Schizophrenia, Bipolar, or Major Depressive Disorder and Postacute Sequelae of COVID-19

Abstract

Importance: Given the increased vulnerability to COVID-19 among those with a serious mental illness (SMI), it remains unclear whether these individuals face a higher risk of developing postacute sequelae of SARS-CoV-2 (PASC). Understanding this association could inform secondary prevention efforts. Objective: To identify the risk of developing PASC in patients with an SMI. Design, Setting, and Participants: This longitudinal cohort study used data derived from large-scale electronic health records (EHRs) between March 2020 and April 2023, inclusive of 180-day follow-up. Patients included adults aged 21 years or older with a confirmed COVID-19 infection evidenced by a relevant laboratory result, diagnosis, or prescription order. Exposures: Evidence of an SMI diagnosis (schizophrenia, bipolar disorder, or recurrent major depressive disorder) recorded before COVID-19 infection. Main Outcomes and Measures: Evidence of PASC symptoms within 30 to 180 days' follow-up after COVID-19 infection reported as odds ratios (OR) mutually adjusted for age, sex, race and ethnicity, insurance type, Charlson Comorbidity Index (CCI) score, and COVID-19 severity. Results: A total of 1625857 patients with a COVID-19 infection were included (mean [SD] age, 52 [17] years; 998237 [61.4%] female, 204237 [12.6%] non-Hispanic Black, 219220 [13.5%] Hispanic, 833411 [51.3%] non-Hispanic White, and 1228664 [75.6%] urban patients), of whom 258523 (15.9%) had an SMI and 403641 (24.8%) developed PASC. Individuals with an SMI had increased adjusted odds of developing PASC (OR, 1.10; 95% CI, 1.08-1.11; P