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Lancet Psychiatry, Published: September 17, 2020 | https://doi.org/10.1016/S2215-0366(20)30421-1 Association between mental illness and COVID-19 susceptibility and clinical outcomes in South Korea: a nationwide cohort study

Prof Seung Won Lee MD^a,†, Jee Myung Yang PhD^b,†, Sung Yong Moon BS^a, Prof In Kyung Yoo PhD^c, Prof Eun Kyo Ha MD^g, Prof So Young Kim PhD^d, Un Min Park BS^h, Sejin Choi MDⁱ, Prof Sang-Hyuk Lee PhD^e, Prof Yong Min Ahn PhD^j, Prof Jae-Min Kim MD^k, Hyun Yong Koh PhD^l,†, Dong Keon Yon MD^f,m,*

^aDepartment of Data Science, Sejong University College of Software Convergence, Seoul, South Korea
^bDepartment of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
^cDepartment of Gastroenterology, CHA University School of Medicine, Seongnam, South Korea
^dDepartment of Otorhinolaryngology, Head and Neck Surgery, CHA University School of Medicine, Seongnam, South Korea
^eDepartment of Psychiatry, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, South Korea
^fDepartment of Pediatrics, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, South Korea
^gDepartment of Pediatrics, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea
^hSchool of Stomatology, Capital Medical University, Beijing, China
ⁱSeoul Detention Center, Ministry of Justice, South Korea
^jDepartment of Psychiatry and Behavioral Science, Institute of Human Behavioral Medicine, Seoul National University College of Medicine, Seoul, South Korea
^kDepartment of Psychiatry, Chonnam National University Medical School, Gwangju, South Korea
^lFM Kirby Neurobiology Center, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
^mArmed Force Medical Command, Republic of Korea Armed Forces, Seongnam, South Korea

^†Contributed equally

^*Corresponding author

Abstract

Background
Evidence for the associations between mental illness and the likelihood of a positive severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) test result and the clinical outcomes of COVID-19 is scarce. We aimed to investigate these associations with data from a national register in South Korea.

Methods
A nationwide cohort study with propensity score matching was done in South Korea using data collected from the Health Insurance Review and Assessment Service of Korea. We defined mental illness as present if one of the relevant ICD-10 codes was recorded at least twice within 1 year for an outpatient or inpatient. Severe mental illness was considered as non-affective or affective disorders with psychotic features. We included all patients aged older than 20 years who were tested for SARS-CoV-2 through services facilitated by the Korea Centers for Disease Control and Prevention, the Health Insurance Review and Assessment Service of Korea, and the Ministry of Health and Welfare, South Korea. We investigated the primary outcome (SARS-CoV-2 test positivity) in the entire cohort and the secondary outcomes (severe clinical outcomes of COVID-19: death, admission to the intensive care unit, or invasive ventilation) among those who tested positive.

Findings
Between Jan 1 and May 15, 2020, 216 418 people were tested for SARS-CoV-2, of whom 7160 (3·3%) tested positive. In the entire cohort with propensity score matching, 1391 (3·0%) of 47 058 patients without a mental illness tested positive for SARS-CoV-2, compared with 1383 (2·9%) of 48 058 with a mental illness (adjusted odds ratio [OR] 1·00, 95% CI 0·93–1·08). Among the patients who tested positive for SARS-CoV-2, after propensity score matching, 109 (8·3%) of 1320 patients without a mental illness had severe clinical outcomes of COVID-19 compared with 128 (9·7%) of 1320 with a mental illness (adjusted OR 1·27, 95% CI 1·01–1·66).

Interpretation
Diagnosis of a mental illness was not associated with increased likelihood of testing positive for SARS-CoV-2. Patients with a severe mental illness had a slightly higher risk for severe clinical outcomes of COVID-19 than patients without a history of mental illness. Clinicians treating patients with COVID-19 should be aware of the risk associated with pre-existing mental illness.

논문정보

형식Research article
게재일2020년 09월 (BRIC 등록일 2020-09-22)
연구진국내(교신)+국외 연구진
분야 의약학 > 응용의학
피인용횟수60회 이상 인용된 논문 (상위피인용논문 등록일 2021-10-28)

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