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Kim HJ, Kim MH, Choi MG, Chun EM. Psychiatric adverse events following COVID-19 vaccination: a population-based cohort study in Seoul, South Korea. Mol Psychiatry 2024:10.1038/s41380-024-02627-0. [PMID: 38834668 DOI: 10.1038/s41380-024-02627-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 05/22/2024] [Accepted: 05/24/2024] [Indexed: 06/06/2024]
Abstract
Evidence has suggested an increased risk of psychiatric manifestations following viral infections including coronavirus disease-2019 (COVID-19). However, psychiatric adverse events (AEs) after COVID-19 vaccination, which were documented in case reports and case series, remain unclear. This study is aimed to investigate the psychiatric AEs after COVID-19 vaccination from a large population-based cohort in Seoul, South Korea. We recruited 50% of the Seoul-resident population randomly selected from the Korean National Health Insurance Service (KNHIS) claims database on 1, January, 2021. The included participants (n = 2,027,353) from the Korean National Health Insurance Service claims database were divided into two groups according to COVID-19 vaccination. The cumulative incidences per 10,000 of psychiatric AEs were assessed on one week, two weeks, one month, and three months after COVID-19 vaccination. Hazard ratios (HRs) and 95% Confidence interval (CIs) of psychiatric AEs were measured for the vaccinated population. The cumulative incidence of depression, anxiety, dissociative, stress-related, and somatoform disorders, sleep disorders, and sexual disorders at three months following COVID-19 vaccination were higher in the vaccination group than no vaccination group. However, schizophrenia and bipolar disorders showed lower cumulative incidence in the vaccination group than in the non-vaccinated group. Depression (HR [95% CI] = 1.683 [1.520-1.863]), anxiety, dissociative, stress-related, and somatoform disorders (HR [95% CI] = 1.439 [1.322-1.568]), and sleep disorders (HR [95% CI] = 1.934 [1.738-2.152]) showed increased risks after COVID-19 vaccination, whereas the risks of schizophrenia (HR [95% CI] = 0.231 [0.164-0.326]) and bipolar disorder (HR [95% CI] = 0.672 [0.470-0.962]). COVID-19 vaccination increased the risks of depression, anxiety, dissociative, stress-related, and somatoform disorders, and sleep disorders while reducing the risk of schizophrenia and bipolar disorder. Therefore, special cautions are necessary for administering additional COVID-19 vaccinations to populations vulnerable to psychiatric AEs.
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Affiliation(s)
- Hong Jin Kim
- Department of Orthopedic Surgery, Inje University Sanggye Paik Hospital, College of Medicine, Inje University, Seoul, Republic of Korea
| | - Min-Ho Kim
- Informatization Department, Ewha Womans University Seoul Hospital, Seoul, Republic of Korea
| | - Myeong Geun Choi
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, School of Medicine, Ewha Womans University, Seoul, Republic of Korea
| | - Eun Mi Chun
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, School of Medicine, Ewha Womans University, Seoul, Republic of Korea.
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Davis A, Copeland-Linder N, Phuong K, Belcher H, van Eck K. Hospitalisation and mortality among privately insured individuals with COVID-19 in the United States: The role of intellectual disabilities and Neurogenetic disorders. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2024; 68:573-584. [PMID: 38369907 DOI: 10.1111/jir.13116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 12/09/2023] [Accepted: 12/11/2023] [Indexed: 02/20/2024]
Abstract
BACKGROUND Individuals with intellectual disabilities (IDs) and neurogenetic conditions (IDNDs) are at greater risk for comorbidities that may increase adverse outcomes for this population when they have coronavirus disease 2019 (COVID-19). The study aims are to examine the population-level odds of hospitalisation and mortality of privately insured individuals with COVID-19 with and without IDNDs IDs, controlling for sociodemographics and comorbid health conditions. METHODS This is a retrospective, cross-sectional study of 1174 individuals with IDs and neurogenetic conditions within a population of 752 237 de-identified, privately insured, US patients diagnosed with COVID-19 between February 2020 and September 2020. Odds of hospitalisation and mortality among COVID-19 patients with IDNDs adjusted for demographic characteristics, Health Resources and Services Administration region, states with Affordable Care Act and number of comorbid health conditions were analysed. RESULTS Patients with IDNDs overall had higher rates of COVID-19 hospitalisation than those without IDNDs (35.01% vs. 12.65%, P < .0001) and had higher rates of COVID-19 mortality than those without IDNDs (4.94% vs. .88%, P < .0001). Adjusting for sociodemographic factors only, the odds of being hospitalised for COVID-19 associated with IDNDs was 4.05 [95% confidence interval (CI) 3.56-4.61]. Adjusting for sociodemographic factors and comorbidity count, the odds of hospitalisation for COVID-19 associated with IDNDs was 1.42 (95% CI 1.25-1.61). The odds of mortality from COVID-19 for individuals with IDNDs adjusted for sociodemographic factors only was 4.65 (95% CI 3.47-6.24). The odds of mortality from COVID-19 for patients with IDNDs adjusted for sociodemographic factors and comorbidity count was 2.70 (95% CI 2.03-3.60). A major finding of the study was that even when considering the different demographic structure and generally higher disease burden of patients with IDNDs, having a IDND was an independent risk factor for increased hospitalisation and mortality compared with patients without IDNDs. CONCLUSIONS Individuals with IDNDs had significantly higher odds of hospitalisation and mortality after adjusting for sociodemographics. Results remained significant with a slight attenuation after adjusting for sociodemographics and comorbidities. Adjustments for comorbidity count demonstrated a dose-response increase in odds of both hospitalisation and mortality, illustrating the cumulative effect of health concerns on COVID-19 outcomes. Together, findings highlight that individuals with IDNDs experience vulnerability for negative COVID-19 health outcomes with implications for access to comprehensive healthcare.
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Affiliation(s)
- A Davis
- Disability Health Research Center, Johns Hopkins University School of Nursing, Baltimore, MD, USA
| | - N Copeland-Linder
- Psychology Department, Notre Dame of Maryland University, Baltimore, MD, USA
| | - K Phuong
- Renaissance School of Medicine, Stony Brook University, Stony Brook, NY, USA
| | - H Belcher
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Office for Health, Equity, Inclusion, and Diversity, Kennedy Krieger Institute, Baltimore, MD, USA
| | - K van Eck
- Office for Health, Equity, Inclusion, and Diversity, Kennedy Krieger Institute, Baltimore, MD, USA
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Soreca I, Boudreaux-Kelly M, Seo YJ, Haas G. The Impact of the Global Pandemic on Veterans with Serious Mental Illness (SMI): Healthcare Utilization and Mortality. Behav Sci (Basel) 2024; 14:356. [PMID: 38785847 PMCID: PMC11117568 DOI: 10.3390/bs14050356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 03/30/2024] [Accepted: 04/16/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND Individuals with serious mental illness (SMI) experience barriers to accessing and engaging with healthcare, which may have been exacerbated during the emergence of the global pandemic and the rapid shift to telemedicine platforms, substantially decreasing healthcare utilization for non-COVID-19 disorders. Important repercussions on morbidity and mortality may be seen in the months and years to come, which may disproportionately affect high-risk populations, such as patients with SMI, with reduced access to technology platforms. In this study, we explored the impact of the pandemic on healthcare utilization and all-cause mortality rate in SMI compared to non-SMI individuals for the months of March-September 2020 and the same two quarters in 2019. METHODS Data were obtained from the VA Corporate Data Warehouse (CDW), a data repository from clinical and administrative VA systems. The sample included veterans with ≥1 outpatient clinical encounter nationally between 1 January 2019 and 31 December 2020. RESULTS The cohort for this study included 1,018,047 veterans receiving care through the Veterans Health Administration between 2019 and 2020. Of those, 339,349 had a diagnosis of SMI. Patients with SMI had a significantly larger pre-post-pandemic decrease in outpatient (49.7%, p < 0.001), inpatient (14.4%, p < 0.001), and ED (14.5%, p < 0.001) visits compared to non-SMI patients. Overall, 3752 (1.59%) veterans without SMI and 4562 (1.93%) veterans with SMI died during our observation period. Veterans without SMI who died during the observation period were more likely to have had a positive COVID-19 test compared to veterans with SMI. Unadjusted analyses showed that veterans with SMI were approximately 2.5 times more likely to die than veterans without SMI during the first 6 months of the pandemic, compared to the same two quarters of the previous year. However, after adjustment by pertinent covariates, the predictors associated with an increased risk of death from SMI were older age, being male, a higher CAN score, more inpatient stays in the pre period compared to post, and a positive COVID-19 test. DISCUSSION Consistent with our initial hypothesis, all the indices of healthcare utilization, namely the number of outpatient, inpatient, and ED visits, significantly decreased between pre- and post-pandemic and did more so for veterans with SMI, despite having more chronic medical illnesses and being prescribed more medications than veterans without SMI. On the other hand, while mortality was greater post-pandemic, factors such as age, morbidity, and having a positive COVID-19 test predicted mortality above and beyond having an SMI diagnosis.
