The following is a summary of “Hospitalization Associated With Comorbid Psychiatric and Substance Use Disorders Among Adults With COVID-19 Treated in US Emergency Departments From April 2020 to August 2021,” published in the February 2023 issue of Psychiatry by Schieber, et al.

For a retrospective cross-sectional study, researchers sought to evaluate the association between comorbid psychiatric disorders (PDs) and substance use disorders (SUDs) and the probability of hospitalization among emergency department (ED) patients with COVID-19 in the United States.

The study analyzed discharge data from 970 EDs and inpatient hospitals in the US between April 2020 and August 2021. The participants were adults aged ≥18 years and above who received a COVID-19 diagnosis. The study analyzed any past diagnosis of PDs, including ADHD, anxiety, bipolar disorder, major depression, other mood disorder, PTSD, or schizophrenia, and SUDs from opioids, stimulants, alcohol, cannabis, cocaine, sedatives, or other substances. The main outcome measure was any hospitalization. The study calculated the differences in the probability of hospitalization to assess the association of both PD and SUD compared to PD alone, SUD alone, or neither condition.

Among the 1,274,219 adult patients (mean [SD] age, 54.6 [19.1] years; 667,638 women [52.4%]) diagnosed with COVID-19 in EDs and inpatient hospitals in the US from April 2020 to August 2021, 18.6% had a psychiatric disorder (PD) (mean age, 59.0 years; 37.7% men), 4.6% had a substance use disorder (SUD) (mean age, 50.1 years; 61.7% men), and 2.3% had both (mean age, 50.4 years; 53.1% men). The most prevalent PDs were anxiety (12.9%), major depression (9.8%), poly (≥2) PDs (6.4%), and schizophrenia (1.4%). The most common SUDs were alcohol (2.1%), cannabis (1.3%), opioids (1.0%), and poly (≥2) SUDs (0.9%). Patients with PTSD, schizophrenia, other mood disorder, or ADHD had SUD prevalences of over 21%. Based on significant specific PD-SUD pairs (Q < .05), patients with both PD and SUD had a higher probability of hospitalization compared to those with neither condition by a weighted mean of 20 percentage points (range, 6 to 36; IQR, 16 to 25), those with PD alone by 12 percentage points (range, −4 to 31; IQR, 8 to 16), and those with SUD alone by 4 percentage points (range, −7 to 15; IQR, −2 to 7). The association between comorbid PD and SUD and the probability of hospitalization varied by the types of PD and SUD, with SUD being a stronger predictor of hospitalization than PD.

According to the study, patients who had both PD and SUD were more likely to be hospitalized than those who had either disorder alone or neither disorder. PDs and the likelihood of being hospitalized didn’t seem to be as closely related as substance use disorders. Underestimating the likelihood of hospitalization in ED patients with COVID-19 can occur if possible comorbid PD and SUD are overlooked. Both disorders required screening and evaluation.

Reference: https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2801659