Increased Mortality From COVID-19 In Severe Mental Illness Patients With Comorbidities and Those of Black Race

1. There was higher multimorbidity and increased risk of death in those with severe mental illness (SMI) vs the control group following infection with COVID-19. The risk of death was increased in those with multimorbidity.

2. There was increased risk of death in people of black race vs white race following infection with COVID-19. However, mortality was similar between SMI vs non-SMI in people of black race.

Evidence Rating Level: 2 (Good)

COVID-19 had devastating impacts on society. These impacts were further magnified in those with SMI and those of black race. At baseline, patients with SMI have a 15-20 year lower life expectancy. This was further reduced during the pandemic. In addition to this, healthcare inequality was also further worsened during the pandemic for people of black race. However, the influence of multimorbidity on the mortality of individuals with SMI following COVID 19 infection has not been studied. Additionally, a gap also remains regarding the impact of race on this relationship.

This was a cohort study done in the UK pulling data from a primary care database for two waves of COVID-19. The study compared a non-SMI control group (653024) to a SMI group (7146). The SMI group required a psychiatric diagnosis prior to infection. Only morbidities with known associated risk of increased infection and death were included. Patients diagnosed with SMI after infection, and patients under the age of 6 were excluded. People of black race were identified as those of black Caribbean or African descent. The impact of SMI, comorbidities, and race on mortality were investigated. The primary outcome measured all-cause mortality.

Compared to the control group, the SMI group had increased mortality following COVID-19. This was further increased by the presence of comorbidities. An increase in mortality in people of black race vs white was also seen. However, mortality in people of black race with SMI vs non-SMI was similar. Limitations in this study include the limited time period of the study, and the rollout of the vaccine which affects the true measure of mortality from COVID-19 infection. Furthermore, the impact of race may be underplayed by the study since healthcare inequities for minorities are not homogenous globally. Nevertheless, the study demonstrates the need to prioritize these groups as high risk and employ preventative measures early when facing public health crises.

Click here to read this study in The British Journal Of Psychiatry

Image: PD

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