Mental illness could worsen COVID-19 severity

Diagnosis of mental illness is not associated with an increased likelihood of testing positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), but of an increased risk of severe illness from coronavirus disease 2019 (COVID-19) compared with patients without metal illness, results of a recent study in South Korea have shown.

“Further research is [therefore] required to support our study’s findings. In the meantime, clinicians should be aware of the increased risk of COVID-19 associated with pre-existing mental illness, and take this into consideration for COVID-19 prognosis and care,” said the researchers. [Lancet Psychiatry 2020, doi: 10.1016/S2215-0366(20)30421-1]

In the nationwide cohort study with propensity score (PS) matching, data of 216,418 adults aged ≥20 years living in South Korea with at least one SARS-CoV-2 test referred by medical providers or the Korea Centers for Disease Control and Prevention (KCDC) between 1 January 2020 and 15 May 2020 were retrieved from various National COVID-19–related registries, including the KCDC, the Health Insurance Review and Assessment Service of Korea, and the Ministry of Health and Welfare, South Korea.

Presence of mental illness in the study was defined as ≥2 inpatient and/or outpatient records of relevant International Statistical Classification of Diseases and Related Health Problems 10 (ICD-10) codes within 1 year. Severe mental illness was considered as non-affective or affective disorders with psychotic features, likely to be characterised by cognitive impairment and social isolation.

In the entire cohort, the SARS-CoV-2 detection rate was 3.3 percent (n=7,160). Following PS matching, 2.9 percent vs 3.0 percent of patients with (n=47,058) vs without (n=47,058) a mental illness tested positive for SARS-CoV-2 (fully adjusted odds ratio [OR], 1.00; 95 percent confidence interval [Cl], 0.93 to 1.08).

Severe clinical outcomes of COVID-19, comprising admission to the intensive care unit, invasive ventilation, or death, were observed in 9.7 percent vs 8.3 percent of patients with vs without mental illness (fully adjusted OR, 1.27; 95 percent CI, 1.01 to 1.66), while death occurred in 6.7 percent vs 5.4 percent of patients (fully adjusted OR, 1.38; 95 percent CI, 1.00 to 1.95).

Subgroup analysis revealed positive SARS-CoV-2 test result in 3.3 percent and 2.8 percent of patients with severe mental illness and other mental illnesses, respectively. More than 8 percent (8.2 percent) of patients with other mental illnesses and 13.4 percent of patients with a severe mental illness developed severe SARS-CoV-2 infection.