Mental health indicators in Sweden over a 12-month period during the COVID-19 pandemic

BackgroundThe ongoing COVID-19 pandemic has had an unprecedented impact on the lives of people globally and is expected to have profound effects on mental health. Yet, self-reported large-scale online surveys on mental health are still relatively uncommon. Here we aim to describe the mental health burden experienced in Sweden using baseline data of the Omtanke2020 Study. MethodSelf-reported baseline data collected over a 12-month period (June 9, 2020-June 8, 2021) from the longitudinal online survey of the Omtanke2020 Study including 27,950 adults in Sweden. Participants were volunteers or actively recruited through existing cohorts and after providing informed consent responded to monthly online questionnaires on socio-demographics, mental and physical health, COVID-19 infection, and impact. Poisson regression was fitted to assess the relative risk of high mental health burden (depression, anxiety, and COVID-19 specific PTSD). ResultThe overall proportion of persons with high level of symptoms was 15.6%, 9.5% and 24.5% for depression, anxiety, and COVID-19 specific PTSD, respectively. Overall, 43.4% of the participants had significant, clinically relevant symptoms for at least one mental health outcome and 7.3% had significant symptoms for all three outcomes. We also observed differences in the prevalence of these symptoms across strata of sex, age, recruitment type, COVID-19 status, region, and seasonality. ConclusionWhile the proportion of persons with high mental health burden remains higher than in pre-pandemic publications, our estimates are lower than previously reported levels of depression, anxiety, and PTSD during the pandemic in Sweden and elsewhere.

Genetic predisposition to psychiatric disorders and risk of COVID-19

BackgroundPre-pandemic psychiatric disorders have been associated with an increased risk of COVID-19. However, the underlying mechanisms remain unknown, e.g. to what extent genetic predisposition to psychiatric disorders contributes to the observed association. MethodsThe analytic sample consisted of white British participants of UK Biobank registered in England, with available genetic data, and alive on Jan 31, 2020 (i.e., the start of the COVID-19 outbreak in the UK) (n=346,554). We assessed individuals genetic predisposition to different psychiatric disorders, including substance misuse, depression, anxiety, and psychotic disorder, using polygenic risk score (PRS). Diagnoses of psychiatric disorders were identified through the UK Biobank hospital inpatient data. We performed a GWAS analysis for each psychiatric disorder in a randomly selected half of the study population who were free of COVID-19 (i.e., the base dataset). For the other half (i.e., the target dataset), PRS was calculated for each psychiatric disorder using the discovered genetic variants from the base dataset. We then examined the association between PRS of each psychiatric disorder and risk of COVID-19, or severe COVID-19 (i.e., hospitalization and death), using logistic regression models. The ascertainment of COVID-19 was through the Public Health England dataset, the UK Biobank hospital inpatient data and death registers, updated until July 26, 2020. For validation, we repeated the PRS analyses based on publicly available GWAS summary statistics. Results155,988 participants (including 1,451 COVID-19 cases), with a mean age of 68.50 years at COVID-19 outbreak, were included for PRS analysis. Higher genetic liability forwards psychiatric disorders was associated with increased risk of both any COVID-19 and severe COVID-19, especially genetic risk for substance misuse and depression. The adjusted odds ratios (ORs) for any COVID-19 were 1.15 (95% confidence interval [CI] 1.02-1.31) and 1.26 (1.11-1.42) among individuals with a high genetic risk (above the upper tertile of PRS) for substance misuse and depression, respectively, compared with individuals with a low genetic risk (below the lower tertile). Largely similar ORs were noted for severe COVID-19 and similar albeit slightly lower estimates using PRSs generated from GWAS summary statistics from independent samples. ConclusionIn the UK Biobank, genetic predisposition to psychiatric disorders was associated with an increased risk of COVID-19, including severe course of the disease. These findings suggest the potential role of genetic factors in the observed phenotypic association between psychiatric disorders and COVID-19, underscoring the need of increased medical surveillance of for this vulnerable population during the pandemic.

