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Meta-Analysis
. 2023 Oct 20:32:e61.
doi: 10.1017/S2045796023000719.

COVID-19 risk, course and outcome in people with mental disorders: a systematic review and meta-analyses

Patricio Molero  1   2 , Gabriel Reina  2   3 , Jan Dirk Blom  4   5   6 , Miguel Ángel Martínez-González  2   7   8   9 , Aischa Reinken  4 , E Ronald de Kloet  10 , Marc L Molendijk  4   11
Affiliations
Meta-Analysis

COVID-19 risk, course and outcome in people with mental disorders: a systematic review and meta-analyses

Patricio Molero et al. Epidemiol Psychiatr Sci. .

Abstract

Aims: It has been suggested that people with mental disorders have an elevated risk to acquire severe acute respiratory syndrome coronavirus 2 and to be disproportionally affected by coronavirus disease 19 (COVID-19) once infected. We aimed to analyse the COVID-19 infection rate, course and outcome, including mortality and long COVID, in people with anxiety, depressive, neurodevelopmental, schizophrenia spectrum and substance use disorders relative to control subjects without these disorders.

Methods: This study constitutes a preregistered systematic review and random-effects frequentist and Bayesian meta-analyses. Major databases were searched up until 27 June 2023.

Results: Eighty-one original articles were included reporting 304 cross-sectional and prospective effect size estimates (median n per effect-size = 114837) regarding associations of interest. Infection risk was not significantly increased for any mental disorder that we investigated relative to samples of people without these disorders. The course of COVID-19, however, is relatively severe, and long COVID and COVID-19-related hospitalization are more likely in all patient samples that we investigated. The odds of dying from COVID-19 were high in people with most types of mental disorders, except for those with anxiety and neurodevelopmental disorders relative to non-patient samples (pooled ORs range, 1.26-2.57). Bayesian analyses confirmed the findings from the frequentist approach and complemented them with estimates of the strength of evidence.

Conclusions: Once infected, people with pre-existing mental disorders are at an elevated risk for a severe COVID-19 course and outcome, including long COVID and mortality, relative to people without pre-existing mental disorders, despite an infection risk not significantly increased.

Keywords: COVID-19; corona virus disease; disease course; infection risk; long COVID; mental disorders; substance use disorders.

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Conflict of interest statement

PM reports to have received research grants from the Ministry of Education (Spain), the Government of Navarra (Spain), the Spanish Foundation of Psychiatry and Mental Health, and AstraZeneca; he is a clinical consultant for MedAvanteProPhase and Worldwide Clinical Trials Limited and has received lecture honoraria from or has been a consultant for AB-Biotics, Guidepoint, Janssen, Novumed, Roland Berger, and Scienta. GR declares to have received a research grant or lecture honoraria from Roche, MSD, and GSK. The other authors report not to have any potential conflict of interest.

Figures

Figure 1.
Figure 1.
Flow chart on identification, screening and inclusion of eligible publications.
See this image and copyright information in PMC

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References

    1. Acuff SF, Tucker JA and Murphy JG (2020) Behavioral economics of substance use: Understanding and reducing harmful use during the COVID-19 pandemic. Experimental Clinical Psychopharmacoly 29(6), 739–749. - PMC - PubMed
    1. Al-Aly Z, Bowe B and Xie Y (2022) Long COVID after breakthrough SARS-CoV-2 infection. Nature Medicine 28, 1461–1467. - PMC - PubMed
    1. Al-Diwani AAJ, Pollak TA, Irani SR and Lennox BR (2017) Psychosis: An autoimmune disease? Immunology 152(3), 388–401. - PMC - PubMed
    1. Allen B, El Shahawy O, Rogers ES, Hochman S, Khan MR and Krawczyk N (2020) Association of substance use disorders and drug overdose with adverse COVID-19 outcomes in New York City: January-October 2020. Journal of Public Health (Oxford) 43(3), 462–465. - PMC - PubMed
    1. American Psychiatric Association (1994) Diagnostic and Statistical Manual of Mental Disorders, 4th edn. Washington, DC: American Psychiatric Association.