School of Pharmacy, Sungkyunkwan University, Suwon, Republic of Korea.
Department of Psychiatry, Seoul National University College of Medicine, Republic of Korea; and Department of Neuropsychiatry, Seoul National University Hospital, Republic of Korea; and Department of Brain and Cognitive Sciences, Seoul National University College of Natural Sciences, Republic of Korea; and Institute of Human Behavioral Medicine, Seoul National University Medical Research Center, Republic of Korea.
Br J Psychiatry. 2021 Jun;218(6):344-351. doi: 10.1192/bjp.2020.251.
Epidemiological data on the association between mental disorders and the risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and coronavirus disease 2019 (COVID-19) severity are limited.
To evaluate the association between mental disorders and the risk of SARS-CoV-2 infection and severe outcomes following COVID-19.
We performed a cohort study using the Korean COVID-19 patient database based on national health insurance data. Each person with a mental or behavioural disorder (diagnosed during the 6 months prior to their first SARS-CoV-2 test) was matched by age, gender and Charlson Comorbidity Index with up to four people without mental disorders. SARS-CoV-2-positivity risk and the risk of death or severe events (intensive care unit admission, use of mechanical ventilation and acute respiratory distress syndrome) post-infection were calculated using conditional logistic regression analysis.
Among 230 565 people tested for SARS-CoV-2, 33 653 (14.6%) had mental disorders; 928/33 653 (2.76%) tested SARS-CoV-2 positive and 56/928 (6.03%) died. In multivariable analysis using the matched cohort, there was no association between mental disorders and SARS-CoV-2-positivity risk (odds ratio OR = 0.95; 95% CI 0.87-1.04); however, a higher risk was associated with schizophrenia-related disorders (OR = 1.50; 95% CI 1.14-1.99). Among confirmed COVID-19 patients, the mortality risk was significantly higher in patients with than in those without mental disorders (OR = 1.99, 95% CI 1.15-3.43).
Mental disorders are likely contributing factors to mortality following COVID-19. Although the infection risk was not higher for people with mental disorders overall, those with schizophrenia-related disorders were more vulnerable to infection.
精神障碍与严重急性呼吸综合征冠状病毒 2（SARS-CoV-2）感染和 2019 年冠状病毒病（COVID-19）严重程度之间关联的流行病学数据有限。
评估精神障碍与 SARS-CoV-2 感染风险以及 COVID-19 后严重结局之间的关联。
我们使用基于国家健康保险数据的韩国 COVID-19 患者数据库进行了队列研究。每位患有精神或行为障碍（在首次 SARS-CoV-2 检测前 6 个月内确诊）的人都按年龄、性别和 Charlson 合并症指数与最多 4 名无精神障碍的人进行了匹配。使用条件逻辑回归分析计算 SARS-CoV-2 阳性风险以及感染后的死亡或严重事件（入住重症监护病房、使用机械通气和急性呼吸窘迫综合征）风险。
在 230565 名接受 SARS-CoV-2 检测的人中，有 33653 人（14.6%）患有精神障碍；928/33653（2.76%）检测 SARS-CoV-2 阳性，56/928（6.03%）死亡。在使用匹配队列的多变量分析中，精神障碍与 SARS-CoV-2 阳性风险之间无关联（比值比 OR = 0.95；95%置信区间 0.87-1.04）；然而，与精神分裂症相关的障碍与更高的风险相关（OR = 1.50；95%置信区间 1.14-1.99）。在确诊的 COVID-19 患者中，有精神障碍的患者的死亡率明显高于无精神障碍的患者（OR = 1.99，95%置信区间 1.15-3.43）。
精神障碍可能是 COVID-19 后死亡的促成因素。尽管总体而言，患有精神障碍的人感染风险不高，但患有与精神分裂症相关的障碍的人更容易感染。
