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Psychiatry and Behavioral Health

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

JAMA Network Open

Published Online: September 30, 2020

Research Letter

Article Information and Disclosures

Luming Li, MD¹;

Fangyong Li, MHS, MS²;

Frank Fortunati, JD, MD¹;

John H. Krystal, MD¹

Author Affiliations

¹Yale University School of Medicine, Department of Psychiatry, New Haven, Connecticut
²Yale University School of Public Health, New Haven, Connecticut

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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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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

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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.2016.08.006 PubMed Google Scholar Crossref

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.2009.07.008 PubMed Google Scholar Crossref

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.2007.06101710 PubMed Google Scholar Crossref

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.2008.11.029 PubMed Google Scholar Crossref

AMA CME Accreditation Information

Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

1.00 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
1.00 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;
1.00 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program;
1.00 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program; and
1.00 CME points in the American Board of Surgery’s (ABS) Continuing Certification program

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.