Tue. Dec 7th, 2021

In late 2019, a new coronavirus was discovered in Wuhan, China, later called severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which causes coronavirus disease 2019 (COVID-19). On March 11, 2020, the World Health Organization COVID-19 declared a pandemic. The COVID-19 pandemic continues to mutate and evolve, causing millions of cases of mortality and morbidity worldwide.

Study: How do different pre-existing mental disorders and their co-occurrence affect the clinical outcomes of COVID-19?  A study based on real-world data in the southern United States.  Image credit: DOERS / ShutterstockStudy: How do different pre-existing mental disorders and their co-occurrence affect the clinical outcomes of COVID-19? A study based on real-world data in the southern United States. Image credit: DOERS / Shutterstock

Individuals with pre-existing mental disorders, including internalizing disorders (such as post-traumatic stress disorder, depression, panic disorder, and generalized anxiety disorder), externalizing disorders (such as behavioral disorders, and substance or alcohol dependence), and thought disorders (e.g., schizophrenia, obsessive-compulsive disorder, and mania) ) may be particularly vulnerable to COVID-19 and show deterioration in their mental health.

A team of researchers from the United States conducted a study to assess how pre-existing mental disorders are associated with a SARS-CoV-2 infection and how different clusters of mental disorders affect COVID-19 clinical outcomes. The authors used population-based electronic medical record data from a nationwide cohort of all confirmed and probable COVID-19 adult cases in South Carolina, USA, from March 6, 2020 to April 14, 2021, to provide database evidence to inform health care providers for people with pre-existing mental illness. during the COVID-19 pandemic.

A pre-printed version of this study, which has yet to undergo peer review, is available at medRxiv* preprint server.

The study

This study was performed on 55,300 patients with pre-existing mental disorders, of whom 23,410 had only internalizing disorders, 21,200 had only externalizing disorders, and 618 had only mental disorders. Eight thousand 76 patients had both externalizing and internalizing disorders, 732 had both thought and internalizing disorders, and 388 had thought and externalizing disorders. Eight hundred and seventy-six patients had all three clusters of externalizing, internalizing, and thought disorders.

The data showed that individuals with pre-existing mental disorders represented a higher proportion of COVID-19-related hospitalizations and deaths compared with those without a respective cluster of mental disorders.

People with pre-existing mental disorders had a higher proportion of asymptomatic COVID-19 (internalizing disorders: 54.2% vs. 53.9%; Externalizing disorders: 57.6% vs. 53.7%; Thought disorders: 65.1% vs. 53.9%; Any cluster of mental disorders: 55.5% vs. 53.8%) and severe disease cases (Internalizing disorders: 18.9% vs. 12.2%; Externalizing disorders: 15.1% vs. 12.5%; Thought disorders: 13.3% vs. 12.7% of mental disorders; disorders: 16.8% vs. 12.2%). However, participants with pre-existing mental disorders showed a lower proportion of mild symptomatic COVID-19 (internalizing disorders: 26.9% vs. 33.8%; externalizing disorders: 27.3% vs. 33.8%; thought disorders: 21, 6% vs. 33.4%; Any cluster of mental disorders: 27.7% versus 34.1%).

This study shows multivariate results suggesting that individuals with pre-existing mental disorders have an increased risk of COVID-19 associated hospitalization and death. With respect to COVID-19 hospitalization, the adjusted odds ratio (OR) for having externalizing, internalizing, and thought disorders was 1.49, 2.27, and 4.41. With deaths associated with COVID-19, the adjusted OR for having externalizing, internalizing, and thought disorders was 1.33, 2.25, and 4.48.

However, there was a decrease in the risk of mild cases associated with pre-existing mental disorders, externalizing disorders, internalizing disorders, and thought disorders were all negatively associated with mild cases. When a person presented with two groups of disorders, this was positively associated with COVID-19 related hospitalization and death.

Specifically, compared with people without pre-existing mental disorders, the odds of being admitted were 1.5 times greater in people with externalizing and internalizing disorders, 2.29 times greater among people with mental and externalizing disorders, 2.34 times greater among people with thoughts and externalizing disorders. internalizing disorders and 2.35 times greater among individuals with three clusters of mental disorders.

Similar results were also shown with COVID-19-related deaths, where the odds were 1.02 times greater in people with externalizing and internalizing disorders, 2.17 times greater in people with thought and internalizing disorders, 2.67 times greater in people with mental and internalizing disorders, and 67% greater in those with three clusters of mental disorders.

Implications

The results of this study suggest that individuals suffering from pre-existing mental disorders, especially thought disorders and multiple clusters of disorders, should be included with the other high-risk groups in the population, such as the elderly, due to the need for improved preventive triage and treatment strategies.

With regard to further research on this issue, there is a need for an extended differentiation of the effects of mental disorders on COVID-19 clinical outcomes by severity / disease stage, inclusion of a comprehensive set of social health regulations in the analysis and exploration of the interaction between different clusters of mental disorders and pre-existing somatic conditions.

*Important message

medRxiv publishes preliminary scientific reports that are not peer-reviewed and therefore should not be considered as crucial, guiding clinical practice / health-related behavior or treated as established information.

Journal reference:

  • Qiao, S. et al. (2021) “How do different pre-existing mental disorders and their co-occurrence affect clinical outcomes of COVID-19? A study based on real-world data in the southern United States”. medRxiv. doi: 10.1101 / 2021.10.21.21265340.

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