with COVID-19 (n = 664,956) by diagnosing mental health, compared with patients without diagnoses of mental health in the special version for COVID-19 based on data from Premier Healthcare, USA, March 2020. – July 2021. For each condition, the odds represent the odds of the outcome for patients with illness compared to patients without mental illness. For the length of stay, the percentages represent the percentage difference in the length of stay for patients with illness compared to patients without mental illness. The covariates were selected on the basis of factors known or plausible in relation to both the state of mental health and the outcome. The bold values ​​show statistical significance (2-sided α = 0.05), corrected for multiple comparisons using the Bonferroni-Holm method.

Patients with anxiety are more likely to be admitted to the intensive care unit, mechanical ventilation and death than those without MHC. Patients with one of the selected MHCs had a significantly increased chance of readmission. All selected MHCs were significantly associated with longer mean LOS. On average, patients with anxiety had the longest hospital stay of 34.8 days, followed by those with schizophrenia (25.6 days), bipolar disorder (20.6 days) and depression (19.5 days).

Conclusions

The authors found that anxiety was strongly associated with severe disease outcomes. Each of the selected MHCs was independently associated with an increased risk of readmission for all reasons within 30 days and a longer mean LOS. These results cannot be compared with the findings of previous studies, as they have significant heterogeneity in data / results, aggregation of MHCs and populations with different risk profiles, among others.

In addition, earlier studies did not find a significant association between anxiety and an increased risk of mechanical ventilation, intensive care, or hospital mortality. In contrast, most others do not evaluate results such as LOS and readmission. In summary, MHCs may exacerbate respiratory disease by increasing the risk of readmission or prolonged hospital stay in non-psychiatric hospitalizations. The study showed differences in the risks of each selected MHC and provided evidence that MHCs can be considered high risk factors for patients with COVID-19.

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