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November 12, 2020
3 min read
Source / Disclosures
Disclosures:
Taquet and Yolken do not report relevant financial disclosures. One study author reports being a TriNetX employee.
Survivors of COVID-19 appeared to be at increased risk of psychiatric sequelae, according to the results of an analysis of retrospective cohort studies published in The lancet Psychiatry.
Additionally, the researchers found that a psychiatric diagnosis may be an independent risk factor for COVID-19.
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“Since the early stages of the COVID-19 pandemic, concerns have been raised about its effect on mental health and on patients with mental illness.” Maxime Ribbon, Doctor, from the department of psychiatry at the University of Oxford in the UK, and her colleagues wrote. “However, several months later, we still know little about the mental health consequences of COVID-19 (its psychiatric sequelae) and the susceptibility of patients with mental illness to COVID-19 (their psychiatric history).”
According to the researchers, cohort studies of individuals with COVID-19 with adequate control groups and follow-up are necessary to assess the incidence and relative risks of post-infection psychiatric sequelae.
Taquet and his colleagues sought to address these research gaps by conducting the current EHR network cohort study. They analyzed anonymized EHR data on 54 healthcare organizations in the United States from 69.8 million patients that were included in a worldwide federated network. Data was available on 62,354 patients diagnosed with COVID-19 between January 20 and August 1. The researchers created cohorts of patients who had received a diagnosis of COVID-19 or a variety of other health events and controlled for the confounding factors for COVID-19 risk factors. using propensity score matching. In addition, they determined the incidence and HRs of psychiatric disorders, dementia and insomnia during the first 14 to 90 days after COVID-19 diagnosis.
The results showed that patients with no psychiatric history diagnosed with COVID-19 had an increased risk of a first psychiatric diagnosis in the next 14 to 90 days compared to six other health events, including influenza (HR = 2.1; CI 95%, 1.8-2.5); other respiratory tract infections (HR = 1.7; 95% CI, 1.5-1.9); skin infection (HR = 1.6, 95% CI, 1.4-1.9); cholelithiasis (HR = 1.6; 95% CI, 1.3-1.9); urolithiasis (HR = 2.2, 95% CI, 1.9-2.6); and large bone fracture (HR = 2.1; 95% CI, 1.9-2.5). Taquet and his colleagues found an estimated probability of having been diagnosed with a psychiatric illness in the 14 to 90 days after COVID-19 diagnosis of 181% (95% CI 176-186). Anxiety disorders, insomnia, and dementia had the highest HR. Although the HRs were smaller, Taquet and his colleagues observed similar findings when measuring relapses and new diagnoses. In the 14 to 90 days after COVID-19 diagnosis, the incidence of any psychiatric diagnosis was 18.1% (95% CI, 17.6-18.6), of which 5.8% ( 95% CI, 5.2-6.4) was a first diagnosis. Also during this time period, the incidence of a first dementia diagnosis was 1.6% (95% CI, 1.2-2.2) among people older than 65 years. A psychiatric diagnosis from the previous year was associated with a higher incidence of COVID-19, with a relative risk of 1.65 (95% CI, 1.59-1.71). This risk was not related to known physical health risk factors for COVID-19; however, the investigators noted that they could not exclude possible residual confounders for socioeconomic factors.
“As COVID-19 sample sizes and survival times increase, it will be possible to refine these findings and identify more rare and late psychiatric presentations,” Taquet and colleagues wrote. “Prospective cohort studies and inclusive case records will be valuable to complement electronic medical record analyzes. It will also be important to explore additional risk factors for contracting COVID-19 and for developing psychiatric disorders thereafter, as some elements could be modifiable. “
In a related editorial, Robert In your way, MD, from the Johns Hopkins School of Medicine department of pediatrics, emphasized the potential importance of HCE data in addressing the COVID-19 pandemic.
“Learning to use new tools, such as electronic medical records efficiently, should provide some of the essential information needed to understand and manage the psychiatric consequences of this pandemic and plan for future ones,” Yolken wrote. “In these efforts, we must take into account the words of Sir William Osler that ‘the best preparation for tomorrow is to do today’s work excellently.’
COVID-19 Resource Center
