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Association between mental disorders and COVID-19 outcomes among inpatients in France: A retrospective nationwide
Alexandre Descamps1, Jérôme Frenkiel2, Kevin Zarca2
1Université Paris Cité, Inserm CIC 1417, Assistance Publique-Hôpitaux de Paris, Hôpital Cochin, CIC Cochin Pasteur, Paris, France; DRCI-URC Eco Ile-de-France (AP-HP), Assistance Publique-Hôpitaux de Paris, Paris, France.
Insights
Adults with pre-existing mental disorders face higher COVID-19 mortality risks. This study highlights the need for targeted care for individuals with severe mental illness during the pandemic.
Area of Science:
- Epidemiology
- Psychiatry
- Infectious Diseases
Background:
- Mental disorders increase vulnerability to severe COVID-19 outcomes.
- Limited national data exists on risks for individuals with pre-existing mental disorders hospitalized for COVID-19.
- Subgroup analysis of susceptible populations is needed.
Purpose of the Study:
- To investigate the association between pre-existing psychiatric disorders and COVID-19 outcomes in hospitalized adults.
- To identify specific mental disorder subgroups at higher risk.
- To inform targeted public health interventions.
Main Methods:
- Utilized French national hospital data linked to psychiatric registries.
- Analyzed 97,302 adult COVID-19 hospitalizations (March-September 2020).
- Employed propensity score matching to control for confounders and stratified analysis by psychiatric subgroup.
Main Results:
- 10.3% of hospitalized COVID-19 patients had pre-existing mental disorders, primarily dementia, mood, anxiety, substance use, and psychotic disorders.
- Pre-existing mental disorders were associated with increased 30-day in-hospital mortality (HR 1.15).
- Psychotic disorders (HR 1.90) and substance use disorders (HR 1.53) showed significantly higher mortality; dementia was linked to decreased ICU admission (OR 0.64).
Conclusions:
- Pre-existing mental disorders are independently linked to higher in-hospital mortality following COVID-19.
- Findings emphasize the critical need for enhanced care and interventions for individuals with severe mental illness.
- Public health strategies should prioritize at-risk mental health populations during pandemics.
Background:
Mental disorders are at-risk of severe COVID-19 outcomes. There is limited and heterogeneous national data in hospital settings evaluating the risks associated with any pre-existing mental disorder, and susceptible subgroups. Our study aimed to investigate the association between pre-existing psychiatric disorders and outcomes of adults hospitalised for COVID-19.
Method:
We used data obtained from the French national hospital database linked to the state-level psychiatric registry. The primary outcome was 30-days in-hospital mortality. Secondary outcomes were to compare the length of hospital stay, Intensive Care Unit (ICU) admission and ICU length. Propensity score matching analysis was used to control for COVID-19 confounding factors between patients with or without mental disorder and stratified by psychiatric subgroups.
Results:
Among 97 302 adults hospitalised for COVID-19 from March to September 2020, 10 083 (10.3%) had a pre-existing mental disorder, mainly dementia (3581 [35.5%]), mood disorders (1298 [12.9%]), anxiety disorders (995 [9.9%]), psychoactive substance use disorders (960 [9.5%]), and psychotic disorders (866 [8.6%]). In propensity-matched analysis, 30-days in-hospital mortality was increased among those with at least one pre-existing mental disorder (hazard ratio (HR) 1.15, 95% CI 1.08-1.23), psychotic disorder (1.90, 1.24-2.90), and psychoactive substance disorders (1.53, 1.10-2.14). The odds of ICU admission were consistently decreased for patients with any pre-existing mental disorder (OR 0.83, 95% CI 0.76-0.92) and for those with dementia (0.64, 0.53-0.76).
Conclusion:
Pre-existing mental disorders were independently associated with in-hospital mortality. These findings underscore the important need for adequate care and targeted interventions for at-risk individuals with severe mental illness.
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