Bidirectional associations between COVID-19 and psychiatric disorder: retrospective cohort studies of 62 354 COVID-19 cases in the USA.
Bidirectional associations between COVID-19 and psychiatric disorder: retrospective cohort studies of 62 354 COVID-19 cases in the USA.
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DOI：
10.1016/s2215-0366(20)30462-4
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发表时间：
2021-03
期刊：
影响因子：
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通讯作者：
Harrison PJ
中科院分区：
文献类型：
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作者：
Taquet M;Luciano S;Geddes JR;Harrison PJ
COVID-19对心理健康的不利影响，包括焦虑和抑郁，已被广泛预测，但尚未准确测量。COVID-19有一系列身体健康风险因素，但尚不清楚是否也有精神风险因素。在这项电子健康记录网络队列研究中，使用了来自6900万人的数据，其中62354人被诊断为COVID-19，我们评估了COVID-19的诊断（与其他健康事件相比）是否与后续精神病诊断率的增加有关，以及有精神病史的患者被诊断为COVID-19的风险是否更高。 我们使用了TriNetX Analytics Network，这是一个全球联合网络，可以从美国54家医疗机构的电子健康记录中获取匿名数据，共计6980万患者。TriNetX纳入了2020年1月20日至8月1日期间确诊为COVID-19的62354名患者。 我们创建了被诊断患有COVID-19或一系列其他健康事件的患者队列。我们使用倾向评分匹配来控制COVID-19风险因素和疾病严重程度的混杂因素。我们测量了确诊COVID-19后14至90天内精神疾病、痴呆和失眠的发病率和风险比（HR）。在既往无精神病史的患者中，与其他6起健康事件相比，COVID-19的诊断与随后14至90天内首次精神病诊断的发生率增加相关（HR 2·1，95% CI 1·8-2·5 vs流感; 1·7，1·5-1·9 vs其他呼吸道感染; 1·6，1·4-1·9 vs皮肤感染; 1·6，1·3-1·9 vs胆石症; 2.2，1.9 - 2.6与尿石症，2.1，1.9 - 2.5与大骨骨折;所有p<0.0001）。焦虑症、失眠症和痴呆症的HR最大。当测量复发和新诊断时，我们观察到类似的结果，尽管HR较小。在COVID-19诊断后14至90天内，任何精神病诊断的发生率为18.1%（95%CI 17.6 - 18.6），包括5.8%（5.2 - 6.4）的首次诊断。在65岁以上的人群中，在COVID-19诊断后14至90天内首次诊断为痴呆的发生率为1.6%（95%CI 1.2 - 2.1）。前一年的精神病诊断与COVID-19诊断的发生率较高相关（相对风险1.65，95%CI 1.59 - 1.71; p<0.0001）。该风险独立于COVID-19的已知身体健康风险因素，但我们不能排除社会经济因素可能的剩余混杂因素。COVID-19幸存者出现精神后遗症的风险似乎增加，精神病诊断可能是COVID-19的独立风险因素。虽然是初步的，但我们的研究结果对临床服务有意义，并且有必要进行前瞻性队列研究。国立卫生研究院。
Adverse mental health consequences of COVID-19, including anxiety and depression, have been widely predicted but not yet accurately measured. There are a range of physical health risk factors for COVID-19, but it is not known if there are also psychiatric risk factors. In this electronic health record network cohort study using data from 69 million individuals, 62 354 of whom had a diagnosis of COVID-19, we assessed whether a diagnosis of COVID-19 (compared with other health events) was associated with increased rates of subsequent psychiatric diagnoses, and whether patients with a history of psychiatric illness are at a higher risk of being diagnosed with COVID-19. We used the TriNetX Analytics Network, a global federated network that captures anonymised data from electronic health records in 54 health-care organisations in the USA, totalling 69·8 million patients. TriNetX included 62 354 patients diagnosed with COVID-19 between Jan 20, and Aug 1, 2020. We created cohorts of patients who had been diagnosed with COVID-19 or a range of other health events. We used propensity score matching to control for confounding by risk factors for COVID-19 and for severity of illness. We measured the incidence of and hazard ratios (HRs) for psychiatric disorders, dementia, and insomnia, during the first 14 to 90 days after a diagnosis of COVID-19. In patients with no previous psychiatric history, a diagnosis of COVID-19 was associated with increased incidence of a first psychiatric diagnosis in the following 14 to 90 days compared with six other health events (HR 2·1, 95% CI 1·8–2·5 vs influenza; 1·7, 1·5–1·9 vs other respiratory tract infections; 1·6, 1·4–1·9 vs skin infection; 1·6, 1·3–1·9 vs cholelithiasis; 2·2, 1·9–2·6 vs urolithiasis, and 2·1, 1·9–2·5 vs fracture of a large bone; all p<0·0001). The HR was greatest for anxiety disorders, insomnia, and dementia. We observed similar findings, although with smaller HRs, when relapses and new diagnoses were measured. The incidence of any psychiatric diagnosis in the 14 to 90 days after COVID-19 diagnosis was 18·1% (95% CI 17·6–18·6), including 5·8% (5·2–6·4) that were a first diagnosis. The incidence of a first diagnosis of dementia in the 14 to 90 days after COVID-19 diagnosis was 1·6% (95% CI 1·2–2·1) in people older than 65 years. A psychiatric diagnosis in the previous year was associated with a higher incidence of COVID-19 diagnosis (relative risk 1·65, 95% CI 1·59–1·71; p<0·0001). This risk was independent of known physical health risk factors for COVID-19, but we cannot exclude possible residual confounding by socioeconomic factors. Survivors of COVID-19 appear to be at increased risk of psychiatric sequelae, and a psychiatric diagnosis might be an independent risk factor for COVID-19. Although preliminary, our findings have implications for clinical services, and prospective cohort studies are warranted. National Institute for Health Research.