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Affiliation(s)
- Isabella Soreca
- VISN 4 Mental Illness Research, Education and Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, PA 15240, USA
| | - Monique Boudreaux-Kelly
- VISN 4 Mental Illness Research, Education and Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, PA 15240, USA
| | - Yeon-Jung Seo
- Department of Statistics, University of Pittsburgh, Pittsburgh, PA 15213, USA;
| | - Gretchen Haas
- VISN 4 Mental Illness Research, Education and Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, PA 15240, USA
- Department of Psychiatry and Psychology, University of Pittsburgh, Pittsburgh, PA 15213, USA
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Shang H, Chang T, Yang W, Shi L, Hu S, Tian L, Ren J, Wang T, Wang J, Guo J, Cui Y. Analysis of influencing factors on long COVID in COVID-19 patients infected with omicron variant three months after discharge: a cross-sectional study. BMC Infect Dis 2024; 24:36. [PMID: 38166694 PMCID: PMC10763267 DOI: 10.1186/s12879-023-08947-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 12/23/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND The purpose of this study is to analyze the influencing factors associated with Long-COVID in patients infected with Omicron variant of COVID-19 in Changchun City, Jilin Province, China three months after discharge in March 2022. METHODS In this study, we conducted a telephone follow-up based on the real-world data collected from the Affiliated Hospital to Changchun University of Chinese Medicine, Changchun Tongyuan Shelter Hospital and Changchun Infectious Disease Hospital during the COVID-19 epidemic in Changchun in March 2022. We used the Global COVID-19 Clinical Platform Case Report Form for Post COVID condition as a follow-up questionnaire to collect the general information, past medical history, clinical symptoms, COVID-19 vaccine inoculation doses, and other relevant information to analyze the symptom characteristics of COVID-19 patients three months after discharge from the hospital and related factors affecting Long COVID. RESULTS A total of 1,806 patients with COVID-19 were included in this study, 977 males and 829 females, with a mean age of 38.5 [30.0, 49.4] years, and the number of female patients suffering from Long COVID (50.87%) was greater than male patients (p = 0.023). The binary logistic regression analysis of factors influencing Long COVID showed that smoking history (OR (95%CI) = 0.551(0.425-0.714), p < 0.001, taking never smoking as a reference), allergy history (OR (95%CI) = 1.618 (1.086-2.413), p-value 0.018, taking no allergy as a reference), first symptoms (OR (95%CI) = 0.636 (0.501-0.807), p < 0.001, with no first symptoms as reference) and COVID-19 vaccine inoculation doses (OR (95%CI) = 1.517 (1.190-1.933), p-value 0.001, with ≤ 2 doses of COVID-19 vaccine inoculation doses as reference) constituted its influencing factors. The first symptoms of patients on admission mainly included fever (512 cases, 71.81%), cough (279 cases, 39.13%) and dry or itchy throat (211 cases, 29.59%). The most common symptoms of Long COVID were persistent fatigue (68 cases), amnesia (61 cases), insomnia (50 cases) and excessive sweating (50 cases). CONCLUSION The first symptoms on admission were predominantly fever, cough and dry or itchy throat. The most common symptoms of Long COVID were persistent fatigue, amnesia, insomnia and excessive sweating, and female patients were at a higher risk of Long COVID.
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Affiliation(s)
- Hang Shang
- Changchun University of Chinese Medicine, Changchun, China
| | - Tianying Chang
- EBM office, the Affiliated Hospital to Changchun University of Chinese Medicine, Changchun, China
| | - Wei Yang
- EBM office, the Affiliated Hospital to Changchun University of Chinese Medicine, Changchun, China
| | - Li Shi
- Pulmonary Disease Center, the Affiliated Hospital to Changchun University of Chinese Medicine, Changchun, China
| | - Shaodan Hu
- Pulmonary Disease Center, the Affiliated Hospital to Changchun University of Chinese Medicine, Changchun, China
| | - Lin Tian
- Pulmonary Disease Center, the Affiliated Hospital to Changchun University of Chinese Medicine, Changchun, China
| | - Jixiang Ren
- the Affiliated Hospital to Changchun University of Chinese Medicine, Changchun, China
| | - Tan Wang
- Pulmonary Disease Center, the Affiliated Hospital to Changchun University of Chinese Medicine, Changchun, China
| | - Jian Wang
- the Affiliated Hospital to Changchun University of Chinese Medicine, Changchun, China.
| | - Jiajuan Guo
- the Affiliated Hospital to Changchun University of Chinese Medicine, Changchun, China.
| | - Yingzi Cui
- EBM office, the Affiliated Hospital to Changchun University of Chinese Medicine, Changchun, China.
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Sundh J, Palm A, Ljunggren M, Emilsson ÖI, Grote L, Cajander S, Li H, Nyberg F, Ekström M. Risk and outcomes of COVID-19 in patients with oxygen-dependent chronic respiratory failure- a national cohort study. Respir Med 2023; 218:107392. [PMID: 37598894 DOI: 10.1016/j.rmed.2023.107392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 08/01/2023] [Accepted: 08/16/2023] [Indexed: 08/22/2023]
Abstract
BACKGROUND We aimed to evaluate cumulative occurrence and impact of COVID-19 in patients with chronic respiratory failure (CRF) treated with long-term oxygen therapy (LTOT). MATERIAL AND METHODS Data were obtained from the SCIFI-PEARL study on the entire Swedish population and on patients with oxygen-dependent CRF and no COVID-19 diagnosis before start of LTOT. Analyses were performed for three time periods; pre-alpha (Jan-Dec 2020), alpha (Jan-Mar 2021) and delta/omicron (Apr 2021-May 2022). Cumulative incidence of laboratory-verified COVID-19 was compared between patients with CRF and the general population. Risk factors for severe (hospitalised) to critical (intensive care, or death ≤30 days after infection) COVID-19, and the impact of COVID-19 on one-year mortality, were analysed using multivariable Cox regression. RESULTS Cumulative incidence of COVID-19 was higher in patients with CRF than in the general population during the pre-alpha period (6.4%/4.9%, p = 0.002), but less common during the alpha and delta/omicron periods (2.9%/3.8% and 7.8%/15.5%, p < 0.0001 for both). The risk of severe/critical COVID-19 was much higher in CRF patients during all periods (4.9%/0.5%, 3.8%/0.2% and 15.5%/0.5%, p < 0.0001 for all). Risk factors for COVID-19 infection in people with CRF were higher age, cardiovascular and renal disease, and COVID-19 was associated with increased one-year mortality following infection in the pre-alpha (HR 1.79; [95% CI] 1.27-2.53) and alpha periods (1.43; 1.03-1.99). CONCLUSION Patients with CRF had higher risk of severe/critical COVID-19 than the general population. COVID-19 infection was associated with excess one-year mortality.
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Affiliation(s)
- Josefin Sundh
- Department of Respiratory Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
| | - Andreas Palm
- Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden.
| | - Mirjam Ljunggren
- Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden.
| | - Össur Ingi Emilsson
- Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden.
| | - Ludger Grote
- Centre for Sleep and Wakefulness Disorders, Institute of Medicine, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden.
| | - Sara Cajander
- Department of Infectious Diseases, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
| | - Huiqi Li
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - Fredrik Nyberg
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - Magnus Ekström
- Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Respiratory Medicine, Allergology and Palliative Medicine, Lund, Sweden.
