Identifying psychiatric morbidity and comorbidity patterns associated with COVID-19 mortality. A register-based
Mireia Felez-Nobrega1,2, Iago Giné-Vázquez1,2, Anna Monistrol-Mula1,2,3
1Group of Epidemiology of Mental Disorders and Ageing, Sant Joan de Déu Research Institute, Esplugues de Llobregat, Barcelona, Spain.
Insights
The number of mental disorders in adults significantly increases COVID-19 mortality risk. This study highlights the overall burden of psychiatric diagnoses, not specific patterns, as a key factor in COVID-19 outcomes.
Area of Science:
- Public Health
- Epidemiology
- Psychiatry
Background:
- Limited evidence exists on the link between psychiatric morbidity and COVID-19 mortality.
- Understanding this association is crucial for public health strategies.
Purpose of the Study:
- To evaluate the association between the number of mental disorders and COVID-19 mortality.
- To explore if specific psychiatric comorbidity patterns influence COVID-19 death risk.
Main Methods:
- Utilized deidentified electronic health records from the Catalan public health system.
- Compared adults with mental disorders (2017-2019) to matched controls.
- Analyzed COVID-19 mortality risk (Feb-Dec 2020) using odds ratios and K-means cluster analysis.
Main Results:
- Included 785,378 adults (392,689 with mental disorders).
- Mortality risk increased with the number of mental disorders (OR 1.23 to 5.21).
- Identified comparable psychiatric comorbidity profiles between COVID-19 survivors and those who died.
Conclusions:
- An increasing number of psychiatric diagnoses is linked to higher COVID-19 mortality.
- Specific comorbidity patterns had limited differential influence on outcomes.
- The overall burden of multiple diagnoses, not specific combinations, impacts COVID-19 mortality.
Background:
There is limited evidence on the association between psychiatric morbidity and COVID-19 mortality.
Methods:
We used deidentified electronic health records from the Catalan public health system to evaluate the association between number of mental disorders and COVID-19 mortality. Adults diagnosed with a mental disorder in Catalonia's mental health services (from to 2017-2019) were compared to a matched (1:1) control group by sex, age, and area of residence. COVID-19 mortality risk was evaluated from February to December 2020. Odds ratios (OR) with 95% confidence intervals (CI) were estimated for the association between the number of mental disorders and COVID-19 mortality. To examine if different patterns of psychiatric comorbidity were related to COVID-19 death, we performed K-means cluster analysis on individuals with ≥2 disorders, stratified by COVID-19 death.
Results:
The final sample included 785,378 adults (392,689 with ≥1 mental disorder). Mortality risk increased with the number of mental disorders: OR 1.23 (95% CI: 1.11-1.35) for one mental disorder, up to 5.21 (95% CI: 1.34-20.27) for four or more. Cluster analysis (n=84,207) identified seven psychiatric comorbidity profiles among those who did not die of COVID-19, and six profiles among those who died, with substantial comparability between cohorts.
Conclusion:
An increasing number of psychiatric diagnoses was associated with greater COVID-19 mortality, while specific comorbidity patterns showed limited differential influence. This suggests that it is not the specific combination of mental disorders that influences COVID-19 death outcomes, but rather the overall burden of multiple diagnoses.
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