Association of SARS-CoV-2 Infection With Psychological Distress, Psychotropic Prescribing, Fatigue, and Sleep Problems Among UK Primary Care Patients.
Association of SARS-CoV-2 Infection With Psychological Distress, Psychotropic Prescribing, Fatigue, and Sleep Problems Among UK Primary Care Patients.
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DOI：
10.1001/jamanetworkopen.2021.34803
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发表时间：
2021-11-01
影响因子：
13.8
通讯作者：
Pierce M
中科院分区：
文献类型：
--
作者：
Abel KM;Carr MJ;Ashcroft DM;Chalder T;Chew-Graham CA;Hope H;Kapur N;McManus S;Steeg S;Webb RT;Pierce M
SARS-CoV-2感染是否与后续精神病发病、睡眠问题或疲劳的风险相关？在这项队列研究中，11923105例患者的医疗记录，包括226521例SARS-CoV-2感染患者，虽然感染与睡眠问题和疲劳的风险增加有关，但与随后的精神病发病率的相关性是混合的。这些研究结果表明，在没有充分控制混杂因素的卫生保健记录分析中，与SARS-CoV-2感染相关的精神病发病率可能被夸大了。这项队列研究评估了SARS-CoV-2感染与英国个体发生或重复发生精神疾病、疲劳或睡眠问题的风险之间的关系。SARS-CoV-2感染与COVID-19急性期后很长一段时间的疲劳和睡眠问题有关。此外，有人担心SARS-CoV-2感染会导致精神疾病;然而，直接影响的证据并不确定。评估SARS-CoV-2感染后发生或重复发生精神疾病、疲劳或睡眠问题的风险，并根据人口统计学亚组分析变化。这项队列研究使用临床实践研究Datalink Aurum（英国初级保健登记处，11，923，499名16岁或以上的个体）组装了匹配的队列。患者随访时间长达10个月，从2020年2月1日至12月9日。历史数据少于2年或随访少于1周的个人被排除在外。在SARS-CoV-2测试中获得阳性结果的个人，没有先前的精神疾病或焦虑或抑郁，精神病，疲劳或睡眠问题，与基于性别，一般实践和出生年份的最多4个对照相匹配。对照组是SARS-CoV-2检测结果为阴性的个体。数据分析时间为2021年1月至7月。SARS-CoV-2感染，通过聚合酶链反应检测确定。考克斯比例风险模型估计了阳性SARS-CoV-2检测结果与随后的精神病发病率（抑郁、焦虑、精神病或自残）、睡眠问题、疲劳或精神病处方之间的关联。模型校正了合并症、种族、吸烟和体重指数。在11923105名合格个体中（6011020 [50.4%]女性和5912085 [49.6%]男性;中位数[IQR]年龄为44 [30-61]岁），232780人（2.0%）在SARS-CoV-2测试中呈阳性结果。在应用选择标准后，86922人在匹配队列中没有既往精神疾病，19020人有既往焦虑或抑郁，1036人有精神病，4152人有疲劳，4539人有睡眠问题。调整观察到的混杂因素后，SARS-CoV-2阳性检测结果与精神病发病率（调整后风险比[aHR]，1.83; 95%CI，1.66-2.02）、疲劳（aHR，5.98; 95%CI，5.33-6.71）和睡眠问题（aHR，3.16; 95%CI，2.64-3.78）之间存在相关性。然而，对于SARS-CoV-2检测结果呈阴性的人来说，精神病发病的风险相似（aHR，1.71; 95%CI，1.65-1.77），并且与流感相关的风险增加幅度更大（aHR，2.98; 95%CI，1.55-5.75）。在这项针对大流行期间在英国初级保健实践中注册的个人的队列研究中，有一致的证据表明SARS-CoV-2感染与疲劳和睡眠问题的风险增加有关。然而，阴性对照分析的结果表明，未观察到的混杂因素可能是COVID-19和精神病发病率之间至少部分正相关的原因。
Is SARS-CoV-2 infection associated with risk of subsequent psychiatric morbidity, sleep problems, or fatigue? In this cohort study of the health care records of 11 923 105 patients, including 226 521 patients with SARS-CoV-2 infection, while infection was associated with increased risk of sleep problems and fatigue, associations with subsequent psychiatric morbidity were mixed. These findings suggest that psychiatric morbidity associated with SARS-CoV-2 infection may be overstated in analyses of health care records that do not sufficiently control for confounding. This cohort study assesses the association of SARS-CoV-2 infection with risk of incident or repeat psychiatric illness, fatigue, or sleep problems among individuals in the UK. Infection with SARS-CoV-2 is associated with fatigue and sleep problems long after the acute phase of COVID-19. In addition, there are concerns of SARS-CoV-2 infection causing psychiatric illness; however, evidence of a direct effect is inconclusive. To assess risk of risk of incident or repeat psychiatric illness, fatigue, or sleep problems following SARS-CoV-2 infection and to analyze changes according to demographic subgroups. This cohort study assembled matched