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Das-Munshi J, Bakolis I, Bécares L, Dyer J, Hotopf M, Ocloo J, Stewart R, Stuart R, Dregan A. Severe mental illness, race/ethnicity, multimorbidity and mortality following COVID-19 infection: nationally representative cohort study. Br J Psychiatry 2023; 223:518-525. [PMID: 37876350 PMCID: PMC7615273 DOI: 10.1192/bjp.2023.112] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Revised: 07/14/2023] [Accepted: 08/04/2023] [Indexed: 10/26/2023]
Abstract
BACKGROUND The association of COVID-19 with death in people with severe mental illness (SMI), and associations with multimorbidity and ethnicity, are unclear. AIMS To determine all-cause mortality in people with SMI following COVID-19 infection, and assess whether excess mortality is affected by multimorbidity or ethnicity. METHOD This was a retrospective cohort study using primary care data from the Clinical Practice Research Database, from February 2020 to April 2021. Cox proportional hazards regression was used to estimate the effect of SMI on all-cause mortality during the first two waves of the COVID-19 pandemic. RESULTS Among 7146 people with SMI (56% female), there was a higher prevalence of multimorbidity compared with the non-SMI control group (n = 653 024, 55% female). Following COVID-19 infection, the SMI group experienced a greater risk of death compared with controls (adjusted hazard ratio (aHR) 1.53, 95% CI 1.39-1.68). Black Caribbean/Black African people were more likely to die from COVID-19 compared with White people (aHR = 1.22, 95% CI 1.12-1.34), with similar associations in the SMI group and non-SMI group (P for interaction = 0.73). Following infection with COVID-19, for every additional multimorbidity condition, the aHR for death was 1.06 (95% CI 1.01-1.10) in the SMI stratum and 1.16 (95% CI 1.15-1.17) in the non-SMI stratum (P for interaction = 0.001). CONCLUSIONS Following COVID-19 infection, patients with SMI were at an elevated risk of death, further magnified by multimorbidity. Black Caribbean/Black African people had a higher risk of death from COVID-19 than White people, and this inequity was similar for the SMI group and the control group.
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Affiliation(s)
- Jayati Das-Munshi
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; Centre for Society and Mental Health, King's College London, UK; and South London & Maudsley NHS Trust, London, UK
| | - Ioannis Bakolis
- Centre for Implementation Sciences, Department of Health Services and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Laia Bécares
- Department of Global Health and Social Medicine, King's College London, UK
| | | | - Matthew Hotopf
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; and South London & Maudsley NHS Trust, London, UK
| | - Josephine Ocloo
- Centre for Implementation Sciences, Department of Health Services and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Robert Stewart
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; and South London & Maudsley NHS Trust, London, UK
| | - Ruth Stuart
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; and South London & Maudsley NHS Trust, London, UK
| | - Alex Dregan
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
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Kawai K, Tachimori H, Yamamoto Y, Nakatani Y, Iwasaki S, Sekiguchi A, Kim Y, Tamura N. Trends in the effect of COVID-19 on consultations for persons with clinical and subclinical eating disorders. Biopsychosoc Med 2023; 17:29. [PMID: 37559073 PMCID: PMC10410894 DOI: 10.1186/s13030-023-00285-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 07/28/2023] [Indexed: 08/11/2023] Open
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic has increased the risk of individuals developing eating disorders and has exacerbated existing eating disorders. This observational study investigated the impact of the COVID-19 pandemic on patients with clinical and subclinical eating disorders. METHODS This study was conducted over a period of four years: two years before and after the onset of the COVID-19 pandemic in Japan. We recorded the number and types of consultations provided by the Eating Disorder Treatment and Support Center coordinator. For subgroup analysis, data were classified by age, body mass index, and source of consultation, including patients, families, and personnel. The Seasonal Decomposition of Time Series by Loess was used for time series analysis. RESULTS The total number of consultations increased after the start of the pandemic and peaked around the beginning of 2022, before subsequently falling despite the increase in the number of COVID-19 infections. A similar trend was observed in patients aged 10-29 years. The study period coincided with social isolation and school/college/university closures. CONCLUSIONS The number of eating disorder consultations increased after the start of the pandemic. Although COVID-19 infections persisted, the pandemic's impact was transient.
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Affiliation(s)
- Keisuke Kawai
- Department of Psychosomatic Medicine Kohnodai Hospital, National Center for Global Health Medicine, 1-7-1, Kohnodai, Ichikawa City, 272-8516, Chiba, Japan.
- Chiba Prefecture Support Center for Eating Disorders, Ichikawa, Chiba, Japan.
| | - Hisateru Tachimori
- Endowed Course for Health System Innovation, Keio University School of Medicine, Tokyo, Japan
- Department of Clinical Epidemiology, Translational Medical Center, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Yurie Yamamoto
- Chiba Prefecture Support Center for Eating Disorders, Ichikawa, Chiba, Japan
- Department of Pharmacy, Kohnodai Hospital, National Center for Global Health Medicine, Ichikawa, Chiba, Japan
| | - Yuki Nakatani
- Department of Psychosomatic Medicine Kohnodai Hospital, National Center for Global Health Medicine, 1-7-1, Kohnodai, Ichikawa City, 272-8516, Chiba, Japan
| | - Shinmi Iwasaki
- Chiba Prefecture Support Center for Eating Disorders, Ichikawa, Chiba, Japan
| | - Atsushi Sekiguchi
- National Center of Neurology and Psychiatry, Institute of Mental Health, Tokyo, Japan
| | - Yoshiharu Kim
- National Center of Neurology and Psychiatry, Institute of Mental Health, Tokyo, Japan
| | - Naho Tamura
- Department of Psychosomatic Medicine Kohnodai Hospital, National Center for Global Health Medicine, 1-7-1, Kohnodai, Ichikawa City, 272-8516, Chiba, Japan
- Chiba Prefecture Support Center for Eating Disorders, Ichikawa, Chiba, Japan
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Boschesi Barros V, Fortti Vianna Schmidt F, Chiavegatto Filho ADP. Mortality, survival, and causes of death in mental disorders: comprehensive prospective analyses of the UK Biobank cohort. Psychol Med 2023; 53:3480-3489. [PMID: 35513912 DOI: 10.1017/s0033291722000034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND The UK Biobank is a large middle-aged cohort recruited in 2006-2010. We used data from its participants to analyze mortality, survival, and causes of death associated with mental disorders. METHODS Our exposures were mental disorders identified using (1) symptom-based outcomes derived from an online Mental Health Questionnaire (n = 157 329), including lifetime/current depression, lifetime/current generalized anxiety disorder, lifetime/recent psychotic experience, lifetime bipolar disorder, current alcohol use disorder, and current posttraumatic stress disorder and (2) hospital data linkage of diagnoses within the International Classification of Diseases, 10th revision (ICD-10) (n = 502 422), including (A) selected diagnoses or groups of diagnoses corresponding to symptom-based outcomes and (B) all psychiatric diagnoses, grouped by ICD-10 section. For all exposures, we estimated age-adjusted mortality rates and hazard ratios, as well as proportions of deaths by cause. RESULTS We found significantly increased mortality risk associated with all mental disorders identified by symptom-based outcomes, except for lifetime generalized anxiety disorder (with hazard ratios in the range of 1.08-3.0). We also found significantly increased mortality risk associated with all conditions identified by hospital data linkage, including selected ICD-10 diagnoses or groups of diagnoses (2.15-7.87) and ICD-10 diagnoses grouped by section (2.02-5.44). Causes of death associated with mental disorders were heterogeneous and mostly natural. CONCLUSIONS In a middle-aged cohort, we found a higher mortality risk associated with most mental disorders identified by symptom-based outcomes and with all disorders or groups of disorders identified by hospital data linkage of ICD-10 diagnoses. The majority of deaths associated with mental disorders were natural.
