Lega Ilaria, Nisticò Lorenza, Palmieri Luigi, Caroppo Emanuele, Lo Noce Cinzia, Donfrancesco Chiara, Vanacore Nicola, Scattoni Maria Luisa, Picardi Angelo, Gigantesco Antonella, Brusaferro Silvio, Onder Graziano
National Centre for Disease Prevention and Health Promotion, Istituto Superiore di Sanità, Viale Regina Elena, Rome 299, Italy.
Centre for Behavioural Sciences and Mental Health, Istituto Superiore di Sanità, Viale Regina Elena, Rome 299, Italy.
EClinicalMedicine. 2021 May;35:100854. doi: 10.1016/j.eclinm.2021.100854. Epub 2021 Apr 23.
there is concern about the increased risk for SARS-CoV-2 infection, COVID-19 severe outcomes and disparity of care among patients with a psychiatric disorder (PD). Based on the Italian COVID-19 death surveillance, which collects data from all the hospitals throughout the country, we aimed to describe clinical features and care pathway of patients dying with COVID-19 and a preceding diagnosis of a PD.
in this cross-sectional study, the characteristics of a representative sample of patients, who have died with COVID-19 in Italian hospitals between February 21st and August 3rd 2020, were drawn from medical charts, described and analysed by multinomial logistic regression according to the recorded psychiatric diagnosis: no PD, severe PD (SPD) (i.e. schizophrenia and other psychotic disorders, bipolar and related disorders), common mental disorder (CMD) (i.e. depression without psychotic features, anxiety disorders).
the 4020 COVID-19 deaths included in the study took place in 365 hospitals across Italy. Out of the 4020 deceased patients, 84 (2•1%) had a previous SPD, 177 (4.4%) a CMD. The mean age at death was 78.0 (95%CI 77.6-78.3) years among patients without a PD, 71.8 (95%CI 69.3-72.0) among those with an SPD, 79.5 (95%CI 78.0-81.1) in individuals with a CMD. 2253 (61.2%) patients without a PD, 62 (73.8%) with an SPD, and 136 (78.2%) with a CMD were diagnosed with three or more non-psychiatric comorbidities.When we adjusted for clinically relevant variables, including hospital of death, we found that SPD patients died at a younger age than those without a PD (adjusted OR per 1 year increment 0.96; 95% CI 0.94-0.98). Women were significantly more represented among CMD patients compared to patients without previous psychiatric history (aOR 1.56; 95% CI 1.05-2.32). Hospital admission from long-term care facilities (LTCFs) was strongly associated with having an SPD (aOR 9.02; 95% CI 4.99-16.3) or a CMD (aOR 2.09; 95% CI 1.19-3.66). Comorbidity burden, fever, admission to intensive care and time from symptoms' onset to nasopharyngeal swab did not result significantly associated with an SPD or with a CMD in comparison to those without any PD.
even where equal treatment is in place, the vulnerability of patients with a PD may reduce their chance of recovering from COVID-19. The promotion of personalised therapeutic projects aimed at including people with PD in the community rather than in non-psychiatric LTCFs should be prioritised.
人们担心精神疾病（PD）患者感染新型冠状病毒2（SARS-CoV-2）的风险增加、出现新型冠状病毒肺炎（COVID-19）严重后果以及护理差异。基于意大利COVID-19死亡监测（该监测收集了全国所有医院的数据），我们旨在描述患有COVID-19且先前被诊断为PD的死亡患者的临床特征和护理路径。
在这项横断面研究中，从2020年2月21日至8月3日期间在意大利医院死于COVID-19的患者的代表性样本特征中提取自病历，并根据记录的精神疾病诊断通过多项逻辑回归进行描述和分析：无PD、重度PD（SPD）（即精神分裂症和其他精神病性障碍、双相情感障碍及相关障碍）、常见精神障碍（CMD）（即无精神病性特征的抑郁症、焦虑症）。
该研究纳入的4020例COVID-19死亡病例发生在意大利的365家医院。在4020例死亡患者中，84例（2.1%）先前患有SPD，177例（4.4%）患有CMD。无PD患者的平均死亡年龄为78.0（95%置信区间77.6 - 78.3）岁，患有SPD的患者为71.8（95%置信区间69.3 - 72.0）岁，患有CMD的患者为79.5（95%置信区间78.0 - 81.1）岁。2253例（61.2%）无PD患者、62例（73.8%）患有SPD的患者以及136例（78.2%）患有CMD的患者被诊断患有三种或更多非精神科合并症。当我们对包括死亡医院在内的临床相关变量进行调整后，我们发现患有SPD的患者比无PD的患者死亡年龄更小（每增加1岁调整后的比值比为0.96；95%置信区间0.94 - 0.98）。与无精神病史的患者相比，CMD患者中女性比例显著更高（调整后的比值比为1.56；95%置信区间1.05 - 2.32）。从长期护理机构（LTCF）入院与患有SPD（调整后的比值比为9.02；95%置信区间4.99 - 16.3）或CMD（调整后的比值比为2.09；95%置信区间1.19 - 3.66）密切相关。与无任何PD的患者相比，合并症负担、发热、入住重症监护病房以及从症状出现到鼻咽拭子采样的时间与SPD或CMD均无显著相关性。
即使在实施平等治疗的情况下，患有PD的患者的脆弱性可能会降低他们从COVID-19中康复的机会。应优先推广旨在将患有PD的人纳入社区而非非精神科LTCF的个性化治疗项目。
