After the adjustment for known risk factors, mental health disorders remained associated with an increased risk for COVID-19 mortality.
The presence of other co-morbidities among those with with mental health disorders is likely to increase the risk of worse outcomes in COVID-19. Moreover, mental health problems are associated with low socioeconomic status which has been linked to a greater risk of critical care admission among those infected with COVID-19. Data collected from several countries has already shown that the presence of severe mental illnesses such as schizophrenia, are a risk factor for greater COVID-19 mortality although in contrast, other work has concluded that a diagnosis of mental illness was not associated with an increased likelihood of testing positive for COVID-19. While a meta-analysis has suggested a pre-diagnosis of mental disorders worsens the prognosis of COVID-19, the analysis had methodological issues and did not examine the effect for individual diagnoses. This led a team from the CEReSS-Health Service Research and Quality of Life Centre, Marseille, France, to undertake a systematic review and meta-analysis of the accumulating evidence on mental health disorders and COVID-19. Their primary objective was to determine whether patients with mental health disorders were at an increased risk of COVID-19 mortality compared with those without such problems. A secondary objective was to explore if the presence of a mental health disorder increased the risk of intensive care admission and if there were any mental health conditions that specifically increased the risk of COVID-19 mortality. The team searched for articles which included participants with a diagnosis of a mental health disorder and a clinical diagnosis of COVID-19 and where intensive care unit and mortality data were included. Adjustments were made for the presence of other known risk factors for COVID-19, i.e., co-morbidities, age etc.
A total of 16 population-based cohort studies across seven countries with 19,086 patients were included in the meta-analysis. Overall, the present of mental health disorders was associated with an increased risk of COVID-19 mortality (odds ratio, OR = 1.38, 95% CI 1.15–1.65). In studies where only severe mental illness such as schizophrenia or bipolar disorder were included, the mortality risk was higher (OR = 1.67, 95% CI 1.02–2.73). There was no apparent association between any specific mental health disorder and COVID-19 mortality and there was insufficient data to determine whether mental health disorders were associated with intensive care admission.
Commenting on these findings, the authors suggested that individuals with mental health disorders should be targeted as a high-risk population for severe COVID-19, requiring enhanced disease management strategies. They concluded by calling for future studies to examine the risks associated with individual mental health disorders and to confirm their findings of the link between severe mental health and increased COVID-19 mortality.
Fond G et al. Association Between Mental Health Disorders and Mortality Among Patients With COVID-19 in 7 Countries. A Systematic Review and Meta-analysis. JAMA Psychiatry 2021