close
close

In a recent study published in the CDC New infectious diseases magazine, researchers assessed the association between mental health conditions (MHCs) and severe outcomes from coronavirus disease 2019 (COVID-19).

Individuals with MHC may be at increased risk of severe outcomes after hospitalization with COVID-19. Most previous studies were limited by small sample sizes or MHC aggregation, which obscured differences in risk. In addition, earlier studies did not assess readmissions and length of stay in hospital (LOS).

Study: Psychiatric Disorders and Severe Consequences of COVID-19 After Hospitalization, USA.  Image credit: lumezia.com/ShutterstockStudy: Mental health status and severe outcomes of COVID-19 after hospitalization, USA. Image credit: lumezia.com/Shutterstock

About the study

In the current study, investigators examined the associations of individual MHCs with severe COVID-19 outcomes, LOS, and readmission. They analyzed a large database of patients in the United States (USA). Patients hospitalized with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and discharged between March 1, 2020 and July 31, 2021 were identified. Anxiety, bipolar disorder, depression, and schizophrenia were selected by the MHC. The outcomes of interest were intensive care unit (ICU) admissions, LOS, invasive mechanical ventilation, readmission for all causes to the same hospital within 30 days, and all-cause mortality during hospital stay.

The association between each MHC with each outcome was studied using mixed effects models. The reference cohort included patients without a diagnosis of MHC. Adjusted odds ratios and corresponding 95% confidence intervals (CIs) were estimated using logistic models. 95% CI and percentage differences for LOS were calculated using Poisson models. The models were adjusted for age, race, gender, ethnicity, month of hospitalization, insurance type, Elixhauser comorbidity index, and hospital characteristics.

Results

The study sample consisted of 664,956 patients hospitalized with COVID-19. The majority of patients (77.1%) were 50 years of age or older, and 55% of male patients did not have a diagnosis of MHC compared to 45% of females. Patients with schizophrenia suffered more men (53.8%) than women (46.2%). In contrast, the majority of female patients had depression (61.7%), anxiety (61%), or bipolar disorder (58.8%), outnumbering male patients.

Outcomes of hospitalized COVID-19 patients (n = 664,956) diagnosed with a psychiatric disorder compared with patients without a diagnosis of a psychiatric disorder in the COVID-19 Special Edition of the Premier Healthcare Database, USA, March 2020-July 2021. For each condition , odds ratios are the odds of a given outcome for patients with a disease compared to patients without a psychiatric disorder.  With regard to length of stay, percentages represent the percentage difference in length of stay for patients with this condition compared to patients without psychiatric disorders.  Covariates were selected based on factors known or likely to be associated with both mental health status and the outcome.  Values ​​in bold indicate statistical significance (two-tailed α = 0.05) adjusted for multiple comparisons using the Bonferroni-Holm method.

Outcomes of hospitalized COVID-19 patients (n = 664,956) diagnosed with a psychiatric disorder compared with patients without a diagnosis of a psychiatric disorder in the COVID-19 Special Edition of the Premier Healthcare Database, USA, March 2020-July 2021. For each condition , odds ratios are the odds of a given outcome for patients with a disease compared to patients without a psychiatric disorder. With regard to length of stay, percentages represent the percentage difference in length of stay for patients with this condition compared to patients without psychiatric disorders. Covariates were selected based on factors known or likely to be associated with both mental health status and the outcome. Values ​​in bold indicate statistical significance (two-tailed α = 0.05) adjusted for multiple comparisons using the Bonferroni-Holm method.

Patients with anxiety had a higher chance of ICU admission, mechanical ventilation, and death than patients without MHC. Patients with any of the selected MHCs had a significantly increased chance of readmission. All selected MHCs were significantly associated with longer mean LOS. Patients with anxiety averaged the longest hospital stay of 34.8 days, followed by patients with schizophrenia (25.6 days), bipolar disorder (20.6 days) and depression (19.5 days).

conclusions

The authors found that anxiety was strongly associated with severe disease outcomes. Each of the selected MHCs was independently associated with an increased risk of rehospitalization for any reason within 30 days and a longer average service life. These results could not be compared with those of previous studies as they had significant heterogeneity in data/results, MHC aggregation, and populations with different risk profiles, among others.

Moreover, earlier studies have not found a significant association between anxiety and an increased risk of mechanical ventilation, admission to the intensive care unit, or in-hospital mortality. In contrast, most others did not assess outcomes such as LOS and readmission. Thus, MHC may exacerbate respiratory disease by increasing the risk of readmission or prolonged hospital stay in non-psychiatric hospitalizations. The study showed differences in the risks of each selected MHC and provided evidence that MHC can be considered high risk factors for patients with COVID-19.

By them

Leave a Reply

Your email address will not be published.