Risk of Death in Individuals Hospitalized for COVID-19 With and Without Psychiatric Disorders: An Observational Multicenter Study in France

Nicolas Hoertel; Marina Sánchez-Rico; Pedro de la Muela; Miriam Abellán; Carlos Blanco; Marion Leboyer; Céline Cougoule; Erich Gulbins; Johannes Kornhuber; Alexander Carpinteiro; Katrin Anne Becker; Raphaël Vernet; Nathanaël Beeker; Antoine Neuraz; Jesús M Alvarado; Juan José Herrera-Morueco; Guillaume Airagnes; Cédric Lemogne; Frédéric Limosin; AP-HP/Université de Paris/Inserm COVID-19 Research Collaboration and the AP-HP COVID CDR Initiative, “Entrepôt de Données de Santé,” AP-HP Consortium

doi:10.1016/j.bpsgos.2021.12.007

Risk of Death in Individuals Hospitalized for COVID-19 With and Without Psychiatric Disorders: An Observational Multicenter Study in France

Biol Psychiatry Glob Open Sci. 2023 Jan;3(1):56-67. doi: 10.1016/j.bpsgos.2021.12.007. Epub 2022 Jan 4.

Authors

Nicolas Hoertel^{1

2

3}, Marina Sánchez-Rico^{1

4}, Pedro de la Muela^{1

4}, Miriam Abellán¹, Carlos Blanco⁵, Marion Leboyer^{6

7}, Céline Cougoule⁸, Erich Gulbins⁹, Johannes Kornhuber¹⁰, Alexander Carpinteiro^{9

11}, Katrin Anne Becker⁹, Raphaël Vernet¹², Nathanaël Beeker¹³, Antoine Neuraz^{14

15}, Jesús M Alvarado⁴, Juan José Herrera-Morueco^{1

4}, Guillaume Airagnes¹, Cédric Lemogne¹⁶, Frédéric Limosin¹; AP-HP/Université de Paris/Inserm COVID-19 Research Collaboration and the AP-HP COVID CDR Initiative, “Entrepôt de Données de Santé,” AP-HP Consortium

Collaborators

AP-HP/Université de Paris/Inserm COVID-19 Research Collaboration and the AP-HP COVID CDR Initiative, “Entrepôt de Données de Santé,” AP-HP Consortium:
Pierre-Yves Ancel, Alain Bauchet, Nathanaël Beeker, Vincent Benoit, Mélodie Bernaux, Ali Bellamine, Romain Bey, Aurélie Bourmaud, Stéphane Breant, Anita Burgun, Fabrice Carrat, Charlotte Caucheteux, Julien Champ, Sylvie Cormont, Christel Daniel, Julien Dubiel, Catherine Ducloas, Loic Esteve, Marie Frank, Nicolas Garcelon, Alexandre Gramfort, Nicolas Griffon, Olivier Grisel, Martin Guilbaud, Claire Hassen-Khodja, François Hemery, Martin Hilka, Anne Sophie Jannot, Jerome Lambert, Richard Layese, Judith Leblanc, Léo Lebouter, Guillaume Lemaitre, Damien Leprovost, Ivan Lerner, Kankoe Levi Sallah, Aurélien Maire, Marie-France Mamzer, Patricia Martel, Arthur Mensch, Thomas Moreau, Antoine Neuraz, Nina Orlova, Nicolas Paris, Bastien Rance, Hélène Ravera, Antoine Rozes, Elisa Salamanca, Arnaud Sandrin, Patricia Serre, Xavier Tannier, Jean-Marc Treluyer, Damien Van Gysel, Gaël Varoquaux, Jill Jen Vie, Maxime Wack, Perceval Wajsburt, Demian Wassermann, Eric Zapletal

