Patients with serious mental illness at high risk of postacute sequelae of SARS-CoV-2

Among patients who sustained COVID-19 infection, the risk of postacute sequelae of SARS-CoV-2 (PASC) is high in the presence of a serious mental illness, according to a study.

Researchers used data derived from large-scale electronic health records from adult patients with a COVID-19 infection, as confirmed by a relevant laboratory result, diagnosis, or prescription order. A serious mental illness diagnosis, such as schizophrenia, bipolar disorder, or recurrent major depressive disorder, was recorded before COVID-19 infection.

The analysis included 1,625,857 patients (mean age 52 years, 61.4 percent female, 51.3 percent non-Hispanic White, 75.6 percent urban patients) with a COVID-19 infection. Of these, 258,523 (15.9 percent) had a serious mental illness and 403,641 (24.8 percent) developed PASC.

The presence of a serious mental illness was associated with 10-percent greater odds of developing PASC (odds ratio [OR], 1.10, 95 percent confidence interval [CI], 1.08–1.11; p<0.001). Among patients with a serious mental illness, factors associated with PASC included older age (35–44 vs 22–34 years: OR, 1.04, 95 percent CI, 1.03–1.06; 45–64 vs 22–34 years: OR, 1.11, 95 percent CI, 1.10–1.12; ≥65 vs 22–34 years: OR, 1.18, 95 percent CI, 1.17–1.20), race/ethnicity (non-Hispanic Black vs non-Hispanic White:  OR, 1.08, 95 percent CI, 1.07–1.10; Hispanic vs non-Hispanic White: OR, 1.12, 95 percent CI, 1.11–1.13), higher vs no chronic disease burden (CCI 1 to 3: OR, 1.13, 95 percent CI, 1.12–1.14; CCI ≥4: OR, 1.23, 95 percent CI, 1.22–1.25), and hospitalization with initial COVID-19 infection vs no hospitalization (hospitalized: OR, 1.80, 95 percent CI, 1.77–1.82; hospitalized with ventilation: OR, 2.17, 95 percent CI, 2.12–2.22).

Compared with public insurance, commercial health insurance was associated with lower odds of PASC (OR, 0.85, 95 percent CI, 0.84–0.86).