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Affiliation(s)
- Vivian Boschesi Barros
- Department of Epidemiology, School of Public Health, University of São Paulo, São Paulo, Brazil
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Hassan L, Sawyer C, Peek N, Lovell K, Carvalho AF, Solmi M, Tilston G, Sperrin M, Firth J. Heightened COVID-19 Mortality in People With Severe Mental Illness Persists After Vaccination: A Cohort Study of Greater Manchester Residents. Schizophr Bull 2023; 49:275-284. [PMID: 36029257 PMCID: PMC9452124 DOI: 10.1093/schbul/sbac118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND HYPOTHESIS Previous studies show that people with severe mental illness (SMI) are at higher risk of COVID-19 mortality, however limited evidence exists regarding risk postvaccination. We investigated COVID-19 mortality among people with schizophrenia and other SMIs before, during and after the UK vaccine roll-out. STUDY DESIGN Using the Greater Manchester (GM) Care Record to access routinely collected health data linked with death records, we plotted COVID-19 mortality rates over time in GM residents with schizophrenia/psychosis, bipolar disorder (BD), and/or recurrent major depressive disorder (MDD) from February 2020 to September 2021. Multivariable logistic regression was used to compare mortality risk (risk ratios; RRs) between people with SMI (N = 193 435) and age-sex matched controls (N = 773 734), adjusted for sociodemographic factors, preexisting comorbidities, and vaccination status. STUDY RESULTS Mortality risks were significantly higher among people with SMI compared with matched controls, particularly among people with schizophrenia/psychosis (RR 3.18, CI 2.94-3.44) and/or BD (RR 2.69, CI 2.16-3.34). In adjusted models, the relative risk of COVID-19 mortality decreased, though remained significantly higher than matched controls for people with schizophrenia (RR 1.61, CI 1.45-1.79) and BD (RR 1.92, CI 1.47-2.50), but not recurrent MDD (RR 1.08, CI 0.99-1.17). People with SMI continued to show higher mortality rate ratios relative to controls throughout 2021, during vaccination roll-out. CONCLUSIONS People with SMI, notably schizophrenia and BD, were at greater risk of COVID-19 mortality compared to matched controls. Despite population vaccination efforts that have prioritized people with SMI, disparities still remain in COVID-19 mortality for people with SMI.
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Affiliation(s)
- Lamiece Hassan
- To whom correspondence should be addressed; Jean McFarlane Building, Division of Psychology and Mental Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, M13 9PL, UK; tel: +44 (0) 161 306 6000, e-mail:
| | - Chelsea Sawyer
- Division of Psychology and Mental Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, M13 9PL, UK
| | - Niels Peek
- Centre for Health Informatics, Division of Informatics, Imaging and Data Sciences, The University of Manchester, M13 9PL, UK
- NIHR Greater Manchester Patient Safety Translational Research Centre, The University of Manchester, Manchester, UK
- Manchester Academic Health Science Centre, National Institute for Health Research Manchester Biomedical Research Centre, The University of Manchester, Manchester, M13 9PL, UK
| | - Karina Lovell
- Division of Nursing, Midwifery and Social Work, University of Manchester, Manchester Academic Health Science Centre, Manchester, M13 9PL, UK
| | - Andre F Carvalho
- IMPACT (Innovation in Mental and Physical Health and Clinical Treatment) Strategic Research Centre, School of Medicine, Barwon Health, Deakin University, Geelong, Victoria, Australia
| | - Marco Solmi
- Psychiatry Department, University of Ottawa, Ottawa, ON, Canada
- The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute (OHRI), University of Ottawa, Ottawa, ON, Canada
| | - George Tilston
- Centre for Health Informatics, Division of Informatics, Imaging and Data Sciences, The University of Manchester, M13 9PL, UK
- Manchester Academic Health Science Centre, National Institute for Health Research Manchester Biomedical Research Centre, The University of Manchester, Manchester, M13 9PL, UK
| | - Matthew Sperrin
- Centre for Health Informatics, Division of Informatics, Imaging and Data Sciences, The University of Manchester, M13 9PL, UK
| | - Joseph Firth
- Division of Psychology and Mental Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, M13 9PL, UK
- Greater Manchester Mental Health NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, M13 9PL, UK
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10
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Shakeshaft A, Blakey R, Kwong ASF, Riglin L, Davey Smith G, Stergiakouli E, Tilling K, Thapar A. Mental-health before and during the COVID-19 pandemic in adults with neurodevelopmental disorders. J Psychiatr Res 2023; 159:230-239. [PMID: 36753897 PMCID: PMC9885110 DOI: 10.1016/j.jpsychires.2023.01.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 01/11/2023] [Accepted: 01/26/2023] [Indexed: 01/31/2023]
Abstract
The COVID-19 pandemic negatively impacted mental health globally. Individuals with neurodevelopmental disorders (NDDs), including autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD), are at elevated risk of mental health difficulties. We investigated the impact of the pandemic on anxiety, depression and mental wellbeing in adults with NDDs using data from the Avon Longitudinal Study of Parents and Children (n = 3058). Mental health data were collected pre-pandemic (age 21-25) and at three timepoints during the pandemic (ages 27-28) using the Short Mood and Feelings Questionnaire, Generalized Anxiety Disorder Assessment-7, and Warwick Edinburgh Mental Wellbeing Scale. ADHD and ASD were defined using validated cut-points of the Strengths and Difficulties Questionnaire and Autism Spectrum Quotient, self-reported at age 25. We used multi-level mixed-effects models to investigate changes in mental health in those with elevated ADHD/ASD traits compared to those without. Prevalences of depression, anxiety and poor mental wellbeing were higher at all timepoints (pre-pandemic and during pandemic) in those with ADHD and ASD compared to those without. Anxiety increased to a greater extent in those with ADHD (β = 0.8 [0.2,1.4], p = 0.01) and ASD (β = 1.2 [-0.1,2.5], p = 0.07), while depression symptoms decreased, particularly in females with ASD (β = -3.1 [-4.6,-1.5], p = 0.0001). On average, mental wellbeing decreased in all, but to a lesser extent in those with ADHD (β = 1.3 [0.2,2.5], p = 0.03) and females with ASD (β = 3.0 [0.2,5.9], p = 0.04). To conclude, anxiety disproportionately increased in adults with NDDs during the pandemic, however, the related lockdowns may have provided a protective environment for depressive symptoms in the same individuals.
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Affiliation(s)
- Amy Shakeshaft
- Division of Psychological Medicine and Clinical Neurosciences, Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, UK; Wolfson Centre for Young People's Mental Health, Cardiff University, UK
| | - Rachel Blakey
- Population Health Sciences and MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
| | - Alex S F Kwong
- Population Health Sciences and MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK; Division of Psychiatry, University of Edinburgh, UK
| | - Lucy Riglin
- Division of Psychological Medicine and Clinical Neurosciences, Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, UK; Wolfson Centre for Young People's Mental Health, Cardiff University, UK
| | - George Davey Smith
- Population Health Sciences and MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
| | - Evie Stergiakouli
- Population Health Sciences and MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
| | - Kate Tilling
- Population Health Sciences and MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
| | - Anita Thapar
- Division of Psychological Medicine and Clinical Neurosciences, Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, UK; Wolfson Centre for Young People's Mental Health, Cardiff University, UK.
