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Association of a Prior Psychiatric Diagnosis With Mortality Among Hospitalized Patients With Coronavirus Disease 2019 (COVID-19) Infection

Educational Objective
To understand the association of a prior psychiatric diagnosis with mortality amongst hospitalized patients with COVID-19
1 Credit CME

Psychiatric disorders are associated with shortened life expectancy (ie, shortened by as much as 10 years).1 There is a concern that psychiatric comorbidity might increase Coronavirus Disease 2019 (COVID-19)–related mortality, as suggested by prior preliminary studies of cardiac and infectious disease outcomes.2,3 A large population study in Demark suggested that an a priori diagnosis of depression was associated with a higher 30-day mortality for those hospitalized for an infection.3 Here, we evaluate the association between having any prior psychiatric diagnosis and COVID-19–related mortality of hospitalized patients with COVID-19.

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CME Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships. If applicable, all relevant financial relationships have been mitigated.

Article Information

Accepted for Publication: August 27, 2020.

Published: September 30, 2020. doi:10.1001/jamanetworkopen.2020.23282

Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2020 Li L et al. JAMA Network Open.

Corresponding Author: Luming Li, MD, Yale University School of Medicine, Department of Psychiatry, 184 Liberty St, New Haven, CT 06511 (luming.li@yale.edu).

Author Contributions: Dr L. Li and Mr F. Li had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: L. Li, Fortunati, Krystal.

Acquisition, analysis, or interpretation of data: L. Li, F. Li.

Drafting of the manuscript: L. Li, F. Li.

Critical revision of the manuscript for important intellectual content: All authors.

Statistical analysis: F. Li, Krystal.

Obtained funding: Krystal.

Administrative, technical, or material support: L. Li, Fortunati.

Supervision: Krystal.

Conflict of Interest Disclosures: Dr L. Li reported grants from a Health and Aging Policy Fellowship during the conduct of the study. Dr Krystal reported receiving royalties from Janssen Pharmaceuticals, stock from Biohaven Pharmaceuticals, stock options from Blackthorn Pharmaceuticals, stock from Spring Health, stock options from Terran Biosciences, personal fees and provision of drugs for research from Novartis, provision of drugs for research from AstraZeneca, personal fees from Sunovion, Takeda, Cerevel, Biogen, EpiVario, Heptares, Otsuka, Taisho, BioXcel, and Psychogenics, stock from Sage, and personal fees from Cadent Pharmaceuticals outside the submitted work and is the editor of Biological Psychiatry and a member of the Society of Biological Psychiatry. No other disclosures were reported.

Additional Contributions: The authors would like to acknowledge Mr Todd Barnes of Yale New Haven Hospital for help reviewing the results of the study. No compensation was received for his role.

References
1.
Weye  N , Momen  NC , Christensen  MK ,  et al.  Association of specific mental disorders with premature mortality in the Danish population using alternative measurement methods.   JAMA Netw Open. 2020;3(6):e206646. doi:10.1001/jamanetworkopen.2020.6646PubMedGoogle Scholar
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Druss  BG , Bradford  WD , Rosenheck  RA , Radford  MJ , Krumholz  HM .  Quality of medical care and excess mortality in older patients with mental disorders.   Arch Gen Psychiatry. 2001;58(6):565-572. doi:10.1001/archpsyc.58.6.565PubMedGoogle ScholarCrossref
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Davydow  DS , Ribe  AR , Pedersen  HS , Vestergaard  M , Fenger-Grøn  M .  The association of unipolar depression with thirty-day mortality after hospitalization for infection: a population-based cohort study in Denmark.   J Psychosom Res. 2016;89:32-38. doi:10.1016/j.jpsychores.2016.08.006PubMedGoogle ScholarCrossref
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Kilbourne  AM , Morden  NE , Austin  K ,  et al.  Excess heart-disease-related mortality in a national study of patients with mental disorders: identifying modifiable risk factors.   Gen Hosp Psychiatry. 2009;31(6):555-563. doi:10.1016/j.genhosppsych.2009.07.008PubMedGoogle ScholarCrossref
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Kales  HC , Valenstein  M , Kim  HM ,  et al.  Mortality risk in patients with dementia treated with antipsychotics versus other psychiatric medications.   Am J Psychiatry. 2007;164(10):1568-1576. doi:10.1176/appi.ajp.2007.06101710PubMedGoogle ScholarCrossref
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Miller  AH , Maletic  V , Raison  CL .  Inflammation and its discontents: the role of cytokines in the pathophysiology of major depression.   Biol Psychiatry. 2009;65(9):732-741. doi:10.1016/j.biopsych.2008.11.029PubMedGoogle ScholarCrossref
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