Affiliations

¹ Département Médico-Universitaire Psychiatrie et Addictologie, Service de Psychiatrie et Addictologie, Assistance Publique-Hôpitaux de Paris Centre, Hôpital Corentin-Celton, Issy-les-Moulineaux, France.
² Institut National de la Santé et de la Recherche Médicale (INSERM) U1266, Paris, France.
³ Université de Paris, Paris, France.
⁴ Department of Psychobiology & Behavioural Sciences Methods, Faculty of Psychology, Universidad Complutense de Madrid, Campus de Somosaguas, Pozuelo de Alarcón, Spain.
⁵ Division of Epidemiology, Services and Prevention Research, National Institute on Drug Abuse, Bethesda, Maryland.
⁶ INSERM U955, Neuro-Psychiatrie Translationnelle, Université Paris-Est, Paris, France.
⁷ Département Médico-Universitaire IMPACT, Département Médical Universitaire de Psychiatrie, Hôpitaux Universitaires Henri Mondor, Créteil, France.
⁸ Institut de Pharmacologie et de Biologie Structurale, Université de Toulouse, Toulouse, France.
⁹ Department of Molecular Biology, University Medicine Essen, Essen, Germany.
¹⁰ Department of Psychiatry and Psychotherapy, University Hospital, Friedrich Alexander University of Erlangen Nuremberg, Erlangen, Germany.
¹¹ Department of Hematology and Stem Cell Transplantation, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.
¹² Department of Medical Informatics, Biostatistics and Public Health Department, L'Assistance Publique-Hôpitaux de Paris Centre-Université de Paris, Hôpital Européen Georges Pompidou, Paris, France.
¹³ Unité de Recherche clinique, L'Assistance Publique-Hôpitaux de Paris, Hôpital Cochin, Paris, France.
¹⁴ INSERM UMR_S 1138, Cordeliers Research Center, Université de Paris, Paris, France.
¹⁵ Department of Medical Informatics, L'Assistance Publique-Hôpitaux de Paris, Necker-Enfants Malades Hospital, Paris, France.
¹⁶ Département Médico-Universitaire Psychiatrie et Addictologie, L'Assistance Publique-Hôpitaux de Paris, Hôpital Hôtel-Dieu, Université de Paris, Service de Psychiatrie de l'adulte, INSERM, Institut de Psychiatrie et Neurosciences de Paris, Paris, France.

Abstract

Background: Prior research suggests that psychiatric disorders could be linked to increased mortality among patients with COVID-19. However, whether all or specific psychiatric disorders are intrinsic risk factors of death in COVID-19 or whether these associations reflect the greater prevalence of medical risk factors in people with psychiatric disorders has yet to be evaluated.

Methods: We performed an observational, multicenter, retrospective cohort study to examine the association between psychiatric disorders and mortality among patients hospitalized for laboratory-confirmed COVID-19 at 36 Greater Paris University hospitals.

Results: Of 15,168 adult patients, 857 (5.7%) had an ICD-10 diagnosis of psychiatric disorder. Over a mean follow-up period of 14.6 days (SD = 17.9), 326 of 857 (38.0%) patients with a diagnosis of psychiatric disorder died compared with 1276 of 14,311 (8.9%) patients without such a diagnosis (odds ratio 6.27, 95% CI 5.40-7.28, p < .01). When adjusting for age, sex, hospital, current smoking status, and medications according to compassionate use or as part of a clinical trial, this association remained significant (adjusted odds ratio 3.27, 95% CI 2.78-3.85, p < .01). However, additional adjustments for obesity and number of medical conditions resulted in a nonsignificant association (adjusted odds ratio 1.02, 95% CI 0.84-1.23, p = .86). Exploratory analyses after the same adjustments suggested that a diagnosis of mood disorders was significantly associated with reduced mortality, which might be explained by the use of antidepressants.

Conclusions: These findings suggest that the increased risk of COVID-19-related mortality in individuals with psychiatric disorders hospitalized for COVID-19 might be explained by the greater number of medical conditions and the higher prevalence of obesity in this population and not by the underlying psychiatric disease.

Keywords: Antidepressants; COVID-19; Comorbidity; Mental disorders; Mood disorders; Mortality; Obesity; Psychiatric disorders; Risk of death; SARS-CoV-2.