Preexisting Neuropsychiatric Conditions, Treatments Tied to Risk for COVID-19

Several neuropsychiatric disorders have been associated with the risk for the development of a broad range of respiratory infections, including COVID-19 and other severe acute respiratory infections (SARIs), according to study findings published in JAMA Psychiatry.

Researchers sought to determine whether a preexisting diagnosis of and/or treatment for a neuropsychiatric condition is associated with severe outcomes from a SARS-CoV-2 infection and other SARIs, as well as whether any observed association is similar between the 2 outcomes.

The study included 2 temporally distinct longitudinal cohorts: (1) a prepandemic cohort that comprised adults aged 18 years and older who entered the study from January 24, 2015, until January 23, 2020 (the day prior to the first recorded COVID-19 case in the United Kingdom); and (2) a contemporary cohort that comprised all adults who entered the study from January 24, 2020, until the date of data extraction (ie, May 31, 2021).

In the prepandemic cohort, the index date was the latest of the following: (1) January 24, 2015; (2) December 31 in the year that the patients turned 18 years of age; or (3) 1 year following registration with a participating practice if the registration was after January 24, 2014.

In the contemporary cohort, the index date was January 24, 2020, with individuals younger than 18 years of age and those not registered with a participating practice for 1 year or more on that date excluded from the study. Follow-up time was from the index date until the first record of any outcome (ie, COVID-19–related or SARI-related hospitalization or intensive care unit admission, or death) or censoring: the earliest of date of deregistration from an EMIS practice or study end (January 23, 2020, for the prepandemic cohort and May 31, 2021, for the contemporary cohort).

Regarding exposures, the researchers grouped similar neuropsychiatric disorders and their respective pharmacologic treatments under the following categories: anxiety, mood, and psychotic disorders, which were paired with hypnotic/anxiolytic, antidepressant, and antipsychotic medications.

A total of 11,134,789 adults were enrolled in the prepandemic cohort, with 2.0% (223,569 of 11,134,789) of them reported to be SARI cases.  Overall, 50.7% of the prepandemic cohort were made up of women. The median participant age in this cohort was 42 years (range, 29-58 years).

In contrast, the contemporary cohort comprised a total of 8,388,956 adults, with 0.7% (58,203 of 8,388,956) of them reported to be severe COVID-19 cases. Overall, 50.2% of the contemporary cohort were men. The median participant age in this cohort was
48 years (range, 34-63 years).

Diagnosis and/or treatment of neuropsychiatric disorders other than dementia was associated with an increased likelihood of a severe outcome from SARI (anxiety diagnosis: hazard ratio [HR], 1.16; 99% CI, 1.13-1.18; psychotic disorder diagnosis and treatment: HR, 2.56; 99% CI, 2.40-2.72) and from COVID-19 (anxiety diagnosis: HR, 1.16; 99% CI, 1.12-1.20; psychotic disorder treatment: HR, 2.37; 99% CI, 2.20-2.55).

The effect estimate for experiencing a severe outcome with dementia was higher for those with COVID-19 compared with those with SARI (HR, 2.85; 99% CI, 2.71-3.00 vs HR, HR, 2.13; 99% CI, 2.07-2.19, respectively).

The study had several limitations that warrant mention. The use of routinely collected health care data denotes that outcomes and exposures are not formally adjudicated, because the database depends on coding by individual practitioners. Additionally, recording bias might have been present because of the disruption in patient attendance at general practices during the study period — in particular, during the COVID-19 pandemic.

“In this longitudinal cohort study, UK patients with preexisting neuropsychiatric conditions and treatments were associated with similarly increased risks of severe outcome from COVID-19 infection and SARIs, except for dementia,” the researchers stated.

“These findings suggest the importance of recognizing the association of several neuropsychiatric illnesses with risk of developing a broad range of respiratory infections, not just COVID-19 infection.”

Disclosure: Some of the study authors have declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.