Pre-existing neuropsychiatric conditions and associated risk of severe COVID-19 infection and other acute respiratory infections

JAMAScott Cunningham MD PhD, et al. | November 15, 2022



It has previously been reported that patients with neuropsychiatric disorders are at increased risk for more severe acute respiratory infections and COVID-19-associated mortality. It is not clear, however, if these findings are due to the neuropsychiatric disorder, the medications prescribed for the neuropsychiatric disorder, or both.

In the current study, the increased risk of severe acute respiratory infections among patients with neuropsychiatric disorders was confirmed and the increased risk for severe COVID-19 infections was demonstrated.

The QResearch database (England) was the source of data. Patients who were diagnosed with anxiety, depression, dementia, schizophrenia, and bipolar disorder, as well as the prescribed medications, were included in the study.

The following outcomes were recorded: COVID-19-related mortality; COVID-19-related hospital and ICU admission; other respiratory infection-related mortality; and other respiratory infection-related hospital and ICU admission.

The pre-pandemic cohort consisted of 11,134,789 patients (median age = 42 y) and 223,569 cases of severe acute respiratory infections. The pandemic cohort consisted of 8,388,956 patients (median age = 48 y) and 58,203 cases of severe COVID-19.

Among pre-pandemic era patients with anxiety and psychotic disorders, the risk of a severe acute respiratory infection was increased (HR = 1.16 and 2.56, respectively). Similarly, among pandemic era patients with anxiety and psychotic disorders, the risk of severe COVID-19 was increased (HR = 1.16 and 2.37, respectively).

Interestingly, patients who were treated with an anti-depressant, even those patients who were not previously diagnosed with depression, were at increased risk for severe acute respiratory infections and COVID-19.