The Association Between Mental Illness and Covid-19 Susceptibility

An interesting article published in September 2020 in The Lancet Psychiatry by Professor Juan Lee and others looked at the evidence of the associations between mental illness and the likelihood of a positive severe acute respiratory syndrome Coronavirus test result. 

They tested this association with data from a national register in South Korea.  They defined mental illness as present when one of the relevant ICD-10 causes were recorded at least twice within a year for an outpatient or an inpatient. 

Severe mental illness was considered as non-affective or affective disorders with psychotic features.  They included all patients aged older than 20 years who were tested for SARS-CoV-2 through the services facilitated by the Korea Centers for Disease Control and Prevention, the Health Insurance Review and Assessment Service Korea and a Ministry of Health and Welfare of South Korea.

They investigated the primary outcome of SARS-CoV-2 test positivity in the entire cohort and the secondary outcomes, severe clinical outcomes of Covid-19: death, admission to the ITU, or invasive ventilation amongst those who tested positive. 

In the entire cohort with propensity score matching, 3% of 47,058 patients without a mental illness tested positive for SARS-CoV-2 compared with 2.9% of 48,058 with a mental illness.  Among the patients who tested positive for SARS-CoV-2, 8.3% of 1,720 patients without a mental illness had severe clinical outcomes of Covid-19 compared with 128, 9.7% of 1,720 with a mental illness. 

They concluded that the diagnosis of a mental illness was not associated with increased likelihood of testing positive for SARS-CoV-2.

Patients with a severe mental illness had a slightly higher risk of severe clinical outcomes of Covid-19 in patients with a history of mental illness. 

The clinicians treating patients with Covid-19 should be aware of the risks associated with pre-existing mental illness.

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