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11
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Xu H, Li S, Mehta HB, Hommel EL, Goodwin JS. Excess deaths from COVID-19 among Medicare beneficiaries with psychiatric diagnoses: Community versus nursing home. J Am Geriatr Soc 2023; 71:167-177. [PMID: 36137264 PMCID: PMC9537955 DOI: 10.1111/jgs.18062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 08/31/2022] [Accepted: 09/05/2022] [Indexed: 01/26/2023]
Abstract
BACKGROUND Psychiatric illness may pose an additional risk of death for older adults during the COVID-19 pandemic. Older adults in the community versus institutions might be influenced by the pandemic differently. This study examines excess deaths during the COVID-19 pandemic among Medicare beneficiaries with and without psychiatric diagnoses (depression, anxiety, bipolar disorder, and schizophrenia) in the community versus nursing homes. METHODS This is a retrospective cohort study of a 20% random sample of 15,229,713 fee-for-service Medicare beneficiaries, from January 2019 through December 2021. Unadjusted monthly mortality risks, COVID-19 infection rates, and case-fatality rates after COVID-19 diagnosis were calculated. Excess deaths in 2020, compared to 2019 were estimated from multivariable logistic regressions. RESULTS Of all included Medicare beneficiaries in 2020 (N = 5,140,619), 28.9% had a psychiatric diagnosis; 1.7% lived in nursing homes. In 2020, there were 246,422 observed deaths, compared to 215,264 expected, representing a 14.5% increase over expected. Patients with psychiatric diagnoses had more excess deaths than those without psychiatric diagnoses (1,107 vs. 403 excess deaths per 100,000 beneficiaries, p < 0.01). The largest increases in mortality risks were observed among patients with schizophrenia (32.4% increase) and bipolar disorder (25.4% increase). The pandemic-associated increase in deaths with psychiatric diagnoses was only found in the community, not in nursing homes. The increased mortality for patients with psychiatric diagnoses was limited to those with medical comorbidities. The increase in mortality for psychiatric diagnoses was associated with higher COVID-19 infection rates (1-year infection rate = 7.9% vs. 4.2% in 2020), rather than excess case fatality. CONCLUSIONS Excess deaths during the COVID-19 pandemic were disproportionally greater in beneficiaries with psychiatric diagnoses, at least in part due to higher infection rates. Policy interventions should focus on preventing COVID-19 infections and deaths among community-dwelling patients with major psychiatric disorders in addition to those living the nursing homes.
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Affiliation(s)
- Huiwen Xu
- School of Public and Population Health, University of Texas Medical Branch, Galveston, TX;,Sealy Center on Aging, University of Texas Medical Branch, Galveston, TX;,Corresponding author: Huiwen Xu, PhD, School of Public and Population Health and Sealy Center on Aging, University of Texas Medical Branch. 301 University Blvd., Galveston, TX 77555-1150. Phone: +1 409-772-5899; ; Twitter handle: @Dr_HuiwenXu
| | - Shuang Li
- Sealy Center on Aging, University of Texas Medical Branch, Galveston, TX
| | - Hemalkumar B. Mehta
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Erin L. Hommel
- Sealy Center on Aging, University of Texas Medical Branch, Galveston, TX;,Department of Medicine, University of Texas Medical Branch, Galveston, TX
| | - James S. Goodwin
- Sealy Center on Aging, University of Texas Medical Branch, Galveston, TX;,Department of Medicine, University of Texas Medical Branch, Galveston, TX
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12
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Harrison L, Carducci B, Klein JD, Bhutta ZA. Indirect effects of COVID-19 on child and adolescent mental health: an overview of systematic reviews. BMJ Glob Health 2022; 7:bmjgh-2022-010713. [PMID: 36585030 PMCID: PMC9808753 DOI: 10.1136/bmjgh-2022-010713] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 11/07/2022] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION To control the spread of COVID-19, mitigation strategies have been implemented globally, which may have unintended harmful effects on child and adolescent mental health. This study aims to synthesise the indirect mental health impacts on children and adolescents globally due to COVID-19 mitigation strategies. METHODS We included relevant reviews from MEDLINE, Embase, PsycINFO, LILACS, CINAHL, The Cochrane Library and Web of Science until January 2022 that examined the impact of COVID-19-related lockdown and stay-at-home measures on the mental health of children and adolescents. Data extraction and quality assessments were completed independently and in duplicate by BC and LH. A Measurement Tool to Assess Systematic Reviews-2 was used to assess the methodological quality. RESULTS Eighteen systematic reviews, comprising 366 primary studies, found a pooled prevalence of 32% for depression (95% CI: 27 to 38, n=161 673) and 32% for anxiety (95% CI: 27 to 37, n=143 928) in children and adolescents globally following COVID-19 mitigation measures. Subgroup analyses also uncovered important differences for both depression and anxiety by World Health Organization regions with few studies from Africa and relative high burden of anxiety and depression in the Eastern Mediterranean region. CONCLUSIONS Our findings reveal a high prevalence of depression and anxiety in children and adolescents during the COVID-19 pandemic, globally, compared with prepandemic estimates. These findings highlight the urgency for governments and policymakers to strengthen mental health systems in the COVID-19 recovery, especially in low-and middle-income countries where compounding psychological stress, access and affordability of care and discrepant reporting of mental health in this population remains a challenge. We also provide insight into how to alter mitigation strategies to reduce the unintended negative consequences for the health and well-being of children and adolescents in future pandemics. PROSPERO REGISTRATION NUMBER CRD42022309348.
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Affiliation(s)
- Leila Harrison
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Bianca Carducci
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada,Department of Nutritional Sciences, University of Toronto Temerty Faculty of Medicine, Toronto, Ontario, Canada
| | - Jonathan D Klein
- Pediatrics, University of Illinois Chicago, Chicago, Illinois, USA
| | - Zulfiqar Ahmed Bhutta
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada,Department of Nutritional Sciences, University of Toronto Temerty Faculty of Medicine, Toronto, Ontario, Canada,Center of Excellence in Women and Child Health, Aga Khan University, Karachi, Pakistan
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13
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Significant regional inequalities in the prevalence of intellectual disability and trends from 1990 to 2019: a systematic analysis of GBD 2019. Epidemiol Psychiatr Sci 2022; 31:e91. [PMID: 36539341 PMCID: PMC9805697 DOI: 10.1017/s2045796022000701] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
AIMS Policymakers and researchers have little evidence on prevalence rates of intellectual disability (ID) or their changes over time to tailor healthcare interventions. Prevalence rates and trends of ID are especially lacking in regions with lower socio-demographic development. Additionally, the assessment of inequalities in the prevalence of ID across regions with varying socio-demographic development is understudied. This study assessed variations in prevalence rates of ID from 1990 to 2019 and the related inequalities between low and high socio-demographic index (SDI) regions. METHODS This study used global data from 1990 to 2019 for individuals with ID from the 2019 Global Burden of Diseases study. Data analyses were performed from September 2021 to January 2022. Prevalence for individuals with ID was extracted by sex, age groups and SDI regions. Annual percentage change (APC) was estimated for each demographic group within SDI regions to assess their prevalence trends over 30 years. Relative and absolute inequalities were calculated between low and high SDI regions for the various age groups. RESULTS In 2019, there were 107.62 million (1.74%) individuals with ID, with an APC of -0.80 (-0.88 to -0.72). There was a slightly higher prevalence among males (1.42%) than females (1.37%). The highest prevalence rates were found in the low-middle SDI regions (2.42%) and the lowest prevalence rates were in the high SDI regions (0.33%). There was a large reduction in the prevalence rate between the youngest age group v. the oldest age group in all the SDI regions and at all time points. The relative inequalities between low and high SDI regions increased over three decades. CONCLUSIONS While an overall decrease in global prevalence rate for ID was found, relative inequalities continue to increase with lower SDI regions needing more comprehensive support services. The demographic trends indicate a significantly higher mortality rate among those with ID v. the rest of the population. Our study highlights the necessity for policies and interventions targeting lower SDI regions to mobilise resources that better support individuals with ID and achieve sustainable development goals proposed by the United Nations.
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Impara E, Bakolis I, Bécares L, Dasch H, Dregan A, Dyer J, Hotopf M, Stewart RJ, Stuart R, Ocloo J, Das-Munshi J. COVID-19 ethnic inequalities in mental health and multimorbidities: protocol for the COVEIMM study. Soc Psychiatry Psychiatr Epidemiol 2022; 57:2511-2521. [PMID: 35737082 PMCID: PMC9219393 DOI: 10.1007/s00127-022-02305-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 05/05/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE The COVID-19 pandemic may have exacerbated ethnic health inequalities, particularly in people with multiple long-term health conditions, the interplay with mental health is unclear. This study investigates the impact of the pandemic on the association of ethnicity and multimorbidity with mortality/service use among adults, in people living with severe mental illnesses (SMI). METHODS This study will utilise secondary mental healthcare records via the Clinical Record Interactive Search (CRIS) and nationally representative primary care records through the Clinical Practice Interactive Research Database (CPRD). Quasi-experimental designs will be employed to quantify the impact of COVID-19 on mental health service use and excess mortality by ethnicity, in people living with severe mental health conditions. Up to 50 qualitative interviews will also be conducted, co-produced with peer researchers; findings will be synthesised with quantitative insights to provide in-depth understanding of observed associations. RESULTS 81,483 people in CRIS with schizophrenia spectrum, bipolar or affective disorder diagnoses, were alive from 1st January 2019. Psychiatric multimorbidities in the CRIS sample were comorbid somatoform disorders (30%), substance use disorders (14%) and personality disorders (12%). In CPRD, of 678,842 individuals with a prior probable diagnosis of COVID-19, 1.1% (N = 7493) had an SMI diagnosis. People in the SMI group were more likely to die (9% versus 2% in the non-SMI sample) and were more likely to have mental and physical multimorbidities. CONCLUSION The effect of COVID-19 on people from minority ethnic backgrounds with SMI and multimorbidities remains under-studied. The present mixed methods study aims to address this gap.
