Associations between psychiatric disorders, COVID-19 testing probability and COVID-19 testing results: Findings from a population-based study
Abstract
Objective
To compare prevalence of COVID-19 testing and test outcomes among individuals with psychiatric disorders to those without such diagnoses, and to examine the associations of testing probability and outcome with psychiatric diagnosis categories.
Design
Large population-based study to perform association analyses of psychiatric disorder diagnoses with COVID-19 testing probability and such test results, by using two-sided Fisher exact tests and logistic regressions.
Setting
UK Biobank.
Participants
1 474 men and women of British ancestry that had been tested for COVID-19, with a mean age of 58.2 years.
Main outcome measures
COVID-19 testing probability and COVID-19 test results.
Results
Individuals with psychiatric disorders were overrepresented among the 1 474 UKB participants with test data: 23% of the COVID-19 test sample had a psychiatric diagnosis compared to 10% in the full cohort (p<0.0001). This overrepresentation persisted for each of the specific psychiatric disorders tested. Furthermore, individuals with a psychiatric disorder (p=0.01), particularly with substance use disorder (p<0.005), had negative test results significantly more often than individuals without psychiatric disorders. Sensitivity analyses confirmed our results.
Conclusions
In contrast with our hypotheses, UKB participants with psychiatric disorders have been tested for COVID-19 more frequently than individuals without a psychiatric history, pleading against the notion that limited health care access is preventing them from undergoing testing. Among those tested, test outcomes were more frequently negative for UKB participants with psychiatric disorders than in others, countering arguments that people with psychiatric disorders are particularly prone to contract the virus.
SUMMARY BOX
What is already known on this topic (2–3 sentences)
We searched PubMed using the terms "COVID-19" combined with "mental health", "psychiatric disorder" or "mental illness" for all articles published in any language before April 21st, 2020. Two hundred articles were retrieved, most of which related to the Chinese experience when dealing with the pandemic, including the mental health impact of the COVID-19 pandemic on general population mental health and healthcare workers; and on advancing mental healthcare resources in times of crisis. No evidence was found on testing patterns for severe acute respiratory syndromes (e.g. COVID-19, SARS, MERS) or Ebola virus on people with psychiatric disorders.
What this study adds (2–3 sentences)
We highlight a positive association between psychiatric disorders and the likelihood of being tested for COVID-19, as well as an association between psychiatric disorders and negative results. The results thus counter arguments that patients with psychiatric disorders are suffering from limited health care access preventing them from undergoing testing. Additionally, these are important findings as they carry the potential to reduce stigma: while people in the general population may be concerned that patients with psychiatric disorders do not comply with containment measures and are susceptible to contract COVID-19, our findings may help counter such concerns.
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