Risk of adverse outcome of COVID-19 among patients in secure psychiatric services: observational cohort study

Natasa Basrak, Naoise Mulcrone, Sue Sharifuddin, Zeshan Ghumman, Nirvana Bechan, Enas Mohamed, Michael Murray, Hariharan Rajendran, Sean Gunnigle, Mark Nolan, Tim Quane, Masashi Terao, Tracey Hoare, Kevin Kirrane, Harry G Kennedy, Mary Davoren, Natasa Basrak, Naoise Mulcrone, Sue Sharifuddin, Zeshan Ghumman, Nirvana Bechan, Enas Mohamed, Michael Murray, Hariharan Rajendran, Sean Gunnigle, Mark Nolan, Tim Quane, Masashi Terao, Tracey Hoare, Kevin Kirrane, Harry G Kennedy, Mary Davoren

Abstract

Background: Secure forensic mental health services treat patients with high rates of treatment-resistant psychoses. High rates of obesity and medical comorbidities are common. Population-based studies have identified high-risk groups in the event of SARS-CoV-2 infection, including those with problems such as obesity, lung disease and immune-compromising conditions. Structured assessment tools exist to ascertain the risk of adverse outcome in the event of SARS-CoV-2 infection.

Aims: To assess risk of adverse outcome in the event of SARS-CoV-2 infection in a complete population of forensic psychiatry patients using structured assessment tools.

Method: All patients of a national forensic mental health service (n = 141) were rated for risk of adverse outcome in the event of SARS-CoV-2 infection, using two structured tools, the COVID-Age tool and the COVID-Risk tool.

Results: We found high rates of relevant physical comorbidities. Mean chronological age was 45.5 years (s.d. = 11.4, median 44.1), mean score on the COVID-Age tool was 59.1 years (s.d. = 19.4, median 58.0), mean difference was 13.6 years (s.d. = 15.6), paired t = 10.9, d.f. = 140, P < 0.001. Three patients (2.1%) were chronologically over 70 years of age, compared with 43 (30.5%) with a COVID-Age over 70 (χ2 = 6.99, d.f. = 1, P = 0.008, Fisher's exact test P = 0.027).

Conclusions: Patients in secure forensic psychiatric services represent a high-risk group for adverse outcomes in the event of SARS-COV-2 infection. Population-based guidance on self-isolation and other precautions based on chronological age may not be sufficient. There is an urgent need for better physical health research and treatment in this group.

Keywords: COVID-19; forensic mental health services; obesity; risk assessment; schizophrenia.

Conflict of interest statement

None.

Figures

Fig. 1
Fig. 1
Association between COVID-Risk tool score and COVID-Age tool score: Spearman's r = 0.776, P < 0.001, R2 = 0.4947.
Fig. 2
Fig. 2
Mean chronological age and mean COVID-Age score in each hospital unit.

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Source: PubMed

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