Serious Mental Illness and In-hospital Mortality Among Hospitalized Patients with Acute COVID-19: A Large-database Analysis in Japan

Overview

Journal Gen Hosp Psychiatry

Specialties Health Services
Psychiatry

Date 2023 Mar 3

PMID 36868102

Authors

Yasuharu Tokuda

Peter B Barnett

Shohei Sanji

Yu Takaizumi

Misa Tomono

Haruka Tokuda

Kiyosu Taniguchi

Kenji Shibuya

Affiliations

Soon will be listed here.

Abstract

Objective: The association of serious mental illness (affective or non-affective psychotic disorders) with higher mortality in patients infected with acute coronavirus disease 2019 (COVID-19) has been suggested. Although this association remains significant after adjusting for medical comorbidities in previous studies, admission clinical status and treatment modalities should be considered as important confounding factors.

Methods: We aimed to assess whether serious mental illness is associated with in-hospital mortality, in patients with COVID-19 by adjusting for comorbidities, admission clinical status, and treatment modalities. Our nationwide cohort in Japan included consecutive patients admitted to 438 acute care hospitals for laboratory-confirmed acute COVID-19 from January 1, 2020 to November 30, 2021.

Results: Of 67,348 hospitalized patients (mean [standard deviation] age, 54 [18.6] years; 3891 [53.0%] female), 2524 patients (3.75%) had serious mental illness. In-hospital mortality was 282/2524 (11.17%) among patients with serious mental illness, while it was 2118/64,824 (3.27%) in other patients. In the fully adjusted model, serious mental illness was significantly associated with in-hospital mortality (odds ratio, 1.49; 95% CI, 1.27-1.72). E-value analysis confirmed the robustness of the results.

Conclusion: Serious mental illness remains a risk for mortality in acute COVID-19 after adjusting for comorbidities, admission clinical status, and treatment modalities. Vaccination, diagnosis, early assessment and treatment should be prioritized for this vulnerable group.

Citing Articles

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COVID-19 risk, course and outcome in people with mental disorders: a systematic review and meta-analyses.

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References

Hoertel N, Sanchez-Rico M, Herrera-Morueco J, de la Muela P, Gulbins E, Kornhuber J . Comorbid medical conditions are a key factor to understand the relationship between psychiatric disorders and COVID-19-related mortality: Results from 49,089 COVID-19 inpatients. Mol Psychiatry. 2021; 27(3):1278-1280. PMC: 8622106. DOI: 10.1038/s41380-021-01393-7. View

Vai B, Mazza M, Delli Colli C, Foiselle M, Allen B, Benedetti F . Mental disorders and risk of COVID-19-related mortality, hospitalisation, and intensive care unit admission: a systematic review and meta-analysis. Lancet Psychiatry. 2021; 8(9):797-812. PMC: 8285121. DOI: 10.1016/S2215-0366(21)00232-7. View

Iwasaka S, Shono Y, Tokuda K, Nakashima K, Yamamoto Y, Maki J . Clinical improvement in a patient with severe coronavirus disease 2019 after administration of hydroxychloroquine and continuous hemodiafiltlation with nafamostat mesylate. J Infect Chemother. 2020; 26(12):1319-1323. PMC: 7409929. DOI: 10.1016/j.jiac.2020.08.001. View

Nishi D, Ishikawa H, Kawakami N . Prevalence of mental disorders and mental health service use in Japan. Psychiatry Clin Neurosci. 2019; 73(8):458-465. DOI: 10.1111/pcn.12894. View

Haneuse S, VanderWeele T, Arterburn D . Using the E-Value to Assess the Potential Effect of Unmeasured Confounding in Observational Studies. JAMA. 2019; 321(6):602-603. DOI: 10.1001/jama.2018.21554. View

Yamana H, Moriwaki M, Horiguchi H, Kodan M, Fushimi K, Yasunaga H . Validity of diagnoses, procedures, and laboratory data in Japanese administrative data. J Epidemiol. 2017; 27(10):476-482. PMC: 5602797. DOI: 10.1016/j.je.2016.09.009. View

VanderWeele T, Ding P . Sensitivity Analysis in Observational Research: Introducing the E-Value. Ann Intern Med. 2017; 167(4):268-274. DOI: 10.7326/M16-2607. View

Chojnowski G, Bochtler M . The statistics of the highest E value. Acta Crystallogr A. 2007; 63(Pt 4):297-305. DOI: 10.1107/S010876730701848X. View

Heiberg I, Jacobsen B, Balteskard L, Bramness J, Naess O, Ystrom E . Undiagnosed cardiovascular disease prior to cardiovascular death in individuals with severe mental illness. Acta Psychiatr Scand. 2019; 139(6):558-571. PMC: 6619029. DOI: 10.1111/acps.13017. View

10.

