Association between mental illness and COVID-19 in South Korea
Authors: Jewel Park, Hye Chang Rhim
Journal: The Lancet Psychiatry (2021)

In their nationwide cohort study, Seung Won Lee and colleagues suggest that patients with a severe mental illness had a slightly higher risk for severe clinical outcomes of COVID-19.1Lee SW Yang JM Moon SY et al.Association between mental illness and COVID-19 susceptibility and clinical outcomes in South Korea: a nationwide cohort study.Lancet Psychiatry. 2020; 7: 1025-1031Summary Full Text Full Text PDF PubMed Scopus (174) Google Scholar Although the authors classified region of residence into urban and rural categories to adjust for potential confounding, the high number of COVID-19 cases in Daegu (the fourth most populous city in South Korea) indicates that bias could remain due to uncontrolled confounding as a result of regional differences. By May 15, 2020, 11 307 COVID-19 cases had been confirmed in South Korea, of which 6869 (60·7%) cases occurred in Daegu.2Ministry of Health and Welfare South KoreaUpdates on COVID-10 in Republic of Korea.http://ncov.mohw.go.kr/en/tcmBoardView.do?brdId=12&brdGubun=125&dataGubun=&ncvContSeq=2385&contSeq=2385&board_id=&gubun=#Date: May 18, 2020Date accessed: October 1, 2020Google Scholar A rapid local outbreak in the region resulted in a severe shortage of more than 2000 hospital beds at the peak of the pandemic.3Kim SW Lee KS Kim K Lee JJ Kim JY A brief telephone severity scoring system and therapeutic living centers solved acute hospital-bed shortage during the COVID-19 outbreak in Daegu, Korea.J Korean Med Sci. 2020; 35: e152Crossref PubMed Scopus (55) Google Scholar More severe clinical outcomes of COVID-19 are likely in settings where health-care facilities are overwhelmed. According to the Korean Statistical Information Service, Daegu has the highest prevalence of severe mental illness in South Korea (1500·8 cases per 100 000 people vs 1205·9 cases per 100 000 people nationally). High prevalence of severe mental illness in the area compounded with the local hospital bed shortage in Daegu might partly explain the association between severe mental illness and severe clinical outcomes of COVID-19 reported by Lee and colleagues. Additionally, clusters of COVID-19 infection were reported at two psychiatric hospitals in Daegu: 120 cases were reported at Cheongdo Daenam Hospital, located approximately 30 km from Daegu, and 192 cases were reported at Second Mi-Ju hospital, located within Daegu.2Ministry of Health and Welfare South KoreaUpdates on COVID-10 in Republic of Korea.http://ncov.mohw.go.kr/en/tcmBoardView.do?brdId=12&brdGubun=125&dataGubun=&ncvContSeq=2385&contSeq=2385&board_id=&gubun=#Date: May 18, 2020Date accessed: October 1, 2020Google Scholar Although these hospitals had inadequate capacity to provide medical care, a lockdown was implemented to contain the virus, thus delaying the transfer of patients to treatment facilities with adequate resources.4Kim MJ How a South Korean psychiatric ward became a 'medical disaster' when coronavirus hit. The Washington Post, Feb 29, 2020https://www.washingtonpost.com/world/asia_pacific/how-a-south-korean-psychiatric-ward-became-a-medical-disaster-when-coronavirus-hit/2020/02/29/fe8f6e40-5897-11ea-8efd-0f904bdd8057_story.htmlDate accessed: October 1, 2020Google Scholar Such delays might have contributed to the development of more severe clinical outcomes of COVID-19 among these patients. The rapid COVID-19 outbreak and high prevalence of mental illness in Daegu and the lockdown of psychiatric hospitals in the area could have influenced the association between severe clinical outcomes of COVID-19 and severe mental illness in South Korea reported by Lee and colleagues. Stratifying location according to residence in Daegu versus the rest of South Korea rather than by rural versus urban location could aid interpretation of the results of this study. We declare no competing interests. Association between mental illness and COVID-19 susceptibility and clinical outcomes in South Korea: a nationwide cohort studyDiagnosis of a mental illness was not associated with increased likelihood of testing positive for SARS-CoV-2. Patients with a severe mental illness had a slightly higher risk for severe clinical outcomes of COVID-19 than patients without a history of mental illness. Clinicians treating patients with COVID-19 should be aware of the risk associated with pre-existing mental illness. Full-Text PDF Association between mental illness and COVID-19 in South KoreaWe read with interest the article by Seung Won Lee and colleagues in The Lancet Psychiatry,1 in which the authors examined the association between mental illness and testing positive for COVID-19 with data from a national register in South Korea. It was surprising that a diagnosis of a mental illness was not associated with an increased likelihood of testing positive for COVID-19, given that this opposed the results of recent research findings. Yang and colleagues2 reported that pre-existing psychiatric disorders are associated with an increased risk of COVID-19, based on data from the UK Biobank. Full-Text PDF Association between mental illness and COVID-19 in South Korea: a post-hoc analysisWe are honoured to respond to the letters by Hirofumi Hirakawa and colleagues1 and Jewel Park and colleagues2 regarding our Article,3 which investigated the potential association between pre-existing mental illness and positivity for SARS-CoV-2 and clinical outcomes of COVID-19 in a South Korean nationwide cohort. The authors proposed the need for further analysis stratified by subtype of psychiatric disorders and region of residence. Full-Text PDF