General Psychiatry

Bidirectional Association Between Psychiatric Illnesses and COVID-19 Infection

Jessica Nye, PhD
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Using data from 69 million individuals, researchers assessed whether a diagnosis of COVID-19 compared with other health events was associated with increased rates of subsequent psychiatric diagnoses, and whether patients with a history of psychiatric illness are at a higher risk of being diagnosed with COVID-19.

Researchers from the University of Oxford observed that survivors of coronavirus 2019 (COVID-19) were at increased risk for long-term psychiatric consequences and patients recently diagnosed with a psychiatric illness were at increased risk for an infection. These findings, from a retrospective cohort study, were published in Lancet Psychiatry.

The TriNetX database, which aggregates electronic medical records from 54 health care organizations in the United States was used for this study. Patients (n=44,779) diagnosed with COVID-19 after January 20, 2020 who had no prior history of psychiatric illness and control cohorts of patients with influenza (n=26,497), other respiratory tract infections (n=44,775), skin infections (n=38,977), cholelithiasis (n=19,733), urolithiasis (n=28,827), and large bone fractures (n=37,841) were included. Patients were assessed for psychiatric diagnoses 14 to 90 days after the primary diagnosis.

During the first 90 days after a COVID-19 diagnosis, the investigators estimated 5.8% (95% CI, 5.2%-6.4%) of patients would receive a first psychiatric diagnosis. This was greater than patients with influenza (2.8%; 95% CI, 2.5%-3.1%; P <.0001), other respiratory infections (3.4%; 95% CI, 3.1%-3.7%; P <.0001), skin infections (3.3%; 95% CI, 3%-3.7%; P <.0001), cholelithiasis (3.2%; 95% CI, 2.8%-3.7%; P <.0001), urolithiasis (2.5%; 95% CI, 2.2%-2.8%; P <.0001), and fractures (2.5%; 95% CI, 2.2%-2.7%; P <.0001).

Anxiety disorders were most frequently diagnosed among patients with COVID-19 (4.7%; 95% CI, 4.2%-5.3%; hazard ratios [HRs], 1.59-2.62; all P <.0001).

Diagnoses of mood disorders were more frequently observed among those with COVID-19 compared against patients with influenza (HR, 1.79; 95% CI, 1.37-2.33; P <.0001), urolithiasis (HR, 1.62; 95% CI, 1.26-2.07; P =.00011), fracture (HR, 1.35; 95% CI, 1.094-1.67; P =.0050), and other respiratory infections (HR, 1.33; 95% CI, 1.09-1.63; P =.0054).

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The risk for psychiatric sequelae was highest among patients who required admission to the hospital for their COVID-19 symptoms (HR, 1.40; 95% CI, 1.06-1.85; P =.019). Risk for psychiatric sequelae remained significantly higher among patients who were not admitted to the hospital compared with other control cohorts (HRs, 1.54-2.23; P <.0001).

A secondary analysis of 1,729,837 patients who had been diagnosed with a psychiatric illness between 2019 and 2020 were matched with a cohort of the same size who had never been diagnosed with a psychiatric illness.

Among patients with a psychiatric illness diagnosed during the previous year, the risk for COVID-19 infection was 65% higher (risk ratio [RR], 1.65; 95% CI, 1.59-1.71; P <.0001). The increased risk was particularly elevated among older patients (odds ratio [OR], 1.25; 95% CI, 1.14-1.38; P <.0001). This association between previous psychiatric illness and COVID-19 was robust to models which corrected for comorbidities (RR, 1.57; 95% CI, 1.39-1.76; P <.0001) and housing and economic characteristics (RR, 1.57; 95% CI, 1.52-1.61; P <.0001).

This study was possibly limited by unknown discrepancies between how clinicians care for psychiatric symptoms among patients with COVID-19 compared with other patients.

These data indicated there was sufficient evidence to suggest a COVID-19 diagnosis increased risk for psychiatric illness, and that individuals with a comorbid psychiatric illness were at increased risk for COVID-19 infection.

Disclosure: An author declared affiliations with industry. Please refer to the original article for a full list of disclosures.

Reference

Taquet M, Luciano S, Geddes JR, Harrison PJ. Bidirectional associations between COVID-19 and psychiatric disorder: Retrospective cohort studies of 62 354 COVID-19 cases in the USA. Lancet Psychiatry. 2020;S2215-0366(20)30462-4. doi: 10.1016/S2215-0366(20)30462-4.