cohorts using the Clinical Practice Research Datalink Aurum, a UK primary care registry of 11 923 499 individuals aged 16 years or older. Patients were followed-up for up to 10 months, from February 1 to December 9, 2020. Individuals with less than 2 years of historical data or less than 1 week follow-up were excluded. Individuals with positive results on a SARS-CoV-2 test without prior mental illness or with anxiety or depression, psychosis, fatigue, or sleep problems were matched with up to 4 controls based on sex, general practice, and year of birth. Controls were individuals who had negative SARS-CoV-2 test results. Data were analyzed from January to July 2021. SARS-CoV-2 infection, determined via polymerase chain reaction testing. Cox proportional hazard models estimated the association between a positive SARS-CoV-2 test result and subsequent psychiatric morbidity (depression, anxiety, psychosis, or self-harm), sleep problems, fatigue, or psychotropic prescribing. Models adjusted for comorbidities, ethnicity, smoking, and body mass index. Of 11 923 105 eligible individuals (6 011 020 [50.4%] women and 5 912 085 [49.6%] men; median [IQR] age, 44 [30-61] years), 232 780 individuals (2.0%) had positive result on a SARS-CoV-2 test. After applying selection criteria, 86 922 individuals were in the matched cohort without prior mental illness, 19 020 individuals had prior anxiety or depression, 1036 individuals had psychosis, 4152 individuals had fatigue, and 4539 individuals had sleep problems. After adjusting for observed confounders, there was an association between positive SARS-CoV-2 test results and psychiatric morbidity (adjusted hazard ratio [aHR], 1.83; 95% CI, 1.66-2.02), fatigue (aHR, 5.98; 95% CI, 5.33-6.71), and sleep problems (aHR, 3.16; 95% CI, 2.64-3.78). However, there was a similar risk of incident psychiatric morbidity for those with a negative SARS-CoV-2 test results (aHR, 1.71; 95% CI, 1.65-1.77) and a larger increase associated with influenza (aHR, 2.98; 95% CI, 1.55-5.75). In this cohort study of individuals registered at an English primary care practice during the pandemic, there was consistent evidence that SARS-CoV-2 infection was associated with increased risk of fatigue and sleep problems. However, the results from the negative control analysis suggest that unobserved confounding may be responsible for at least some of the positive association between COVID-19 and psychiatric morbidity.
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DOI：
10.1097/ede.0b013e3181d61eeb
发表时间：
2010-05
期刊：
Epidemiology (Cambridge, Mass.)
影响因子：
--
作者：
Lipsitch M;Tchetgen Tchetgen E;Cohen T
通讯作者：
Cohen T
影响因子：
64.3
作者：
Pierce, Matthias;McManus, Sally;Hope, Holly;Hotopf, Matthew;Ford, Tamsin;Hatch, Stephani L.;John, Ann;Kontopantelis, Evangelos;Webb, Roger T.;Wessely, Simon;Abel, Kathryn M.
通讯作者：
Abel, Kathryn M.
影响因子：
64.8
作者：
Al-Aly, Ziyad;Xie, Yan;Bowe, Benjamin
通讯作者：
Bowe, Benjamin
影响因子：
6.6
作者：
Serrano-Ripoll, Maria J.;Meneses-Echavez, Jose F.;Goncalves-Bradley, Daniela C.
通讯作者：
Goncalves-Bradley, Daniela C.
影响因子：
13.8
作者：
Liao TF;De Maio F
通讯作者：
De Maio F