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Affiliation(s)
- E Impara
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK
| | - I Bakolis
- Centre for Implementation Science, Health Services, Population and Research Department, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | | | - H Dasch
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK
| | - A Dregan
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK
| | - J Dyer
- Black Thrive Global, NHS-E/I, London, UK
| | - M Hotopf
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - R J Stewart
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - R Stuart
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK
| | - J Ocloo
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK
- Centre for Implementation Science, Health Services, Population and Research Department, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK
- National Institute for Health Research (NIHR) Applied Research Collaboration South London (NIHR ARC South London) At King's College Hospital NHS Foundation Trust, London, UK
| | - J Das-Munshi
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK.
- South London and Maudsley NHS Foundation Trust, London, UK.
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15
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Axenhus M, Frederiksen KS, Zhou RZ, Waldemar G, Winblad B. The impact of the COVID-19 pandemic on mortality in people with dementia without COVID-19: a systematic review and meta-analysis. BMC Geriatr 2022; 22:878. [PMCID: PMC9675075 DOI: 10.1186/s12877-022-03602-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 11/08/2022] [Indexed: 11/21/2022] Open
Abstract
Introduction Significant mortality amongst vulnerable populations, such as people living with dementia, might go undetected during pandemic conditions due to refocus of care efforts. There is an urgent need to fully evaluate the pandemic impact on mortality amongst people living with dementia in order to facilitate future healthcare reforms and prevent deaths. The purpose of this study was to determine whether there was any significant difference in mortality amongst people with dementia without COVID-19 during the COVID-19 pandemic compared to previous years. Methods A literature search was conducted in 5 databases. The relative risk ratio and confidence interval was used to estimate the change in mortality rates amongst people with dementia during the COVID-19 pandemic. The I2 value was used to assess heterogeneity, publication bias, and sensitivity analyses were performed. Results Pooled analysis of 11 studies showed that mortality amongst people living with dementia was significantly increased during the COVID-19 pandemic for people with dementia without COVID-19. Mortality risk increased by 25% during the time period studied. Subgroup analysis was not performed due the low number of included studies. Conclusions The results of this study suggest that people with dementia had a significant increased mortality during the pandemic even if they did not have COVID-19. People with dementia should participate in efforts that reduce general social spread and pandemic impact on healthcare system such as vaccinations, mask mandates, and testing. These results have clinical implications as preventing direct COVID-19 infection is not enough to adequately protect people living with dementia from increased mortality. Measures to limit social spread of infections and help support patients should also be a focus for clinicians. Further research should focus on the identification of mechanisms and other explanations for increased mortality as well as contributing factors such as living in care homes and differences between countries with various pandemic strategies. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-03602-6.
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Affiliation(s)
- Michael Axenhus
- grid.465198.7Division of Neurogeriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Solna, Sweden ,grid.24381.3c0000 0000 9241 5705Theme Inflammation and Aging, Karolinska University hospital, Huddinge, Sweden
| | - Kristian Steen Frederiksen
- grid.5254.60000 0001 0674 042XDanish Dementia Research Centre, Department of Neurology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Robin Ziyue Zhou
- grid.465198.7Division of Neurogeriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Solna, Sweden
| | - Gunhild Waldemar
- grid.5254.60000 0001 0674 042XDanish Dementia Research Centre, Department of Neurology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark ,grid.5254.60000 0001 0674 042XDept. of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Bengt Winblad
- grid.465198.7Division of Neurogeriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Solna, Sweden ,grid.24381.3c0000 0000 9241 5705Theme Inflammation and Aging, Karolinska University hospital, Huddinge, Sweden
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Brown C, Cook JA, Jonikas JA, Steigman PJ, Burke-Miller J, Hamilton MM, Rosen C, Tessman DC, Santos A. Nutrition and Exercise for Wellness and Recovery: A Randomized Controlled Trial of a Community-Based Health Intervention. Psychiatr Serv 2022; 74:463-471. [PMID: 36377367 DOI: 10.1176/appi.ps.202200038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The purpose of this study was to examine the efficacy of the Nutrition and Exercise for Wellness and Recovery (NEW-R) intervention for improving competency and behaviors related to diet, physical activity, and weight management. METHODS Participants with psychiatric disabilities were recruited from four community mental health agencies and a hospital-based psychiatric outpatient clinic and randomly assigned to the NEW-R intervention (N=55) or control condition (N=58). Outcome measures included the Perceived Competence Scale, Health-Promoting Lifestyle Profile (HPLP), and weight change; random-effects regression models were used. A follow-up analysis examined the interactions of group, time, and site. RESULTS Fifty of the 55 intervention participants and 57 of the 58 control participants completed the study. The two groups did not differ significantly on any measured baseline characteristic. The intervention group had statistically significant improvements, compared with the control group, in perceived competence for exercise and healthy eating, total HPLP score, and scores on two HPLP subscales (nutrition and spiritual growth). No significant difference between groups was found for weight loss. A study condition × time × site effect was observed: at the three sites where mean weight loss occurred, NEW-R participants lost significantly more weight than did control participants. CONCLUSIONS NEW-R offers promise as an intervention that can initiate the change to healthy lifestyle behaviors and boost perceived competence in a healthy lifestyle. It may also be effective for weight loss when administered in supportive settings.
