Center for Advancing Population Science, Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI 53226, USA.
Department of Medicine, Division of General Internal Medicine, Medical College of Wisconsin, 8701 Watertown Plank Rd., Milwaukee, WI 53226, USA.
Psychol Med. 2023 Feb;53(3):927-935. doi: 10.1017/S0033291721002312. Epub 2021 May 26.
There is a paucity of literature on the relationship between pre-existing mental health conditions and coronavirus disease-2019 (COVID-19) outcomes. The aim was to examine the association between pre-existing mental health diagnosis and COVID-19 outcomes (positive screen, hospitalization, mortality).
Electronic medical record data for 30 976 adults tested for COVID-19 between March 2020 and 10th July 2020 was analyzed. COVID-19 outcomes included positive screen, hospitalization among screened positive, and mortality among screened positive and hospitalized. Primary independent variable, mental health disorders, was based on ICD-10 codes categorized as bipolar, internalizing, externalizing, and psychoses. Descriptive statistics were calculated, unadjusted and adjusted logistic regression and Cox proportional hazard models were used to investigate the relationship between each mental health disorder and COVID-19 outcomes.
Adults with externalizing (odds ratio (OR) 0.67, 95%CI 0.57-0.79) and internalizing disorders (OR 0.78, 95% CI 0.70-0.88) had lower odds of having a positive COVID-19 test in fully adjusted models. Adults with bipolar disorder had significantly higher odds of hospitalization in fully adjusted models (OR 4.27, 95% CI 2.06-8.86), and odds of hospitalization were significantly higher among those with externalizing disorders after adjusting for demographics (OR 1.71, 95% CI 1.23-2.38). Mortality was significantly higher in the fully adjusted model for patients with bipolar disorder (hazard ratio 2.67, 95% CI 1.07-6.67).
Adults with mental health disorders, while less likely to test positive for COVID-19, were more likely to be hospitalized and to die in the hospital. Study results suggest the importance of developing interventions that incorporate elements designed to address smoking cessation, nutrition and physical activity counseling and other needs specific to this population to improve COVID-19 outcomes.
目前关于先前存在的心理健康状况与 2019 年冠状病毒病（COVID-19）结局之间的关系的文献很少。本研究旨在探讨先前存在的心理健康诊断与 COVID-19 结局（阳性筛查、住院、死亡）之间的关系。
分析了 2020 年 3 月至 2020 年 7 月 10 日期间接受 COVID-19 检测的 30976 名成年人的电子病历数据。COVID-19 结局包括阳性筛查、阳性筛查住院和阳性筛查及住院死亡。主要的独立变量为基于 ICD-10 编码的精神障碍，分为双相、内化、外化和精神病。计算了描述性统计数据，使用未调整和调整后的逻辑回归和 Cox 比例风险模型来研究每种精神障碍与 COVID-19 结局之间的关系。
在完全调整的模型中，患有外化（优势比（OR）0.67，95%CI 0.57-0.79）和内化障碍（OR 0.78，95%CI 0.70-0.88）的成年人检测出 COVID-19 阳性的可能性较低。在完全调整的模型中，双相障碍患者住院的可能性显著较高（OR 4.27，95%CI 2.06-8.86），在调整人口统计学因素后，外化障碍患者住院的可能性也显著较高（OR 1.71，95%CI 1.23-2.38）。在完全调整的模型中，双相障碍患者的死亡率显著较高（风险比 2.67，95%CI 1.07-6.67）。
患有精神障碍的成年人虽然 COVID-19 检测阳性的可能性较低，但更有可能住院治疗，且在住院期间死亡的风险更高。研究结果表明，开发干预措施的重要性，这些措施应纳入旨在解决戒烟、营养和身体活动咨询以及针对该人群的其他特定需求的元素，以改善 COVID-19 结局。
