Severe Mental Disorders Increases Risk of COVID-19 Mortality

Martin Maripuu

New research shows patients with severe mental disorders (SMD) such as bipolar disorder or psychotic disorders have a higher risk of somatic comorbidity and overall mortality than the rest of the population.

A team, led by Martin Maripuu, Division of Psychiatry, Department of Clinical Sciences, Umeå University, assessed whether this patient population had a higher risk of death after contracting the coronavirus disease 2019 (COVID-19) than individuals without severe mental disorders.

Sample Population

In the cross-sectional, population-based study, the Swedish Board for Health and Welfare (Socialstyrelsen) provided anonymized tabulated summary data for further analysis.

The researchers compared the number of COVID-19 associated deaths in individuals with severe mental disorders and without SMD. The team also calculated the odds ratio (OR) for the entire sample and by age group, as well as with 4 comorbidities—diabetes, cardiovascular disease, hypertension, and chronic lung disease.

The sample data included individuals in the Swedish population over the age of 20 between March 11 and June 15, 2020. The study included individuals who suffered from psychotic disorders including schizophrenia and bipolar, but did not include depression or anxiety.

Results

Overall, there was a sample of 7.9 million patients, 103,999 with severe mental disorders and 7.8 million in the control group. There were also 130 (0.1%) COVID-19 associated deaths in the study group and 4945 (0.06%) in the control group. This corresponds with an OR of 1.98 (95% CI, 1.66-2.35; P <0.001).

In addition, the odds were four-fold for the 60-79 year old age group and 1.5-fold for cardiovascular disease, while individuals with SMD without any of the risk factors under the study had three-fold odds of COVID-19 associated death.

“Our preliminary results identify individuals with SMD as a further group at increased risk of COVID-19 associated death,” the authors wrote. “In regard to comorbidities, future studies should explore the potential confounding or mediation role in the relationship between SMD and COVID-19 associated deaths.”

Policy Decisions

The researchers believe the preliminary results should help shape policy decisions regarding the COVID-19 pandemic.

"We see a high excess mortality due to COVID-19 among the elderly with severe mental disorders, which gives us reason to consider whether this group should be given priority for vaccines," Maripuu said in a statement.

Previous studies have shown severe mental disorders have a substantial impact on life expectancy, which could be shortened by 10-20 years. Somatic disorders account for at least 50% of the short life expectancy.

The premature deaths are mainly caused by cardiovascular disease.

However, infectious diseases also might contribute to the shortened life expectancy in this patient popular.

The study, “Death Associated With Coronavirus (COVID-19) Infection in Individuals With Severe Mental Disorders in Sweden During the Early Months of the Outbreak—An Exploratory Cross-Sectional Analysis of a Population-Based Register Study,” was published online in Frontiers in Psychiatry.