Divergent risk of SARS-CoV-2 infection, severe COVID-19 and mortality across psychiatric disorders: analysis from electronic health records in Catalonia

TL;DR

This study found that people with different psychiatric disorders have varying risks of SARS-CoV-2 infection, hospitalization, and death from COVID-19.

Contribution

The study reveals divergent risks of SARS-CoV-2 infection and outcomes among specific psychiatric disorder groups using electronic health records.

Findings

Psychosis and bipolar disorder were associated with lower infection risk but higher mortality from COVID-19.

Stress-related and neurotic/somatoform disorders showed higher infection risk but lower hospitalization and mortality.

Depressive disorders had lower hospitalization risk but no significant infection risk differences.

Abstract

People with psychiatric disorders are particularly vulnerable to SARS-CoV-2 infection and its associated complications. However, current literature show that not all psychiatric disorders are equally vulnerable to COVID-19.

This study aimed to assess whether individuals with distinct psychiatric disorders exhibit different risk of SARS-CoV-2 infection, COVID-19 hospitalization, and mortality.

We conducted a case-control study using data of electronic health records from Catalonia. Cases included adults with a hospital admission between 2017 and 2019 for non-affective psychosis, bipolar disorder, depressive disorder, stress-related disorders, neurotic/somatoform disorders, and substance misuse. These were matched to patients without a diagnosis by sex, 5-year age band, and living area. Outcomes included SARS-CoV-2 infection, hospitalization, and COVID-19-related death up to December 2021. Logistic regression analysis were employed to test the association between the six groups of psychiatric disorders and COVID-19 outcomes, controlling for age, sex, smoking, being in a nursing home, and physical comorbidities.

785,378 subjects were included. Preliminary findings showed that patients diagnosed with psychosis and bipolar disorder had lower risk of infection [OR: 0.85 (95% CI: 0.79-0.92), p<0.001; OR: 0.84 (95% CI: 0.76-0.92), p<0.001], whereas individuals with stress-related and neurotic/somatoform disorders had higher risk of infection [OR: 1.08 (95% CI: 1.04-1.14), p<0.001; OR: 1.06 (95% CI: 1.03-1.10), p<0.001]. People with depressive, stress-related, and neurotic/somatoform disorders had lower risk of COVID-19 hospitalization [OR: 0.87 (95% CI: 0.78-0.97), p = 0.01; OR: 0.71 (95% CI: 0.61-0.84), p<0.001; OR: 0.67 (95% CI: 0.60-0.76), p<0.001]. In line with these results, individuals with stress-related disorders also experienced lower mortality [0.49 (95% CI: 0.33-0.70), p<0.001]. Conversely, people with psychosis, bipolar disorder, and substance misuse exhibited higher risk of COVID-19-related death [OR: 2.9 (95% CI: 1.68-3.1), p<0.001; OR: 1.95 (95% CI: 1.30-2.81), p<0.001; OR: 1.82 (95% CI: 1.49-2.20), p<0.001].

We found different risks of SARS-CoV-2 infection, COVID-19 hospitalization, and COVID-19 mortality for psychiatric disorder groups. Differences in vulnerability to COVID-19 among people with psychiatric disorders might be explained by factors such as shared living facilities, physical comorbidities, psychotropic medications, and difficulties in accessing high-intensity medical care. Special attention should be directed towards individuals with psychosis, bipolar disorder, and substance misuse.

None Declared