Excess cardiovascular deaths in the beginning of COVID-19 outbreak

ImportanceThe healthcare demand created by the COVID-19 pandemic was far beyond the hospital surge capacity in many countries, resulting in possible negative influence on prognosis of other severe diseases, such as cardiovascular disease (CVD). ObjectiveTo assess the impact of the COVID-19 outbreak on CVD-related hospitalizations and mortality. DesignCommunity-based prospective cohort study. Setting the UK Biobank population. Participants421,717 UK Biobank participants who were registered in England and alive on December 1st 2019. Main outcomes and measuresThe primary outcome of interest was CVD death, as deaths with CVD as a cause of death according to the death registers. We retrieved information on hospitalizations with CVD as the primary diagnosis based on the UK Biobank hospital inpatient data. The study period was between December 1st 2019 and May 30th 2020, and we used the same calendar period of the three preceding years as the reference period. Standardized mortality/incidence ratios (SMRs/SIRs) with 95% confidence intervals were used to estimate the relative risk of CVD outcomes during the study period, compared with the reference period, to control for seasonal variations and aging of the study population. ResultsWe observed a distinct increase in CVD-related deaths in March and April 2020 as compared to the corresponding months of the three preceding years. The observed number of CVD death (n=217) was almost doubled in April, compared with the expected number (n=120), corresponding to an SMR of 1.81 (95% CI 1.58-2.06). We observed a sharp decline of CVD hospitalization in March (n=841) and April (n=454), compared with the expected number (n=1208 for March and 1026 for April), leading to an SIR of 0.70 (95% CI 0.65-0.74) for March and 0.44 (95% CI 0.40-0.48) for April. There was also a clear increase of death, but a clear decrease of hospitalization, in March and April for all the five major subtypes of CVD. ConclusionsWe observed a distinct excess in CVD deaths in the beginning of the COVID-19 outbreak in the UK Biobank population. In addition to CVD complications of SARS-CoV-2 infections, the reduced hospital capacity might have contributed to the observed excess CVD deaths. Key PointsO_ST_ABSQuestionC_ST_ABSHow did the COVID-19 outbreak affect rates of CVD-related death and hospitalization? FindingIn this prospective study involving 421,717 UK Biobank participants, we observed excess CVD-related mortality in parallel with decreased CVD-related hospitalization in the beginning of the COVID-19 pandemic, March and April 2020. MeaningIn addition to severe SARS-CoV-2 infection progressing to CVD-related death, reduced hospital resources might have partially contributed to the excess CVD mortality.

Pre-pandemic psychiatric disorders and risk of COVID-19: a cohort analysis in the UK Biobank

ObjectiveTo determine the association between pre-pandemic psychiatric disorders and the risk of COVID-19. DesignCommunity-based prospective cohort study. SettingUK Biobank population. Participants421,048 participants who were recruited in England and alive by January 31st 2020, i.e., the start of COVID-19 outbreak in the UK. 50,815 individuals with psychiatric disorders recorded in the UK Biobank inpatient hospital data before the outbreak were included in the exposed group, while 370,233 participants without such conditions were in the unexposed group. MeasurementsWe obtained information on positive results of COVID-19 test as registered in the Public Health England, COVID-19 related hospitalizations in the UK Biobank inpatient hospital data, and COIVD-19 related deaths from the death registers. We also identified individuals who was hospitalized for infections other than COVID-19 during the follow-up. Logistic regression models were used to estimate odds ratios (ORs) with 95% confidence intervals (CIs), controlling for multiple confounders. ResultsThe mean age at outbreak was 67.8 years and around 43% of the study participants were male. We observed an elevated risk of COVID-19 among individuals with pre-pandemic psychiatric disorder, compared with those without such diagnoses. The fully adjusted ORs were 1.44 (95%CI 1.27 to 1.64), 1.67 (1.42 to 1.98), and 2.03 (1.56 to 2.63) for any COVID-19, inpatient COVID-19, COVID-19 related death, respectively. The excess risk was observed across all levels of somatic comorbidities and subtypes of pre-pandemic psychiatric disorders, while further increased with greater number of pre-pandemic psychiatric disorders. We also observed an association between pre-pandemic psychiatric disorders and increased risk of hospitalization for other infections (1.85 [1.65 to 2.07]). ConclusionsPre-pandemic psychiatric disorders are associated with increased risk of COVID-19, especially severe and fatal COVID-19. The similar association observed for hospitalization for other infections suggests a shared pathway between psychiatric disorders and different infections, including altered immune responses. Summary boxO_ST_ABSWhat is already known on this topic?C_ST_ABSPsychiatric morbidities have been associated with risks of severe infections through compromised immunity and/or health-behaviors. While recent studies showed that unhealthy lifestyle and psychosocial factors (including self-reported psychological distress) increased the risk of COVID-19 hospitalization, data on the role of clinically confirmed psychiatric disorders in COVID-19 susceptibility are to date absent. What this study adds?Using the large community-based data in UK Biobank, our analysis is the first to demonstrate an increase in the risk of COVID-19, especially severe and fatal COVID-19, among individuals with pre-pandemic psychiatric disorders, independently of many important confounders. A similar association was also observed between pre-pandemic psychiatric disorder and hospitalization due to other infections during the COVID-19 outbreak, suggesting a shared pathway between psychiatric disorders and different infections, including altered immune responses. This finding underscores the need of surveillance and care in vulnerable populations with history of psychiatric disorders during the COVID-19 outbreak.