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Association of Psychiatric Disorders With Mortality Among Patients With COVID-19

Educational Objective:
To assess whether a diagnosis of a schizophrenia spectrum disorder, mood disorder, or anxiety disorder is associated with mortality in patients with COVID-19.
1 Credit CME
Key Points

Question  Is a diagnosis of schizophrenia spectrum, mood, or anxiety disorders associated with increased risk of mortality in patients with coronavirus disease 2019 (COVID-19)?

Findings  In this cohort study of 7348 adults with laboratory-confirmed COVID-19 in a New York health system, a schizophrenia spectrum diagnosis was associated with an increased risk of death after adjusting for demographic and medical risk factors. Mood and anxiety disorders were not associated with increased risk of mortality.

Meaning  A diagnosis of a schizophrenia spectrum disorder may be a risk factor for mortality in patients with COVID-19.

Abstract

Importance  To date, the association of psychiatric diagnoses with mortality in patients infected with coronavirus disease 2019 (COVID-19) has not been evaluated.

Objective  To assess whether a diagnosis of a schizophrenia spectrum disorder, mood disorder, or anxiety disorder is associated with mortality in patients with COVID-19.

Design, Setting, and Participants  This retrospective cohort study assessed 7348 consecutive adult patients for 45 days following laboratory-confirmed COVID-19 between March 3 and May 31, 2020, in a large academic medical system in New York. The final date of follow-up was July 15, 2020. Patients without available medical records before testing were excluded.

Exposures  Patients were categorized based on the following International Statistical Classification of Diseases, Tenth Revision, Clinical Modification diagnoses before their testing date: (1) schizophrenia spectrum disorders, (2) mood disorders, and (3) anxiety disorders. Patients with these diagnoses were compared with a reference group without psychiatric disorders.

Main Outcomes and Measures  Mortality, defined as death or discharge to hospice within 45 days following a positive severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) test result.

Results  Of the 26 540 patients tested, 7348 tested positive for SARS-CoV-2 (mean [SD] age, 54 [18.6] years; 3891 [53.0%] women). Of eligible patients with positive test results, 75 patients (1.0%) had a history of a schizophrenia spectrum illness, 564 (7.7%) had a history of a mood disorder, and 360 (4.9%) had a history of an anxiety disorder. After adjusting for demographic and medical risk factors, a premorbid diagnosis of a schizophrenia spectrum disorder was significantly associated with mortality (odds ratio [OR], 2.67; 95% CI, 1.48-4.80). Diagnoses of mood disorders (OR, 1.14; 95% CI, 0.87-1.49) and anxiety disorders (OR, 0.96; 95% CI, 0.65-1.41) were not associated with mortality after adjustment. In comparison with other risk factors, a diagnosis of schizophrenia ranked behind only age in strength of an association with mortality.

Conclusions and Relevance  In this cohort study of adults with SARS-CoV-2–positive test results in a large New York medical system, adults with a schizophrenia spectrum disorder diagnosis were associated with an increased risk for mortality, but those with mood and anxiety disorders were not associated with a risk of mortality. These results suggest that schizophrenia spectrum disorders may be a risk factor for mortality in 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: November 23, 2020.

Published Online: January 27, 2021. doi:10.1001/jamapsychiatry.2020.4442

Corresponding Author: Donald C. Goff, MD, Department of Psychiatry, New York University Langone Medical Center, One Park Avenue, New York, NY 10016 (donald.goff@nyulangone.org).

Author Contributions: Drs Namani and Goff had full access to the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Nemani, Olfson, Goff.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: Nemani, Blessing, Goff.

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

Statistical analysis: Li, Razavian, Petkova.

Administrative, technical, or material support: Goff.

Supervision: Li, Goff.

Conflict of Interest Disclosures: Dr Goff reported receiving research support and travel reimbursement from Avanir Pharmaceuticals and Takeda. No other disclosures were reported.

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