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Bispebjerg Hospital - a part of Copenhagen University Hospital

Severe mental illness is associated with increased mortality and severe course of COVID-19

Research output: Contribution to journalJournal articleResearchpeer-review


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  • Carlo Alberto Barcella
  • Christoffer Polcwiartek
  • Grimur Høgnason Mohr
  • Gethin Hodges
  • Kathrine Søndergaard
  • Casper Bang
  • Mikkel Porsborg Andersen
  • Emil Fosbøl
  • Lars Køber
  • Morten Schou
  • Christian Torp-Pedersen
  • Lars Vedel Kessing
  • Gunnar Gislason
  • Kristian Kragholm
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OBJECTIVE: Psychiatric disorders have been associated with unfavourable outcome following respiratory infections. Whether this also applies to coronavirus disease 2019 (COVID-19) has been scarcely investigated.

METHODS: Using the Danish administrative databases, we identified all patients with a positive real-time reverse transcription-polymerase chain reaction test for COVID-19 in Denmark up to and including 2 January 2021. Multivariable cox regression was used to calculate 30-day absolute risk and average risk ratio (ARR) for the composite end point of death from any cause and severe COVID-19 associated with psychiatric disorders, defined using both hospital diagnoses and redemption of psychotropic drugs.

RESULTS: We included 144,321 patients with COVID-19. Compared with patients without psychiatric disorders, the standardized ARR of the composite outcome was significantly increased for patients with severe mental illness including schizophrenia spectrum disorders 2.43 (95% confidence interval [CI], 1.79-3.07), bipolar disorder 2.11 (95% CI, 1.25-2.97), unipolar depression 1.70 (95% CI, 1.38-2.02), and for patients who redeemed psychotropic drugs 1.70 (95% CI, 1.48-1.92). No association was found for patients with other psychiatric disorders 1.13 (95% CI, 0.86-1.38). Similar results were seen with the outcomes of death or severe COVID-19. Among the different psychiatric subgroups, patients with schizophrenia spectrum disorders had the highest 30-day absolute risk for the composite outcome 3.1% (95% CI, 2.3-3.9%), death 1.2% (95% CI, 0.4-2.0%) and severe COVID-19 2.7% (95% CI, 1.9-3.6%).

CONCLUSION: Schizophrenia spectrum disorders, bipolar disorder, unipolar depression and psychotropic drug redemption are associated with unfavourable outcomes in patients with COVID-19.

Original languageEnglish
JournalActa Psychiatrica Scandinavica
Issue number1
Pages (from-to)82-91
Number of pages10
Publication statusPublished - Jul 2021

    Research areas

  • COVID-19, bipolar disorder, depression, respiratory infection, schizophrenia, unfavourable outcome

ID: 65157100