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. 2021 Jan 11;7(1):e31.
doi: 10.1192/bjo.2020.169.

Risk of adverse outcome of COVID-19 among patients in secure psychiatric services: observational cohort study

Natasa Basrak  1 , Naoise Mulcrone  1 , Sue Sharifuddin  1 , Zeshan Ghumman  1 , Nirvana Bechan  1 , Enas Mohamed  1 , Michael Murray  1 , Hariharan Rajendran  1 , Sean Gunnigle  1 , Mark Nolan  2 , Tim Quane  1 , Masashi Terao  1 , Tracey Hoare  1 , Kevin Kirrane  1 , Harry G Kennedy  3 , Mary Davoren  3
Affiliations

Risk of adverse outcome of COVID-19 among patients in secure psychiatric services: observational cohort study

Natasa Basrak et al. BJPsych Open. .

Abstract

Background: Secure forensic mental health services treat patients with high rates of treatment-resistant psychoses. High rates of obesity and medical comorbidities are common. Population-based studies have identified high-risk groups in the event of SARS-CoV-2 infection, including those with problems such as obesity, lung disease and immune-compromising conditions. Structured assessment tools exist to ascertain the risk of adverse outcome in the event of SARS-CoV-2 infection.

Aims: To assess risk of adverse outcome in the event of SARS-CoV-2 infection in a complete population of forensic psychiatry patients using structured assessment tools.

Method: All patients of a national forensic mental health service (n = 141) were rated for risk of adverse outcome in the event of SARS-CoV-2 infection, using two structured tools, the COVID-Age tool and the COVID-Risk tool.

Results: We found high rates of relevant physical comorbidities. Mean chronological age was 45.5 years (s.d. = 11.4, median 44.1), mean score on the COVID-Age tool was 59.1 years (s.d. = 19.4, median 58.0), mean difference was 13.6 years (s.d. = 15.6), paired t = 10.9, d.f. = 140, P < 0.001. Three patients (2.1%) were chronologically over 70 years of age, compared with 43 (30.5%) with a COVID-Age over 70 (χ2 = 6.99, d.f. = 1, P = 0.008, Fisher's exact test P = 0.027).

Conclusions: Patients in secure forensic psychiatric services represent a high-risk group for adverse outcomes in the event of SARS-COV-2 infection. Population-based guidance on self-isolation and other precautions based on chronological age may not be sufficient. There is an urgent need for better physical health research and treatment in this group.

Keywords: COVID-19; forensic mental health services; obesity; risk assessment; schizophrenia.

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Conflict of interest statement

None.

Figures

Fig. 1
Fig. 1
Association between COVID-Risk tool score and COVID-Age tool score: Spearman's r = 0.776, P < 0.001, R2 = 0.4947.
Fig. 2
Fig. 2
Mean chronological age and mean COVID-Age score in each hospital unit.
See this image and copyright information in PMC

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