Kang Jiseung, Park Jaeyu, Son Yejun, Kim Hyeon Jin, Fond Guillaume, Boyer Laurent, Rahmati Masoud, Lee Hayeon, Yon Dong Keon
School of Health and Environmental Science, Korea University College of Health Science, Seoul, South Korea.
Department of Health and Safety Convergence Science, Korea University Graduate School, Seoul, South Korea.
J Med Virol. 2025 May;97(5):e70406. doi: 10.1002/jmv.70406.
Understanding whether individuals with mental illness, who face challenges related to healthcare barriers, are more vulnerable to postacute sequelae of COVID-19 is limited. Here, we investigated the potential association between pre-existing mental illness and postacute sequelae of COVID-19 across 12 major health domains and 141 specific diseases in COVID-19 survivors. The large-scale, population-based cohorts from South Korea (K-COV-N cohort) used in the study included 8 632 221 individuals aged 20 years or older who were infected with SARS-CoV-2 between January 1, 2020, and December 31, 2022. The risk of postacute sequelae of COVID-19 was assessed in the 1:2 propensity score-matched cohorts, comprising 12 major health domains and 141 diseases based on the ICD-10 code, following mental illness among patients with COVID-19. We assessed the time attenuation effect of major health outcomes after 30 days following SARS-CoV-2 infection. Multiple subgroup analyses were conducted by severity of mental illness, COVID-19 severity, vaccination, and SARS-CoV-2 strain. After 1:2 exposure-driven propensity score matching, we identified 1 341 320 participants with mental illness (mean age, 49.51 [SD, 13.82] years; 62.27% female) and 2 653 597 controls (mean age, 48.78 [SD, 13.75] years; 62.03% female). Individuals with mental illness exhibited significantly higher risks across all 12 major health domains, including: infectious and parasitic events (adjusted hazard ratio [aHR], 1.36 [95% CI, 1.33-1.38]), blood and immune-related events (1.21 [1.17-1.26]), endocrine, nutritional, and metabolic events (1.21 [1.18-1.24]), nerve-related events (2.13 [2.07-2.19]), eye-related events (1.29 [1.25-1.34]), ear and mastoid events (1.52 [1.50-1.54]), circulatory events (1.25 [1.17-1.35]), respiratory events (1.26 [1.24-1.29]), digestive events (1.41 [1.40-1.41]), skin-related events (1.34 [1.30-1.38]), musculoskeletal events (1.42 [1.41-1.43]), and genitourinary events (1.54 [1.18-2.01]). Of the 141 postacute sequelae of COVID-19, 133 showed significantly increased risks. The association was strongest within the first 6-12 months after SARS-CoV-2 infection, with risks progressively attenuating beyond 12 months and nearly disappearing after 18 months. Subgroup analysis revealed that individuals with mild mental illness exhibited higher aHRs for 11 of the 12 health outcome domains compared with those with severe mental illness. Altogether, our findings show the increased risk of postacute sequelae of COVID-19 across 12 major health domains in individuals with mental illness among COVID-19 survivors. These findings highlight the need for targeted monitoring and intervention strategies to address the vulnerabilities of this population, particularly during the post-COVID-19 period.
对于患有精神疾病且面临医疗保健障碍相关挑战的个体是否更容易出现新冠病毒感染后急性后遗症，目前了解有限。在此，我们调查了新冠病毒感染幸存者中，既往存在的精神疾病与新冠病毒感染后急性后遗症在12个主要健康领域和141种特定疾病之间的潜在关联。本研究中使用的来自韩国的大规模人群队列（K-COV-N队列）包括8632221名20岁及以上的个体，他们在2020年1月1日至2022年12月31日期间感染了严重急性呼吸综合征冠状病毒2（SARS-CoV-2）。在1:2倾向评分匹配队列中评估了新冠病毒感染后急性后遗症的风险，该队列基于国际疾病分类第十版（ICD-10）编码，涵盖12个主要健康领域和141种疾病，这些疾病发生在新冠病毒感染患者出现精神疾病之后。我们评估了SARS-CoV-2感染后30天主要健康结局的时间衰减效应。通过精神疾病严重程度、新冠病毒感染严重程度、疫苗接种情况和SARS-CoV-2毒株进行了多项亚组分析。在进行1:2暴露驱动的倾向评分匹配后，我们确定了1341320名患有精神疾病的参与者（平均年龄49.51岁[标准差13.82]；62.27%为女性）和2653597名对照者（平均年龄48.78岁[标准差13.75]；62.03%为女性）。患有精神疾病的个体在所有12个主要健康领域均表现出显著更高的风险，包括：感染和寄生虫事件（调整后风险比[aHR]为1.36[95%置信区间，1.33 - 1.38]）、血液和免疫相关事件（1.21[1.17 - 1.26]）、内分泌、营养和代谢事件（1.21[1.18 - 1.24]）、神经相关事件（2.13[2.07 - 2.19]）、眼部相关事件（1.29[1.25 - 1.34]）、耳部和乳突事件（1.52[1.50 - 1.54]）、循环系统事件（1.25[1.17 - 1.35]）、呼吸系统事件（1.26[1.24 - 1.29]）、消化系统事件（1.41[1.40 - 1.41]）、皮肤相关事件（1.34[1.30 - 1.38]）、肌肉骨骼事件（1.42[1.41 - 1.43]）和泌尿生殖系统事件（1.54[1.18 - 2.01]）。在新冠病毒感染后141种急性后遗症中，13种显示风险显著增加。这种关联在SARS-CoV-2感染后的前6 - 12个月内最强，12个月后风险逐渐减弱，18个月后几乎消失。亚组分析显示，与患有严重精神疾病的个体相比，患有轻度精神疾病的个体在12个健康结局领域中的11个领域表现出更高的调整后风险比。总之，我们的研究结果表明，新冠病毒感染幸存者中患有精神疾病的个体在12个主要健康领域出现新冠病毒感染后急性后遗症的风险增加。这些发现凸显了需要有针对性的监测和干预策略，以应对这一人群的脆弱性，特别是在新冠疫情后期。
