Systematic review finds link between mental illness and death due to COVID-19
What you need to know
There is evidence that people with mental health disorders tend to have worse outcomes when they have coronavirus disease 2019 (COVID-19). An international research team conducted a systematic review to determine if there is a link between mental illness and risk of death from COVID-19. They found that people with mental health disorders who had COVID-19 had a higher risk of dying compared to people without mental health disorders. This risk was highest for people with severe mental health disorders, especially those with schizophrenia and/or bipolar disorder.
What is this research about?
There is evidence that people with mental health disorders tend to have poor outcomes when they have coronavirus disease 2019 (COVID-19). A preliminary meta-analysis showed that people with mental health disorders were at higher risk of dying from COVID-19, but the meta-analysis had methodological issues.
An international team of researchers conducted a systematic review to determine if people with mental illness were at increased risk of dying from COVID-19 compared to people without mental illness.
What did the researchers do?
For their literature search, the researchers replaced the term “mental” with the following terms: psychiatric, schizophrenia, psychotic, bipolar disorder, mood disorders, major depressive disorder, anxiety disorder, personality disorder, eating disorder, alcohol abuse, alcohol misuse, substance abuse and substance misuse.
The researchers included population-based cohort studies of all patients with identified COVID-19 that looked at the association between various mental health disorders and mortality.
They used a three-level random-effects statistical approach with a hierarchical structure. This approach allowed them to estimate the strength of the association between mental health disorders and the risk of dying from COVID-19.
What did the researchers find?
They identified 16 studies in seven countries (Denmark, France, Israel, South Korea, Spain, the United Kingdom, and the United States). These studies involved 19,086 patients with mental health disorders. The studies covered December 2019 to July 2020.
COVID-19 mortality was associated with an increased risk for people with mental health disorders compared to those without mental health disorders. This increased risk was statistically significant and was independent of the main clinical risk factors for severe COVID-19 (age, obesity, smoking, kidney disease, cardiovascular and cerebrovascular disease, and chronic obstructive pulmonary disease). People with severe mental health disorders, such as schizophrenia and/or bipolar disorder, had the highest risk of dying from COVID-19.
These findings suggest that people with COVID-19 and mental health disorders should be targeted as a high-risk population for severe forms of COVID-19 that require a more intense level of prevention and disease management.
Limitations of the research
The researchers pointed out several limitations of their study. For example, the studies used different definitions of control groups; some excluded patients with mental health disorders while others only included patients with or without one disorder in a direct head-to-head comparison.
The researchers did not gather information on the stage of illness (acute versus stabilized), which could have affected the risk for severe COVID-19 outcomes. They noted that some databases underreported comorbidities (such as obesity or tobacco smoking) and most of the studies did not include information on social deprivation, both of which could influence the risk of developing severe COVID-19 or dying.
How can you use this research?
This research would be of use to health promotion and prevention professionals in developing COVID-19 awareness campaigns and vaccination campaigns. It would also be of use to health administrators in developing targeted approaches to the treatment of COVID-19. Future studies should evaluate the risk for each mental health disorder, which could not be determined with the current published data, as well as the factors that lead to increased COVID-19 mortality in this population.
About the researchers
Guillaume Fond1,2, Katlyn Nemani3, Damien Etchecopar-Etchart1, Anderson Loundou1, Donald C. Goff3, Seung Won Lee4, Christophe Lancon1,2, Pascal Auquier1, Karine Baumstarck1, Pierre-Michel Llorca2,5, Dong Keon Yon6, Laurent Boyer1,2
- Aix-Marseille University, CEReSS-Health Service Research and Quality of Life Center, Marseille, France
- FondaMental Academic Advanced Center of Expertise for Bipolar Disorders and Schizophrenia (FACE-BD, FACE-SZ), Créteil, France
- Department of Psychiatry, New York University Langone Medical Center, New York, NY, U.S.A.
- Department of Data Science, Sejong University College of Software Convergence, Seoul, South Korea
- Faculté de Médecine, Université d'Auvergne, Clermont-Ferrand, France
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, South Korea