Importance Heterogeneous evidence exists for the association between COVID-19 and the clinical outcomes of patients with mental health disorders. It remains unknown whether patients with COVID-19 and mental health disorders are at increased risk of mortality and should thus be targeted as a high-risk population for severe forms of COVID-19. Objective To determine whether patients with mental health disorders were at increased risk of COVID-19 mortality compared with patients without mental health disorders. Data Sources For this systematic review and meta-analysis, MEDLINE, Web of Science, and Google Scholar were searched from inception to February 12, 2021. Bibliographies were also searched, and the corresponding authors were directly contacted. The search paradigm was based on the following combination: (mental, major[MeSH terms]) AND (COVID-19 mortality[MeSH terms]). To ensure exhaustivity, the term mental was replaced by psychiatric, schizophrenia, psychotic, bipolar disorder, mood disorders, major depressive disorder, anxiety disorder, personality disorder, eating disorder, alcohol abuse, alcohol misuse, substance abuse, and substance misuse. Study Selection Eligible studies were population-based cohort studies of all patients with identified COVID-19 exploring the association between mental health disorders and mortality. Data Extraction and Synthesis Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline was used for abstracting data and assessing data quality and validity. This systematic review is registered with PROSPERO. Main Outcomes and Measures Pooled crude and adjusted odds ratios (ORs) for the association of mental health disorders with mortality were calculated using a 3-level random-effects (study/country) approach with a hierarchical structure to assess effect size dependency. Results In total, 16 population-based cohort studies (data from medico-administrative health or electronic/medical records databases) across 7 countries (1 from Denmark, 2 from France, 1 from Israel, 3 from South Korea, 1 from Spain, 1 from the UK, and 7 from the US) and 19 086 patients with mental health disorders were included. The studies covered December 2019 to July 2020, were of good quality, and no publication bias was identified. COVID-19 mortality was associated with an increased risk among patients with mental health disorders compared with patients without mental health disorders according to both pooled crude OR (1.75 [95% CI, 1.40-2.20]; P < .05) and adjusted OR (1.38 [95% CI, 1.15-1.65]; P < .05). The patients with severe mental health disorders had the highest ORs for risk of mortality (crude OR: 2.26 [95% CI, 1.18-4.31]; adjusted OR: 1.67 [95% CI, 1.02-2.73]). Conclusions and Relevance In this systematic review and meta-analysis of 16 observational studies in 7 countries, mental health disorders were associated with increased COVID-19-related mortality. Thus, patients with mental health disorders should have been targeted as a high-risk population for severe forms of COVID-19, requiring enhanced preventive and disease management strategies. Future studies should more accurately evaluate the risk for patients with each mental health disorder. However, the highest risk seemed to be found in studies including individuals with schizophrenia and/or bipolar disorders.

中文翻译：

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7 个国家的 COVID-19 患者心理健康障碍与死亡率之间的关联：系统评价和荟萃分析。

重要性 存在关于 COVID-19 与精神健康障碍患者临床结果之间关联的异质证据。目前尚不清楚患有 COVID-19 和精神健康障碍的患者是否有更高的死亡风险，因此应将其作为严重形式的 COVID-19 的高危人群。目的 确定与没有精神疾病的患者相比，精神疾病患者的 COVID-19 死亡风险是否增加。数据来源 对于本系统评价和荟萃分析，检索了 MEDLINE、Web of Science 和 Google Scholar 从开始到 2021 年 2 月 12 日的时间。还检索了参考书目，并直接联系了相应的作者。搜索范式基于以下组合：（心理，主要[MeSH 术语]）和（COVID-19 死亡率[MeSH 术语]）。为了确保详尽无遗，术语精神被精神病、精神分裂症、精神病、双相情感障碍、情绪障碍、重度抑郁症、焦虑症、人格障碍、饮食失调、酗酒、酒精滥用、物质滥用和物质滥用所取代。研究选择 符合条件的研究是对所有确诊 COVID-19 患者的基于人群的队列研究，探索精神健康障碍与死亡率之间的关联。数据提取和综合系统评价和荟萃分析的首选报告项目 (PRISMA) 报告指南用于提取数据和评估数据质量和有效性。该系统评价已在 PROSPERO 注册。主要结果和措施 使用具有分级结构的 3 级随机效应（研究/国家）方法计算精神健康障碍与死亡率相关性的汇总粗略和调整优势比 (OR)，以评估效应大小依赖性。结果 共有 16 个基于人群的队列研究（数据来自医疗行政健康或电子/医疗记录数据库），来自 7 个国家（1 个来自丹麦，2 个来自法国，1 个来自以色列，3 个来自韩国，1 个来自西班牙，1 个来自英国和 7 名来自美国）和 19 086 名精神疾病患者被纳入研究。研究涵盖2019年12月至2020年7月，质量良好，未发现发表偏倚。根据汇总的粗 OR (1.75 [95% CI, 1.40-2.20]; P < .05) 和调整后的 OR ( 1.38 [95% CI, 1.15-1.65]；P < .05)。患有严重精神疾病的患者死亡风险的 OR 最高（粗 OR：2.26 [95% CI，1.18-4.31]；调整后的 OR：1.67 [95% CI，1.02-2.73]）。结论和相关性 在这项对 7 个国家的 16 项观察性研究进行的系统评价和荟萃分析中，精神健康障碍与 COVID-19 相关死亡率增加有关。因此，精神健康障碍患者应该作为严重形式的 COVID-19 的高危人群，需要加强预防和疾病管理策略。未来的研究应该更准确地评估每种精神疾病患者的风险。然而，似乎在包括精神分裂症和/或双相情感障碍患者在内的研究中发现的风险最高。