Psychiatric Predictors of COVID-19 Outcomes in a Skilled Nursing Facility Cohort

Cercy, S. P.

Several medical risk factors for COVID-19 have been identified. However, additional factors likely account for some of the observed variability in COVID-19 outcomes. We examined the relationships between chronic psychiatric disorders and COVID-19 morbidity and mortality. Medical records from a cohort of 141 skilled nursing facility residents were reviewed. Multivariate logistic regression modeling determined psychiatric predictors for hospital admission, intensive care unit (ICU) admission, and mortality after controlling for medical risk factors. After controlling for all medical risk, altered mental status (AMS) was a predictor of hospital admission (p = .005), ICU admission (p = .015), and mortality (p = .006). Anxiety (p = .008) and dementia (p = .040) were also associated with an elevated risk of death. A simplified model yielded comparable findings. AMS was associated with a greater risk of hospital admission (p = .002), ICU admission (p = .024), and mortality (p = .006); anxiety (p = .002) was also a powerful predictor of mortality. After accounting for medical risk, morbidity and mortality due to COVID-19 are higher than expected in patients with chronic anxiety disorders, dementia, and AMS. Mechanisms underlying adverse outcomes remain to be determined. Links to neuroendocrine modulation, inflammation, and immune functioning are considered. Furthermore, outcomes in patients with dementia and AMS suggest COVID-19 poses substantial risk to the brain.