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Affiliation(s)
- Catana Brown
- Department of Occupational Therapy, College of Health Sciences, Midwestern University, Glendale, Arizona (Brown); Department of Psychiatry, College of Medicine, University of Illinois at Chicago, Chicago (Cook, Jonikas, Steigman, Burke-Miller, Hamilton, Rosen); independent practice, Chicago (Tessman); Department of Psychiatry, DePaul Community Health Centers of New Orleans, New Orleans (Santos)
| | - Judith A Cook
- Department of Occupational Therapy, College of Health Sciences, Midwestern University, Glendale, Arizona (Brown); Department of Psychiatry, College of Medicine, University of Illinois at Chicago, Chicago (Cook, Jonikas, Steigman, Burke-Miller, Hamilton, Rosen); independent practice, Chicago (Tessman); Department of Psychiatry, DePaul Community Health Centers of New Orleans, New Orleans (Santos)
| | - Jessica A Jonikas
- Department of Occupational Therapy, College of Health Sciences, Midwestern University, Glendale, Arizona (Brown); Department of Psychiatry, College of Medicine, University of Illinois at Chicago, Chicago (Cook, Jonikas, Steigman, Burke-Miller, Hamilton, Rosen); independent practice, Chicago (Tessman); Department of Psychiatry, DePaul Community Health Centers of New Orleans, New Orleans (Santos)
| | - Pamela J Steigman
- Department of Occupational Therapy, College of Health Sciences, Midwestern University, Glendale, Arizona (Brown); Department of Psychiatry, College of Medicine, University of Illinois at Chicago, Chicago (Cook, Jonikas, Steigman, Burke-Miller, Hamilton, Rosen); independent practice, Chicago (Tessman); Department of Psychiatry, DePaul Community Health Centers of New Orleans, New Orleans (Santos)
| | - Jane Burke-Miller
- Department of Occupational Therapy, College of Health Sciences, Midwestern University, Glendale, Arizona (Brown); Department of Psychiatry, College of Medicine, University of Illinois at Chicago, Chicago (Cook, Jonikas, Steigman, Burke-Miller, Hamilton, Rosen); independent practice, Chicago (Tessman); Department of Psychiatry, DePaul Community Health Centers of New Orleans, New Orleans (Santos)
| | - Marie M Hamilton
- Department of Occupational Therapy, College of Health Sciences, Midwestern University, Glendale, Arizona (Brown); Department of Psychiatry, College of Medicine, University of Illinois at Chicago, Chicago (Cook, Jonikas, Steigman, Burke-Miller, Hamilton, Rosen); independent practice, Chicago (Tessman); Department of Psychiatry, DePaul Community Health Centers of New Orleans, New Orleans (Santos)
| | - Cherise Rosen
- Department of Occupational Therapy, College of Health Sciences, Midwestern University, Glendale, Arizona (Brown); Department of Psychiatry, College of Medicine, University of Illinois at Chicago, Chicago (Cook, Jonikas, Steigman, Burke-Miller, Hamilton, Rosen); independent practice, Chicago (Tessman); Department of Psychiatry, DePaul Community Health Centers of New Orleans, New Orleans (Santos)
| | - Dorothy Clare Tessman
- Department of Occupational Therapy, College of Health Sciences, Midwestern University, Glendale, Arizona (Brown); Department of Psychiatry, College of Medicine, University of Illinois at Chicago, Chicago (Cook, Jonikas, Steigman, Burke-Miller, Hamilton, Rosen); independent practice, Chicago (Tessman); Department of Psychiatry, DePaul Community Health Centers of New Orleans, New Orleans (Santos)
| | - Alberto Santos
- Department of Occupational Therapy, College of Health Sciences, Midwestern University, Glendale, Arizona (Brown); Department of Psychiatry, College of Medicine, University of Illinois at Chicago, Chicago (Cook, Jonikas, Steigman, Burke-Miller, Hamilton, Rosen); independent practice, Chicago (Tessman); Department of Psychiatry, DePaul Community Health Centers of New Orleans, New Orleans (Santos)
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Pearce E, Kamenov K, Barrett D, Cieza A. Promoting equity in health emergencies through health systems strengthening: lessons learned from disability inclusion in the COVID-19 pandemic. Int J Equity Health 2022; 21:149. [PMID: 36284335 PMCID: PMC9593996 DOI: 10.1186/s12939-022-01766-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Discriminatory health systems and inequalities in service provision inevitably create barriers for certain populations in a health emergency. Persons with disabilities have been disproportionately affected by the COVID-19 pandemic. They commonly experience three increased risks - of contracting the disease, of severe disease or death, and of new or worsening health conditions. These added risks occur due to a range of barriers in the health sector, including physical barriers that prevent access to health facilities and specific interventions; informational barriers that prevent access to health information and/or reduce health literacy; and attitudinal barriers which give rise to stigma and exclusion, all of which add to discrimination and inequality. Furthermore, national health emergency preparedness and planning may fail to consider the needs and priorities of persons with disabilities, in all their diversity, thus leaving them behind in responses. This commentary discusses the importance of inclusive health systems strengthening as a prerequisite for accessible and comprehensive health emergency preparedness and response plans that reach everyone. Lessons learned relating to disability inclusion in the COVID-19 pandemic can inform health systems strengthening in recovery efforts, addressing underlying barriers to access and inclusion, and in turn improving preparedness for future health emergencies.
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Affiliation(s)
- Emma Pearce
- grid.3575.40000000121633745Sensory Functions, Disability & Rehabilitation Unit, World Health Organization, Geneva, Switzerland
| | - Kaloyan Kamenov
- Sensory Functions, Disability & Rehabilitation Unit, World Health Organization, Geneva, Switzerland.
| | - Darryl Barrett
- grid.3575.40000000121633745Sensory Functions, Disability & Rehabilitation Unit, World Health Organization, Geneva, Switzerland
| | - Alarcos Cieza
- grid.3575.40000000121633745Sensory Functions, Disability & Rehabilitation Unit, World Health Organization, Geneva, Switzerland
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18
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Incidence, Hospitalization, Mortality and Risk Factors of COVID-19 in Long-Term Care Residential Homes for Patients with Chronic Mental Illness. EPIDEMIOLGIA (BASEL, SWITZERLAND) 2022; 3:391-401. [PMID: 36417246 PMCID: PMC9620926 DOI: 10.3390/epidemiologia3030030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 08/19/2022] [Accepted: 09/02/2022] [Indexed: 12/14/2022]
Abstract
Long-term care residential homes (LTCRH) for patients with chronic mental illness have suffered the enormous impact of COVID-19. This study aimed to estimate incidence, hospitalization, mortality, and risk factors of COVID-19 to prevent future epidemics. From March 2020 to January 2021 and before vaccination anti-SARS-CoV-2 begins, cumulate incidence rate (CIR), hospitalization rate (HR), mortality rate (MR), and risk factors of COVID-19 in the 11 LTCRH of two Health Departments of Castellon (Spain) were studied by epidemiological surveillance and an ecological design. Laboratory tests confirmed COVID-19 cases, and multilevel Poisson regression models were employed. All LTCRH participated and comprised 346 residents and 482 staff. Residents had a mean age of 47 years, 40% women, and suffered 75 cases of COVID-19 (CIR = 21.7%), five hospitalizations (HR = 1.4%), and two deaths (MR = 0.6%) with 2.5% fatality-case. Staff suffered 74 cases of the disease (CIR = 15.4%), one hospitalization (HR = 0.2%), and no deaths were reported. Risk factors associated with COVID-19 incidence in residents were private ownership, severe disability, residents be younger, CIR in municipalities where LTCRH was located, CIR in staff, and older age of the facilities. Conclusion: COVID-19 incidence could be prevented by improving infection control in residents and staff and modernizing facilities with increased public ownership.
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Smith EN, Gee S, O'Brien G, Vicente PA, Griffith R, Patel R, Stapleton J, Finch E, Shah N, Gaughran F, Taylor D, Strang J, Kalk NJ. Golden opportunity for intervention? Identifying vitamin D deficiency in patients with substance use disorders in hospital. BMJ Open Qual 2022; 11:bmjoq-2021-001484. [PMID: 35165098 PMCID: PMC8845314 DOI: 10.1136/bmjoq-2021-001484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 11/20/2021] [Indexed: 11/11/2022] Open
Abstract
Setting Based at a busy city hospital, the alcohol care team is a drug and alcohol specialist service, taking referrals for a wide range of patients with substance use disorders (SUD). Objectives Patients with SUD are at high risk of vitamin D deficiency; this relates to frequent fractures and proximal myopathy. The coronavirus pandemic brought vitamin D into focus. Local guidelines advise that patients at high risk of vitamin D deficiency are offered replacement. There were no local data on vitamin D deficiency prevalence or any mention of patients with SUD in local vitamin D guidelines. The main aim of this project was to offer vitamin D checks and replacement to all appropriate patients. Results We collected data on 207 patients, [pilot study (n=50) and two subsequent samples (n=95 and n=62)]. Our pilot study showed that no patients were offered vitamin D testing or replacement. We then offered vitamin D checks to 95 patients. Most had low vitamin D (30 patients were vitamin D deficient and 26 were vitamin D insufficient). We provided vitamin D replacement and follow-up advice. Quality improvement was demonstrated 6 months later. We collected data on a further 62 patients who were all on our current or recent caseload. Following exclusions, nearly half (48%) of patients had had a vitamin D check. Almost all of these (95%) had low vitamin D (60% being classified as deficient). Conclusions Patients had not been offered vitamin D replacement despite often having multiple risk factors for vitamin D deficiency. Vitamin D checks (and subsequent replacement) rose in frequency since the outset of this project. Local guidelines should add SUD as a risk factor for vitamin D deficiency. Hospital admission provides a rich opportunity to offer this simple intervention to patients who are often poorly engaged with community services.
