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29th July 2021
Patients with mental health problems might be at a greater risk of worse outcomes when infected with COVID-19, especially as such patients often have other co-morbidities, some of which have been identified as risk factors. In addition, mental health problems are associated with low socioeconomic status and which has been linked to a greater risk of critical care admission among those infected with COVID-19. In fact, data collected from several countries has already revealed how severe mental illnesses such as schizophrenia, are a risk factor for greater COVID-19 mortality although other work has concluded that a diagnosis of mental illness was not associated with an increased likelihood of testing positive for COVID-19. While a recent meta-analysis has suggested a pre-diagnosis of mental disorders worsens the prognosis of COVID-19, the analysis had methodological issues and did not examine the effect for individual diagnoses. This led a team from the CEReSS-Health Service Research and Quality of Life Centre, Marseille, France, to undertake a systematic review and meta-analysis of the accumulating evidence on mental health disorders and COVID-19. Their primary objective was simple to determine whether patients with mental health disorders were at an increased risk of COVID-19 mortality compared to those without such problems. A secondary objective was to explore if the presence of a mental health disorder increased the risk of intensive care admission and if there were any mental health conditions that specifically increased the risk of COVID-19 mortality. The team searched for articles which included participants with a diagnosis of a mental health disorder and a clinical diagnosis of COVID-19 and where intensive care unit and mortality data were included. Adjustments were made for the presence of other known risk factors for COVID-19, i.e., co-morbidities, age etc.
A total of 16 population-based cohort studies across seven countries with 19,086 patients were included in the meta-analysis. Overall, the present of mental health disorders was associated with an increased risk of COVID-19 mortality (odds ratio, OR = 1.38, 95% CI 1.15–1.65). In studies where only severe mental illness such as schizophrenia or bipolar disorder were included, the mortality risk was higher (OR = 1.67, 95% CI 1.02–2.73). There was no apparent association between any specific mental health disorder and COVID-19 mortality and there was insufficient data to determine whether mental health disorders were associated with intensive care admission.
Commenting on these findings, the authors suggested that individuals with mental health disorders should be targeted as a high-risk population for severe COVID-19, requiring enhanced disease management strategies. They concluded by calling for future studies to examine the risks associated with individual mental health disorders and to confirm their findings of the link between severe mental health and increased COVID-19 mortality.
Fond G et al. Association Between Mental Health Disorders and Mortality Among Patients With COVID-19 in 7 Countries. A Systematic Review and Meta-analysis. JAMA Psychiatry 2021
23rd July 2021
Healthcare workers are three times more likely to become infected with COVID-19 compared to community individuals. Nevertheless, during viral epidemic outbreaks, an additional burden to healthcare staff is the impact on their mental wellbeing that accompanies the associated increased workload, leading to stress and anxiety. With thousands of patients across the globe developing more severe infection, there has been much focus on management within intensive care units. Such units are a highly demanding environment with staff continually exposed to traumatic and stressful events and a study from 2007, revealed a higher incidence of post-traumatic stress disorder (PTSD) among intensive care nursing staff. Given the high levels of 28-day mortality among patients with COVID-19, this undoubtedly further increases the mental health burden of intensive care staff. However, there is a lack of data specifically examining the mental wellbeing of intensive care staff.
Using an online survey, a team from the Department of Surgery and Cancer, Imperial College Healthcare NHS Trust, Imperial College, London, UK, sought to gain a better understanding of the mental health burden experienced by intensive care staff. The overall aim was to establish the prevalence of indices of depression, insomnia, and PTSD, which the authors suspected would be high among intensive care staff. The survey was conducted among all healthcare professionals working within the intensive care environment and distributed across the UK, France, Italy, Belgium, Egypt, Taiwan and Mainland China.
For the survey, three previously validated questionnaires were included: the two-item patient health questionnaire (PHQ-2) which sought to grade depression severity, an 8-item Athens Insomnia scale (AIS-8) and the 10-item trauma screening questionnaire (TSQ). The corresponding cut-off values for these questionnaires are 3 (PHQ-2), 8 (AIS-8) and 6 (TSQ). As well as these questionnaires, the authors included a series of general questions on wellbeing.
The final cohort included 515 responses from seven different countries and the majority of respondents were female (73%), of white ethnicity (73%) and aged 31–40 years (43.3%). Interestingly, 5.8% of respondents reported a pre-existing mental health condition. Just over half (52.4%) were nurses, with the remainder being senior (13.8%), residents/fellows (8.9%) and junior (6.4%) doctors, physiotherapists and others. Furthermore, nearly two-thirds (60.2%) had been re-deployed from another specialty and only a third (33.8%) were normally based within an intensive care ward.
The median scores were 2, 10 and 3 for PHQ-2, AIS-8 and TSQ respectively. Overall, 37.3%, 78.6% and 27.7% of participants had scores for PHQ-2, AIS-8 and TSQ respectively, that were above the thresholds for each condition. Across the different countries, 16–44% of respondents exceeded the threshold for depression, 60–80% for insomnia and 17–35% for PTSD.
The authors concluded that the COVID-19 pandemic had created a significant mental health burden for intensive care staff and recommended that all such staff have access to mental wellbeing resources, especially given the possibility of further surges in the rates of infection in the future.
Ezzat A. The global mental health burden of COVID-19 on critical care staff. Br J Nurs 2021