Barcella C, Polcwiartek C, Mohr G, Hodges G, Sondergaard K, Bang C . Severe mental illness is associated with increased mortality and severe course of COVID-19. Acta Psychiatr Scand. 2021; 144(1):82-91. PMC: 8250986. DOI: 10.1111/acps.13309. View

11.

Toubasi A, AbuAnzeh R, Tawileh H, Aldebei R, AlRyalat S . A meta-analysis: The mortality and severity of COVID-19 among patients with mental disorders. Psychiatry Res. 2021; 299:113856. PMC: 7927594. DOI: 10.1016/j.psychres.2021.113856. View

12.

CATTELL J . The holiday syndrome. Psychoanal Rev. 1955; 42(1):39-43. View

13.

Teixeira A, Krause T, Ghosh L, Shahani L, Machado-Vieira R, Lane S . Analysis of COVID-19 Infection and Mortality Among Patients With Psychiatric Disorders, 2020. JAMA Netw Open. 2021; 4(11):e2134969. PMC: 8611476. DOI: 10.1001/jamanetworkopen.2021.34969. View

14.

Nemani K, Conderino S, Marx J, Thorpe L, Goff D . Association Between Antipsychotic Use and COVID-19 Mortality Among People With Serious Mental Illness. JAMA Psychiatry. 2021; 78(12):1391-1393. PMC: 8459305. DOI: 10.1001/jamapsychiatry.2021.2503. View

15.

Wang Q, Xu R, Volkow N . Increased risk of COVID-19 infection and mortality in people with mental disorders: analysis from electronic health records in the United States. World Psychiatry. 2020; 20(1):124-130. PMC: 7675495. DOI: 10.1002/wps.20806. View

16.

Fond G, Nemani K, Etchecopar-Etchart D, Loundou A, Goff D, Lee S . Association Between Mental Health Disorders and Mortality Among Patients With COVID-19 in 7 Countries: A Systematic Review and Meta-analysis. JAMA Psychiatry. 2021; 78(11):1208-1217. PMC: 8317055. DOI: 10.1001/jamapsychiatry.2021.2274. View

17.

Nemani K, Li C, Olfson M, Blessing E, Razavian N, Chen J . Association of Psychiatric Disorders With Mortality Among Patients With COVID-19. JAMA Psychiatry. 2021; 78(4):380-386. PMC: 7841576. DOI: 10.1001/jamapsychiatry.2020.4442. View

18.

Inokuchi R, Kuno T, Komiyama J, Uda K, Miyamoto Y, Taniguchi Y . Association between Nafamostat Mesylate and In-Hospital Mortality in Patients with Coronavirus Disease 2019: A Multicenter Observational Study. J Clin Med. 2022; 11(1). PMC: 8745709. DOI: 10.3390/jcm11010116. View

19.

Goldberger N, Bergman-Levy T, Haklai Z, Yoffe R, Davidson M, Susser E . COVID-19 and severe mental illness in Israel: testing, infection, hospitalization, mortality and vaccination rates in a countrywide study. Mol Psychiatry. 2022; 27(7):3107-3114. PMC: 9028900. DOI: 10.1038/s41380-022-01562-2. View

20.

De Hert M, Cohen D, Bobes J, Cetkovich-Bakmas M, Leucht S, Ndetei D . Physical illness in patients with severe mental disorders. II. Barriers to care, monitoring and treatment guidelines, plus recommendations at the system and individual level. World Psychiatry. 2011; 10(2):138-51. PMC: 3104888. DOI: 10.1002/j.2051-5545.2011.tb00036.x. View