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Affiliation(s)
- E Naomi Smith
- Alcohol Care Team, Department of Psychological Medicine, Cheyne Wing (First Floor), King's College Hospital, Denmark Hill, London, UK
- Psychiatry, South London and Maudsley National Health Service Foundation Trust (SLaM) & Institute of Psychiatry, Psychology & Neuroscience (IoPPN), London, UK
| | - Siobhan Gee
- Psychiatry, South London and Maudsley National Health Service Foundation Trust (SLaM) & Institute of Psychiatry, Psychology & Neuroscience (IoPPN), London, UK
| | - Gerri O'Brien
- Alcohol Care Team, Department of Psychological Medicine, Cheyne Wing (First Floor), King's College Hospital, Denmark Hill, London, UK
| | - Pitchy-Ann Vicente
- Alcohol Care Team, Department of Psychological Medicine, Cheyne Wing (First Floor), King's College Hospital, Denmark Hill, London, UK
| | - Rosemary Griffith
- Alcohol Care Team, Department of Psychological Medicine, Cheyne Wing (First Floor), King's College Hospital, Denmark Hill, London, UK
| | - Rina Patel
- Alcohol Care Team, Department of Psychological Medicine, Cheyne Wing (First Floor), King's College Hospital, Denmark Hill, London, UK
| | - Joshua Stapleton
- Alcohol Care Team, Department of Psychological Medicine, Cheyne Wing (First Floor), King's College Hospital, Denmark Hill, London, UK
- Psychiatry, South London and Maudsley National Health Service Foundation Trust (SLaM) & Institute of Psychiatry, Psychology & Neuroscience (IoPPN), London, UK
| | - Emily Finch
- Psychiatry, South London and Maudsley National Health Service Foundation Trust (SLaM) & Institute of Psychiatry, Psychology & Neuroscience (IoPPN), London, UK
| | - Naina Shah
- Alcohol Care Team, Department of Psychological Medicine, Cheyne Wing (First Floor), King's College Hospital, Denmark Hill, London, UK
| | - Fiona Gaughran
- Psychiatry, South London and Maudsley National Health Service Foundation Trust (SLaM) & Institute of Psychiatry, Psychology & Neuroscience (IoPPN), London, UK
| | - David Taylor
- Psychiatry, South London and Maudsley National Health Service Foundation Trust (SLaM) & Institute of Psychiatry, Psychology & Neuroscience (IoPPN), London, UK
| | - John Strang
- Psychiatry, South London and Maudsley National Health Service Foundation Trust (SLaM) & Institute of Psychiatry, Psychology & Neuroscience (IoPPN), London, UK
| | - Nicola J Kalk
- Alcohol Care Team, Department of Psychological Medicine, Cheyne Wing (First Floor), King's College Hospital, Denmark Hill, London, UK
- Psychiatry, South London and Maudsley National Health Service Foundation Trust (SLaM) & Institute of Psychiatry, Psychology & Neuroscience (IoPPN), London, UK
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De Hert M, Mazereel V, Stroobants M, De Picker L, Van Assche K, Detraux J. COVID-19-Related Mortality Risk in People With Severe Mental Illness: A Systematic and Critical Review. Front Psychiatry 2022; 12:798554. [PMID: 35095612 PMCID: PMC8793909 DOI: 10.3389/fpsyt.2021.798554] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 12/03/2021] [Indexed: 01/08/2023] Open
Abstract
Background: Increasing clinical evidence suggests that people with severe mental illness (SMI), including schizophrenia spectrum disorders, bipolar disorder (BD), and major depressive disorder (MDD), are at higher risk of dying from COVID-19. Several systematic reviews examining the association between psychiatric disorders and COVID-19-related mortality have recently been published. Although these reviews have been conducted thoroughly, certain methodological limitations may hinder the accuracy of their research findings. Methods: A systematic literature search, using the PubMed, Embase, Web of Science, and Scopus databases (from inception to July 23, 2021), was conducted for observational studies assessing the risk of death associated with COVID-19 infection in adult patients with pre-existing schizophrenia spectrum disorders, BD, or MDD. Methodological quality of the included studies was assessed using the Newcastle-Ottawa Scale (NOS). Results: Of 1,446 records screened, 13 articles investigating the rates of death in patients with pre-existing SMI were included in this systematic review. Quality assessment scores of the included studies ranged from moderate to high. Most results seem to indicate that patients with SMI, particularly patients with schizophrenia spectrum disorders, are at significantly higher risk of COVID-19-related mortality, as compared to patients without SMI. However, the extent of the variation in COVID-19-related mortality rates between studies including people with schizophrenia spectrum disorders was large because of a low level of precision of the estimated mortality outcome(s) in certain studies. Most studies on MDD and BD did not include specific information on the mood state or disease severity of patients. Due to a lack of data, it remains unknown to what extent patients with BD are at increased risk of COVID-19-related mortality. A variety of factors are likely to contribute to the increased mortality risk of COVID-19 in these patients. These include male sex, older age, somatic comorbidities (particularly cardiovascular diseases), as well as disease-specific characteristics. Conclusion: Methodological limitations hamper the accuracy of COVID-19-related mortality estimates for the main categories of SMIs. Nevertheless, evidence suggests that SMI is associated with excess COVID-19 mortality. Policy makers therefore must consider these vulnerable individuals as a high-risk group that should be given particular attention. This means that targeted interventions to maximize vaccination uptake among these patients are required to address the higher burden of COVID-19 infection in this already disadvantaged group.
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Affiliation(s)
- Marc De Hert
- Department of Neurosciences, Center for Clinical Psychiatry, University Psychiatric Center, KU Leuven, Kortenberg, Belgium
- Antwerp Health Law and Ethics Chair, University of Antwerp, Antwerp, Belgium
| | - Victor Mazereel
- Department of Neurosciences, Center for Clinical Psychiatry, University Psychiatric Center, KU Leuven, Kortenberg, Belgium
| | - Marc Stroobants
- Biomedical Library, University Psychiatric Center, KU Leuven, Kortenberg, Belgium
| | - Livia De Picker
- Collaborative Antwerp Psychiatric Research Institute, University of Antwerp, Antwerp, Belgium
- University Psychiatric Hospital Campus Duffel, Duffel, Belgium
| | - Kristof Van Assche
- Antwerp Health Law and Ethics Chair, University of Antwerp, Antwerp, Belgium
- Research Group Personal Rights and Property Rights, Faculty of Law, University of Antwerp, Antwerp, Belgium
| | - Johan Detraux
- Department of Neurosciences, Public Health Psychiatry, University Psychiatric Center, KU Leuven, Kortenberg, Belgium
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Vai B, Mazza MG, Marisa CD, Beezhold J, Kärkkäinen H, Saunders J, Samochowiec J, Benedetti F, Leboyer M, Fusar-Poli P, De Picker L. Joint European policy on the COVID-19 risks for people with mental disorders: An umbrella review and evidence- and consensus-based recommendations for mental and public health. Eur Psychiatry 2022; 65:e47. [PMID: 35971656 PMCID: PMC9486830 DOI: 10.1192/j.eurpsy.2022.2307] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Abstract
As COVID-19 becomes endemic, identifying vulnerable population groups for severe infection outcomes and defining rapid and effective preventive and therapeutic strategies remains a public health priority. We performed an umbrella review, including comprehensive studies (meta-analyses and systematic reviews) investigating COVID-19 risk for infection, hospitalization, intensive care unit (ICU) admission, and mortality in people with psychiatric disorders, and outlined evidence- and consensus-based recommendations for overcoming potential barriers that psychiatric patients may experience in preventing and managing COVID-19, and defining optimal therapeutic options and current research priorities in psychiatry. We searched Web of Science, PubMed, and Ovid/PsycINFO databases up to 17 January 2022 for the umbrella review. We synthesized evidence, extracting when available pooled odd ratio estimates for the categories “any mental disorder” and “severe mental disorders.” The quality of each study was assessed using the AMSTAR-2 approach and ranking evidence quality. We identified four systematic review/meta-analysis combinations, one meta-analysis, and three systematic reviews, each including up to 28 original studies. Although we rated the quality of studies from moderate to low and the evidence ranged from highly suggestive to non-significant, we found consistent evidence that people with mental illness are at increased risk of COVID-19 infection, hospitalization, and most importantly mortality, but not of ICU admission. The risk and the burden of COVID-19 in people with mental disorders, in particular those with severe mental illness, can no longer be ignored but demands urgent targeted and persistent action. Twenty-two recommendations are proposed to facilitate this process.
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