University of Tsukuba School of Medicine, Ibaraki, Japan; Tokyo Foundation for Policy Research, Minato-ku, Tokyo, Japan.
University of Nevada School of Medicine, Reno, USA.
Gen Hosp Psychiatry. 2023 May-Jun;82:1-6. doi: 10.1016/j.genhosppsych.2023.01.014. Epub 2023 Feb 3.
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.
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.
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.
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.
已有研究表明，严重精神疾病（情感或非情感性精神病障碍）与急性 2019 冠状病毒病（COVID-19）感染患者的死亡率升高有关。尽管在既往研究中，通过调整合并症后，这种关联仍然具有统计学意义，但入院临床状况和治疗方式应被视为重要的混杂因素。
我们旨在通过调整合并症、入院临床状况和治疗方式，评估严重精神疾病是否与 COVID-19 患者的住院死亡率相关。我们在日本的全国性队列研究纳入了 2020 年 1 月 1 日至 2021 年 11 月 30 日期间因实验室确诊的急性 COVID-19 而入住 438 家急性护理医院的连续患者。
在 67348 例住院患者中（平均[标准差]年龄为 54[18.6]岁；3891[53.0%]为女性），2524 例（3.75%）患有严重精神疾病。在严重精神疾病患者中，住院死亡率为 282/2524（11.17%），而在其他患者中为 2118/64824（3.27%）。在完全调整模型中，严重精神疾病与住院死亡率显著相关（比值比，1.49；95%置信区间，1.27-1.72）。E 值分析证实了结果的稳健性。
在调整合并症、入院临床状况和治疗方式后，严重精神疾病仍然是急性 COVID-19 患者死亡的一个危险因素。应优先为这一脆弱群体接种疫苗、诊断、早期评估和治疗。
