People with mental health problems are at increased risk for serious consequences of COVID-19

In a recent study published by the CDC Infectious diseases that are emerging magazine, the researchers assessed the links between mental health conditions (MHC) and the serious outcomes of coronavirus disease 2019 (COVID-19).

People with MHCs may be at high risk for serious post-hospitalization outcomes with COVID-19. Most of the previous studies were limited to small samples or aggregations of MHCs that hid risk differences. In addition, previous studies did not assess readmissions and length of hospital stay (LOS).

Study: Mental Health Conditions and Serious Outcomes of COVID-19 After Hospitalization in the United States. Image credit: lumezia.com/Shutterstock

About the exam

In the present study, researchers investigated associations of selected MHCs with severe COVID-19 outcomes, including LOS and re-entry. They have analyzed a large database of patient records based in the United States (USA). Patients who were hospitalized with severe acute respiratory syndrome with coronavirus 2 (SARS-CoV-2) and were discharged from 1 March 2020 to 31 July 2021 were identified. Anxiety, bipolar disorder, depression, and schizophrenia were selected by the MHC. The interesting results were the admission to the intensive care unit (ICU), LOS, invasive mechanical ventilation, re-admission to the same hospital within 30 days for all causes and the death of all causes in the hospital.

The relationship between each MHC and each result was analyzed using mixed-effect models. The reference cohorts were patients without an MHC diagnosis. The adjusted odds ratios and the corresponding 95% confidence intervals (CI) were estimated with the logistic models. 95% CI and LOS percentage differences were calculated using Poisson models. Models were tailored to age, race, sex, ethnicity, month of admission, type of insurance, Elixhauser Comorbidity Index, and hospital characteristics.

Results

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

Outcomes of hospitalized COVID-19 patients (n = 664,956) according to diagnosis of mental health condition, Premier Healthcare Database Special COVID-19 Release, United States, March 2020 to July 2021, compared to patients without undiagnosed mental health status.  , odds ratios indicate the probability of outcome for patients with the disease compared to patients with no mental health condition.  In terms of length of stay, the percentages indicate the difference in the percentage of stay of patients with the disease compared to patients with no mental health condition.  The cohorts were selected based on factors known or reliably related to their mental health status and outcome.  Bold values ​​indicate statistical significance (α = 0.05 on both sides), adapted for multiple comparisons using the Bonferroni-Holm method.

Outcomes of hospitalized COVID-19 patients (n = 664,956) according to diagnosis of mental health condition, Premier Healthcare Database Special COVID-19 Release, United States, March 2020 to July 2021, compared to patients without undiagnosed mental health status. , odds ratios indicate the probability of outcome for patients with the disease compared to patients with no mental health condition. In terms of length of stay, the percentages indicate a difference in the percentage of stay of patients with the disease compared to patients with no mental health condition. The cohorts were selected based on factors that are known or reliably related to their mental health status and outcome. Bold values ​​indicate statistical significance (α = 0.05 on both sides), adapted for multiple comparisons using the Bonferroni-Holm method.

Admission to the ICU was more likely for mechanical ventilation and death for patients with anxiety than for those without MHC. Patients with a selected MHC had a significantly higher probability of readmission. All selected MHCs were significantly correlated with a longer average LOS. Anxiety patients had the longest average hospital stay of 34.8 days, followed by schizophrenia (25.6 days), bipolar disorder (20.6 days), and depression (19.5 days).

Consequences

The authors found that anxiety was closely linked to serious illness. Each selected MHC was independently associated with an increased risk of readmission for all causes within 30 days and a longer average LOS. These results could not be compared with the findings of previous studies due to their high heterogeneity in data / results, MHC aggregation, and populations with different risk profiles, among others.

In addition, previous studies have found no significant relationship between anxiety and mechanical ventilation, ICU admission, or an increased risk of hospital mortality. In contrast, most others did not evaluate outcomes such as LOS and re-entry. In summary, MHCs may exacerbate respiratory illnesses by increasing the risk of re-admission or hospitalization in non-psychiatric hospitalizations. The study showed the risk differences for each selected MHC and demonstrated that MHCs for COVID-19 patients could be considered high risk factors.

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