COVID-19 patients with mood disorders at greater risk of death, morbidity

A history of mood disorder among hospitalized COVID-19 patients may increase their risk of morbidity and mortality, a US study has found. This population is also at higher risk of need for postacute care.

“In aggregate, this large, multihospital retrospective cohort study suggests that psychiatric comorbidity, and mood disorders in particular, must be carefully considered in hospitalized COVID-19 patients,” the researchers said. “The mechanism by which a pre-existing mood disorder may influence hospital course and outcome merits further investigation in large clinical cohorts, as well as at a neurobiological level.”

Participants were identified from the electronic health records of two academic medical centres and four community hospitals between 15 February and 24 May 2020. Regression models were fitted to examine the associations of mood disorder history with in-hospital mortality and hospital discharge home among hospitalized patients with positive tests for SARS-CoV-2, the causative agent of COVID-19.

A total of 2,988 admitted patients were identified, of whom 717 (24.0 percent) had a history of mood disorder. [Am J Psychiatry 2021;178:541-547]

The presence of such disorder predicted an increased risk for in-hospital death beyond hospital day 12 (crude hazard ratio [HR], 2.156, 95 percent confidence interval [CI], 1.540–3.020; fully adjusted HR, 1.540, 95 percent CI, 1.054–2.250) in Cox regression models adjusted for age, sex, and hospital site.

A diagnosis of mood disorder also correlated with a higher chance of discharge to a skilled nursing facility or other rehabilitation facility rather than home (crude odds ratio [OR], 2.035, 95 percent CI, 1.661–2.493; fully adjusted OR, 1.504, 95 percent CI, 1.132–1.999).

Based on a validated natural language processing approach, inclusion of current neuropsychiatric symptoms indicated that symptoms noted in emergency department documentation failed to clarify the observed mood disorder effects. [Gen Hosp Psychiatry 2019;59:1-6]

“We recently showed that with onset of COVID-19 in the Boston area, documentation of psychiatric symptoms in general was dramatically reduced in the emergency department setting,” the researchers said. “[H]ence, we cannot exclude the possibility that some of the elevation in risk was attributable to acute symptoms as well as longer-term symptoms.” [JAMA Netw Open 2020;3:e2011346]

The current study had certain limitations. First, the use of electronic health records lacked the precision of a more systematic investigation. Second, the researchers could not determine the magnitude to which adverse outcomes might reflect nonspecific consequences of severe illness overall. Finally, the results could not be generalized to other hospitals since this cohort was treated in the midst of a surge in demand in the Boston area.

Nonetheless, these findings could guide clinical and translational approaches to COVID-19 in several ways. These included the need to consider strategies to address brain involvement in COVID-19 even when other consequences might be more obvious and the importance of including symptoms of neurologic and psychiatric illness in surveillance efforts.

“To date, most reports of so-called asymptomatic presentations focus on pulmonary symptoms or general symptoms of infection alone,” the researchers noted. “To this end, efforts to organize consortia to investigate such symptoms as part of routine care may be critical.” [N Engl J Med 2020;382:2302-2315; medRxiv 2020;doi:2020.04.17.20053157; https://i2b2transmart.org/covid-19-community-project; https://www.sciencemag.org/news/2020/04/how-does-coronavirus-kill-clinicians-trace-ferocious-rampage-through-body-brain-toes]