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The risk of hospitalization for psychotic disorders following hospitalization for COVID-19: a French nationwide longitudinal study

Abstract

COVID-19, like other infectious diseases, may be a risk factor for psychotic disorders. We aimed to compare the proportions of hospitalizations for psychotic disorders in the 12 months following discharge from hospital for either COVID-19 or for another reason in the adult general population in France during the first wave of the pandemic. We conducted a retrospective longitudinal nationwide study using the national French administrative healthcare database. Psychotic disorders were first studied as a whole, and then chronic and acute disorders separately. The role of several adjustment factors, including sociodemographics, a history of psychotic disorder, the duration of the initial hospitalization, and the level of care received during that hospitalization, were also analyzed. Between 1 January 2020 and 30 June 2020, a total of 14,622 patients were hospitalized for psychotic disorders in the 12 months following discharge from hospital for either COVID-19 or another reason. Initial hospitalization for COVID-19 (vs. another reason) was associated with a lower rate of subsequent hospitalization for psychotic disorders (0.31% vs. 0.51%, odds ratio (OR) = 0.60, 95% confidence interval (CI) [0.53-0.67]). This was true for both chronic and acute disorders, even after adjusting for the various study variables. Importantly, a history of psychotic disorder was a major determinant of hospitalization for psychotic disorders (adjusted OR = 126.56, 95% CI [121.85-131.46]). Our results suggest that, in comparison to individuals initially hospitalized for another reason, individuals initially hospitalized for COVID-19 present a lower risk of hospitalization for first episodes of psychotic symptoms/disorders or for psychotic relapse in the 12 months following discharge. This finding contradicts the hypothesis that there is a higher risk of psychotic disorders after a severe COVID-19.

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Fig. 1: Rate of hospitalization for psychotic disorders after hospitalization during the first wave of the COVID-19 pandemic.

Data availability

The SNDS (National French administrative healthcare database) comprises a set of strictly pseudonymized databases. By law, Santé Publique France, the French agency for public health, has permanent regulatory access to SNDS data for the performance of its missions (article L.1461-3 and R1461-13 and following of the French public health code [37]). Access to personal data in these systems for research purposes is subject to obtaining authorization from the CNIL (National Commission on Information Technology and Civil Liberties), after approval from the Comité éthique et scientifique pour les recherches, les études et les évaluations dans le domaine de la santé (CESREES, Ethics and Scientific Committee for Research, Studies and Evaluation in the field of health).

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Acknowledgements

We thank Guillaume Airagnes, Christine Chan Chee, Mounia El Yamani, Anne Gallay, Catherine Ha, Mathilde Horn, Maria Melchior and Claudie Menguy, whose insight and expertize enhanced the quality of this study. We are also very grateful to Jude Sweeney for copyediting comments which greatly improved the manuscript. Cédric Lemogne and Baptiste Pignon were supported by a grant “AAP Covid long 2022-1” from the Agence nationale de recherches sur le sida et les hépatites virales (ANRS) | Maladies infectieuses émergentes.

