Pre-pandemic psychiatric disorders and risk of COVID-19: a UK Biobank cohort analysis

Abstract

Background: Psychiatric morbidities have been associated with a risk of severe infections through compromised immunity, health behaviours, or both. However, data are scarce on the association between multiple types of pre-pandemic psychiatric disorders and COVID-19. We aimed to assess the association between pre-pandemic psychiatric disorders and the subsequent risk of COVID-19 using UK Biobank.

Methods: For this cohort analysis, we included participants from UK Biobank who were registered in England and excluded individuals who died before Jan 31, 2020, (the start of the COVID-19 outbreak in the UK) or had withdrawn from UK Biobank. Participants diagnosed with a psychiatric disorder before Jan 31 were included in the group of individuals with pre-pandemic psychiatric disorders, whereas participants without a diagnosis before the outbreak were included in the group of individuals without pre-pandemic psychiatric disorders. We used the Public Health England dataset, UK Biobank hospital data, and death registers to collect data on COVID-19 cases. To examine the relationship between pre-pandemic psychiatric disorders and susceptibility to COVID-19, we used logistic regression models to estimate odds ratios (ORs), controlling for multiple confounders and somatic comorbidities. Key outcomes were all COVID-19, COVID-19 specifically diagnosed in inpatient care, and COVID-19-related deaths. ORs were also estimated separately for each psychiatric disorder and on the basis of the number of pre-pandemic psychiatric disorders. As a positive disease control, we repeated analyses for hospitalisation for other infections.

Findings: We included 421 014 UK Biobank participants in our study and assessed their COVID-19 status between Jan 31 and July 26, 2020. 50 809 participants were diagnosed with psychiatric disorders before the outbreak, while 370 205 participants had no psychiatric disorders. The mean age at outbreak was 67·80 years (SD 8·12). We observed an elevated risk of COVID-19 among individuals with pre-pandemic psychiatric disorders compared with that of individuals without such conditions. The fully adjusted ORs were 1·44 (95% CI 1·28-1·62) for All COVID-19 cases, 1·55 (1·34-1·78) for Inpatient COVID-19 cases, and 2·03 (1·59-2·59) for COVID-19-related deaths. We observed excess risk, defined as risk that increased with the number of pre-pandemic psychiatric disorders, across all diagnostic categories of pre-pandemic psychiatric disorders. We also observed an association between psychiatric disorders and elevated risk of hospitalisation due to other infections (OR 1·74, 95% CI 1·58-1·93).

Interpretation: Our findings suggest that pre-existing psychiatric disorders are associated with an increased risk of COVID-19. These findings underscore the need for surveillance of and care for populations with pre-existing psychiatric disorders during the COVID-19 pandemic.

Funding: National Natural Science Foundation of China.

Figure 1

Study design *The first COVID-19 case was diagnosed on Jan 31, 2020, in the UK. †Defined as psychiatric disorders identified from the UK Biobank inpatient hospital data before Jan 31, 2020.

Figure 2

Risk of COVID-19 and other infections among individuals with any or specific pre-pandemic psychiatric disorders compared with that of individuals without such disorders ORs (95% CI) were derived from logistic regression models, adjusted for birth year, sex, race or ethnicity, Townsend deprivation index, educational attainment, annual household income, body-mass index, smoking status, and history of chronic cardiac disease, diabetes, chronic pulmonary disease, chronic kidney disease, and asthma. OR=odds ratio. *Hospitalisation for other infections was defined as a hospital admission with a main diagnosis of any infection other than COVID-19 between Jan 31 and May 31, 2020, according to the UK Biobank inpatient hospital data; we excluded all individuals with confirmed COVID-19.