Increased risk of COVID-19 infection and mortality in people with mental disorders: analysis from electronic health records in the United States

Abstract

Concerns have been expressed that persons with a pre-existing mental disorder may represent a population at increased risk for COVID-19 infec-tion and with a higher likelihood of adverse outcomes of the infection, but there is no systematic research evidence in this respect. This study assessed the impact of a recent (within past year) diagnosis of a mental disorder - including attention-deficit/hyperactivity disorder (ADHD), bipolar disorder, depression and schizophrenia - on the risk for COVID-19 infection and related mortality and hospitalization rates. We analyzed a nation-wide database of electronic health records of 61 million adult patients from 360 hospitals and 317,000 providers, across 50 states in the US, up to July 29, 2020. Patients with a recent diagnosis of a mental disorder had a significantly increased risk for COVID-19 infection, an effect strongest for depression (adjusted odds ratio, AOR=7.64, 95% CI: 7.45-7.83, p<0.001) and schizophrenia (AOR=7.34, 95% CI: 6.65-8.10, p<0.001). Among patients with a recent diagnosis of a mental disorder, African Americans had higher odds of COVID-19 infection than Caucasians, with the strongest ethnic disparity for depression (AOR=3.78, 95% CI: 3.58-3.98, p<0.001). Women with mental disorders had higher odds of COVID-19 infection than males, with the strongest gender disparity for ADHD (AOR=2.03, 95% CI: 1.73-2.39, p<0.001). Patients with both a recent diagnosis of a mental disorder and COVID-19 infection had a death rate of 8.5% (vs. 4.7% among COVID-19 patients with no mental disorder, p<0.001) and a hospitalization rate of 27.4% (vs. 18.6% among COVID-19 patients with no mental disorder, p<0.001). These findings identify individuals with a recent diagnosis of a mental disorder as being at increased risk for COVID-19 infection, which is further exacerbated among African Americans and women, and as having a higher frequency of some adverse outcomes of the infection. This evidence highlights the need to identify and address modifiable vulnerability factors for COVID-19 infection and to prevent delays in health care provision in this population.

Keywords: ADHD; COVID-19; access to care; bipolar disorder; depression; discrimination; ethnic disparity; gender disparity; hospitalization; mental disorders; mortality; risk of infection; schizophrenia.

Figure 1

Association of recent (within past year) diagnosis of a mental disorder and COVID‐19 infection after adjusting for age, gender and ethnicity. ADHD – attention‐deficit/hyperactivity disorder

Figure 2

Association of recent (within past year) diagnosis of a mental disorder and COVID‐19 infection after adjusting for age, gender, ethnicity, and medical comorbidities (cancers, cardiovascular diseases, type 2 diabetes, obesity, chronic kidney diseases, chronic obstructive pulmonary disease, asthma, and substance use disorders). ADHD – attention‐deficit/hyperactivity disorder

Figure 3

Effects of demographics on odds of COVID‐19 infection among patients with a recently diagnosed mental disorder after adjusting for medical comorbidities (cancers, cardiovascular diseases, type 2 diabetes, obesity, chronic kidney diseases, chronic obstructive pulmonary disease, asthma, and substance use disorders). ADHD – attention‐deficit/hyperactivity disorder