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Baptiste Pignon: ORCID: 0000-0003-0526-3136. Substantial contribution to the conception and design of the research presented; Data interpretation; Drafting the manuscript; Final approval of the version to be published; Agrees to be accountable for all aspects of the research presented and ensures that questions related to the accuracy and integrity of all parts of the research will be appropriately investigated and resolved. Valentina Decio: Substantial contribution to the conception and design of the research presented; Acquisition, analysis, and interpretation of data for the work; Drafting the manuscript; Final approval of the version to be published; Agrees to be accountable for all aspects of the research presented and ensures that questions related to the accuracy and integrity of all parts of the research will be appropriately investigated and resolved. Philippe Pirard: Substantial contribution to the conception and design of the research presented,; Data interpretation; Drafting the manuscript; Final approval of the version to be published; Agrees to be accountable for all aspects of the research presented and ensures that questions related to the accuracy and integrity of all parts of the research will be appropriately investigated and resolved. Olivier Bouaziz: ORCID:  0000-0003-3556-9531 Substantial contributions to the conception or design of the work; Iinterpretation of data for the work; Revising the work critically for important intellectual content; Final approval of the version to be published; Agrees to be accountable for all aspects of the research presented and ensures that questions related to the accuracy and integrity of all parts of the research will be appropriately investigated and resolved. Emmanuelle Corruble: Substantial contributions to the conception or design of the work; Interpretation of data for the work; Revising the work critically for important intellectual content; Final approval of the version to be published; Agrees to be accountable for all aspects of the research presented and ensures that questions related to the accuracy and integrity of all parts of the research will be appropriately investigated and resolved. Pierre A. Geoffroy: ORCID: 0000-0001-9121-209X. Substantial contributions to the interpretation of data for the work; Revising the work critically for important intellectual content; Final approval of the version to be published; Agrees to be accountable for all aspects of the research presented and ensures that questions related to the accuracy and integrity of all parts of the research will be appropriately investigated and resolved. Viviane Kovess-Masfety: Substantial contributions to the conception or design of the work; interpretation of data for the work; Revising the work critically for important intellectual content; Final approval of the version to be published; Agrees to be accountable for all aspects of the research presented and ensures that questions related to the accuracy and integrity of all parts of the research will be appropriately investigated and resolved. Marion Leboyer: ORCID: 0000-0001-5473-3697. Substantial contributions to the interpretation of data for the work; Revising the work critically for important intellectual content; Final approval of the version to be published; Agrees to be accountable for all aspects of the research presented and ensures that questions related to the accuracy and integrity of all parts of the research will be appropriately investigated and resolved. Cédric Lemogne: ORCID: 0000-0002-3487-4721. Substantial contributions to the interpretation of data for the work; Revising the work critically for important intellectual content; Final approval of the version to be published; Agrees to be accountable for all aspects of the research presented and ensures that questions related to the accuracy and integrity of all parts of the research will be appropriately investigated and resolved. Jonathan Messika: Substantial contributions to the conception or design of the work; interpretation of data for the work; Revising the work critically for important intellectual content; Final approval of the version to be published; Agrees to be accountable for all aspects of the research presented and ensures that questions related to the accuracy and integrity of all parts of the research will be appropriately investigated and resolved. Vittorio Perduca: ORCID: 0000-0003-0339-0473. Substantial contributions to the conception or design of the work; interpretation of data for the work; Revising the work critically for important intellectual content; Final approval of the version to be published; Agrees to be accountable for all aspects of the research presented and ensures that questions related to the accuracy and integrity of all parts of the research will be appropriately investigated and resolved. Franck Schürhoff: Substantial contributions to the interpretation of data for the work; Revising the work critically for important intellectual content; Final approval of the version to be published; Agrees to be accountable for all aspects of the research presented and ensures that questions related to the accuracy and integrity of all parts of the research will be appropriately investigated and resolved. Nolwenn Regnault: Substantial contributions to the conception or design of the work; Revising the work critically for important intellectual content; Final approval of the version to be published; Agrees to be accountable for all aspects of the research presented and ensures that questions related to the accuracy and integrity of all parts of the research will be appropriately investigated and resolved. Sarah Tebeka: ORCID: 0000 0003 0269 4600. Substantial contributions to the conception and design of the work; Acquisition, analysis, and data interpretation for the work; Drafting the manuscript; Final approval of the version to be published; Agrees to be accountable for all aspects of the research presented and ensures that questions related to the accuracy and integrity of all parts of the research will be appropriately investigated and resolved.

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Correspondence to Baptiste Pignon.

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Competing interests

Prof. Lemogne reports non-financial support from Nordic Pharma France, outside the submitted work. Prof. Messika received congress reimbursement fees from Biotest and CSL Behring. The other authors have no conflicts of interest to declare.

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Supplementary information

Supplementary Table 1. Characteristics of the population.

41380_2023_2207_MOESM2_ESM.docx

Supplementary Table 2. Comparison of patients previously hospitalized for COVID-19 and those previously hospitalized for another reason among persons subsequently hospitalized for any psychotic disord

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Supplementary Table 3. Rates of hospitalization with (i.e., principal or associated diagnosis) or for (i.e., principal diagnosis only) a psychotic disorder after previous hospitalization for COVID-19

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Supplementary Table 4. Rates of hospitalization with a diagnosis a psychotic disorder (i.e., principal or associated diagnosis) in psychiatric ward after previous hospitalization for COVID-19 or for a

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Supplementary Table 5. Association of previous COVID-19 hospitalization with subsequent (12-month) hospitalization with a diagnosis of a psychotic disorder (i.e., principal or associated diagnosis) am

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Supplementary Table 6. Association of previous COVID-19 hospitalization with subsequent (12-month) hospitalization with a diagnosis of an acute psychotic disorder (i.e., principal or associated diagno

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Pignon, B., Decio, V., Pirard, P. et al. The risk of hospitalization for psychotic disorders following hospitalization for COVID-19: a French nationwide longitudinal study. Mol Psychiatry 28, 3293–3304 (2023). https://doi.org/10.1038/s41380-023-02207-8

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