Patient Demographic Characteristics
Of the 2,358,318 patients identified between March 1st 2020 and August 31st, 2021, 689 306 (29.2%) were 46–65 years old, 1 297 358 (55.1%) were female patients, 235 844 (10%) were Black patients, and 152 771 (6.4%) were Hispanic patients (Table 1).
Patients aged 45–64 years had the highest prevalence of COVID-19 hospitalizations among patients with (41.7%) and without (34.5%) prior psychiatric disorder history. Those hospitalized for COVID-19 were more likely to be female (56.1%) and Black (14.5%). Of the 1 460 025 (61.9%) patients without a history of a prior psychiatric disorder, 384, 716 (26.4%) were hospitalized, of which 33.9% were 45–64 years old, 57.7% were female, and 23.8% reported unknown race and ethnicity (Table 2.2).
Prevalence of Psychiatric Disorders by COVID-19 status
Of the 898 293 (36.1%) patients who had a history of psychiatric disorders, 511 733 (56.9%) had a positive COVID-19 test result, from which 263 359 (29.3%) were hospitalized, and 248 374 (27.6%) were not hospitalized. A total of 190 489 (72.3%) hospitalized and 181 818 (73.2%) non-hospitalized COVID-19 patients reported subsequent psychiatric disorders. The most prevalent subsequent psychiatric disorders were mood disorders among COVID-19 patients, either hospitalized (63 966 [33.6%]) or not hospitalized (61 054 [33.6%]), while SUD was the most common among those who tested negative (53 718 [31.2%]).
In contrast, patients without prior psychiatric disorders (1 460 025 [61.9%]) had lower rates of subsequent psychiatric disorders, indicated by 170 352 (44.3%) hospitalized and 190 014 (37.3%) non-hospitalized COVID-19 patients and 218 213 (38.6%) non-COVID-19 patients (Fig. 1). Conversely, SUD was the most prevalent across all the three groups of patients without prior psychiatric disorders: COVID-19 positive and hospitalized 63 439 (37.2%), COVID-19 positive and not hospitalized 78 171 (41.1%), and COVID-19 negative 82 440 (37.8%).
Distributions of psychiatric disorders were not statistically different by hospitalization status among COVID-19 positive patients (eTable 3), except for SUD among patients without a history of psychiatric disorders (P = .04). There were significant differences in the distributions of mood disorders among patients with a history of psychiatric disorders (P = .008) and SUD (P = .04) between COVID-19 tested positive and negative patients. No demographic differences were observed in the prevalence of psychiatric disorders by COVID-19 status.
Trends of Psychiatric Disorders by COVID-19 status and by Prior Psychiatric Disorders
Among patients with prior psychiatric disorders, anxiety disorders peaked in August 2020 for hospitalized (n = 4756, 10.6%) and non-hospitalized (n = 4154, 11.9%) COVID-19 patients (Fig. 2A, Fig. 2B). Mood disorders, psychosis, and SUD all peaked earlier among non-hospitalized COVID-19 patients (in September 2020, December 2020, August 2020) than in hospitalized COVID-19 patients (in February 2021, March 2021, February 2021). However, the highest prevalence rates were greater among hospitalized patients (7463 [11.7%], 3975 [9.7%], 2341 [10.5%] for mood, psychosis, SUD, respectively) than non-hospitalized patients (5472 [9.0%], 2994 [6.7%], 3725 [9%]). Among COVID-19 negative patients (Fig. 2C), the peak of anxiety disorders (July 2020, n = 4993, 11.9%), mood disorders (September 2020, n = 3634, 8.6%), psychosis (January 2021, n = 3199, 9.0%), and substance disorders (December 2020, n = 2847, 7.9%) were earlier than both hospitalized and non-hospitalized COVID-19 patients.
Among those without prior psychiatric disorders, similar trends were observed for anxiety disorders among hospitalized COVID-19 patients (Fig. 2D), with a peak in August 2020 (n = 4669, 12.6%). SUD, however, increased substantially by 10.3% among hospitalized COVID-19 patients (from 6.8–7.5%), 41.0% among non-hospitalized COVID-19 patients (from 6.1–8.6%), and 80.4% among COVID-19 negative patients (from 4.6–8.3%) between March and August 2020. Mood disorders increased by 488.0% (from 2.5–14.7%) and by 390.0% (from 2.0–9.8%), anxiety disorders increased by 373.2% (from 2.6–12.3%) and by 200.0% (from 3.4–10.2%), and psychosis increased by 232.4% (from 3.7–12.3%) and by 234.2% (from 3.8–12.7%) from February 2021 to August 2021 among COVID-19 negative patients and non-hospitalized COVID-19 patients (Figs. 2E-2F).