Mental disorders, COVID-19-related life-saving measures and mortality in France: A nationwide cohort study

Publikation: Beitrag in FachzeitschriftForschungsartikelBeigetragenBegutachtung

Beitragende

  • Michaël Schwarzinger - , Centre Hospitalier Universitaire de Bordeaux, Université de Bordeaux (Autor:in)
  • Stéphane Luchini - , Aix-Marseille Université (Autor:in)
  • Miriam Teschl - , Aix-Marseille Université (Autor:in)
  • François Alla - , Centre Hospitalier Universitaire de Bordeaux, Université de Bordeaux (Autor:in)
  • Vincent Mallet - , Université Paris Cité (Autor:in)
  • Jürgen Rehm - , Professur für Behaviorale Epidemiologie, University of Toronto, Centre for Addiction and Mental Health (CAMH), Technische Universität Dresden (Autor:in)

Abstract

Background AU Meta-analyses: Pleaseconfirmthatallheadinglevelsarerepresentedcorrectly have shown that preexisting mental disorders : may increase serious Coronavirus Disease 2019 (COVID-19) outcomes, especially mortality. However, most studies were conducted during the first months of the pandemic, were inconclusive for several categories of mental disorders, and not fully controlled for potential confounders. Our study objectives were to assess independent associations between various categories of mental disorders and COVID-19-related mortality in a nationwide sample of COVID-19 inpatients discharged over 18 months and the potential role of salvage therapy triage to explain these associations. Methods and findings We analysed a nationwide retrospective cohort of all adult inpatients discharged with symptomatic COVID-19 between February 24, 2020 and August 28, 2021 in mainland France. The primary exposure was preexisting mental disorders assessed from all discharge information recorded over the last 9 years (dementia, depression, anxiety disorders, schizophrenia, alcohol use disorders, opioid use disorders, Down syndrome, other learning disabilities, and other disorder requiring psychiatric ward admission). The main outcomes were all-cause mortality and access to salvage therapy (intensive-care unit admission or life-saving respiratory support) assessed at 120 days after recorded COVID-19 diagnosis at hospital. Independent associations were analysed in multivariate logistic models. Of 465,750 inpatients with symptomatic COVID-19, 153,870 (33.0%) were recorded with a history of mental disorders. Almost all categories of mental disorders were independently associated with higher mortality risks (except opioid use disorders) and lower salvage therapy rates (except opioid use disorders and Down syndrome). After taking into account the mortality risk predicted at baseline from patient vulnerability (including older age and severe somatic comorbidities), excess mortality risks due to caseload surges in hospitals were +5.0% (95% confidence interval (CI), 4.7 to 5.2) in patients without mental disorders (for a predicted risk of 13.3% [95% CI, 13.2 to 13.4] at baseline) and significantly higher in patients with mental disorders (+9.3% [95% CI, 8.9 to 9.8] for a predicted risk of 21.2% [95% CI, 21.0 to 21.4] at baseline). In contrast, salvage therapy rates were significantly higher than expected in patients without mental disorders (+4.2% [95% CI, 3.8 to 4.5]) and lower in patients with mental disorders (−4.1% [95% CI, −4.4; −3.7]). The main limitations of our study point to the assessment of COVID-19-related mortality at 120 days and potential coding bias of medical information recorded in hospital claims data, although the main study findings were consistently reproduced in multiple sensitivity analyses. Conclusions COVID-19 patients with mental disorders had lower odds of accessing salvage therapy, suggesting that life-saving measures at French hospitals were disproportionately denied to patients with mental disorders in this exceptional context.

Details

OriginalspracheEnglisch
Aufsatznummere1004134
FachzeitschriftPLoS medicine
Jahrgang20
Ausgabenummer2
PublikationsstatusVeröffentlicht - Feb. 2023
Peer-Review-StatusJa

Externe IDs

PubMed 36745669

Schlagworte

Ziele für nachhaltige Entwicklung

ASJC Scopus Sachgebiete