COVID-19 Linked to Increased Mortality for Mental Health Disorder Patients

Guillaume Fond, MD, PhD

The link between COVID-19 infections and outcomes of patients with mental health disorders was apparent since the beginning of the pandemic, but new research shows this patient population is at an increased risk of mortality.

A team, led by Guillaume Fond, MD, PhD, Aix-Marseille University, CEReSS-Health Service Research and Quality of Life Center, determined whether patients with psychiatric disorders at an increased risk of COVID-19 mortality compared to a cohort of patients without mental health disorders.

The secondary objectives in the study were to determine whether patients with mental health disorders are at increased risk of intensive care unit (ICU) admission and which specific mental health disorders were associated with the risk of COVID-19 mortality.

Risk Factors

However, there are several factors that increase the risk of more severe COVID-19 outcomes that are also associated with various mental health disorders.

“Patients with mental health disorders can have multiple comorbidities that have been identified as risk factors for severe COVID-19: diabetes, hypertension, chronic obstructive respiratory disease, and end-stage kidney disease,” the authors wrote.

The Review

In the systematic review, the researchers examined various databases for population-based cohort studies of all patients with identified COVID-19 exploring the link between mental health disorders and mortality.

The investigators sought main outcomes of pooled crude and adjusted odds ratios for the association of mental health disorders with mortality, calculated using a 3-level random-effects approach with a hierarchical structure to assess effect size dependency.

They identified 16 population-based cohort studies from 7 countries—1 from Denmark, 2 from France, 1 from Israel, 3 from South Korea, 1 from Spain, 1 from the UK, and 7 from the US. These studies included 19,086 patients with mental health disorders.

Results

Overall, COVID-19 mortality was linked to an increased risk in patients with mental health disorders compared to the arm of patients without mental health disorders (pooled crude OR, 1.75; 95% CI, 1.40-2.20; P < .05; adjusted OR, 1.38; 95% CI, 1.15-1.65; P < .05).

In addition, patients with severe mental health disorders had the highest odds ratios for the risk of mortality (crude OR, 2.26; 95% CI, 1.18-4.31; adjusted OR, 1.67; 95% CI, 1.02-2.73).

“In this systematic review and meta-analysis of 16 observational studies in 7 countries, mental health disorders were associated with increased COVID-19–related mortality,” the authors wrote. “Thus, patients with mental health disorders should have been targeted as a high-risk population for severe forms of COVID-19, requiring enhanced preventive and disease management strategies.”

The researchers suggest future studies should focus on patients with specific mental health disorders as the results show the highest risk might be found in patients with schizophrenia and/or bipolar disorders, which might be explained by the particular immunological profile of these patients.

The study, “Association Between Mental Health Disorders and Mortality Among Patients With COVID-19 in 7 Countries,” was published online in JAMA Psychiatry.