key: cord-0721393-6l0clu28
authors: Park, Jewel; Rhim, Hye Chang
title: Association between mental illness and COVID-19 in South Korea
date: 2021-02-19
journal: Lancet Psychiatry
DOI: 10.1016/s2215-0366(20)30465-x
sha: 04af4ab98537d631f9d5070bb523989d68c8f7b3
doc_id: 721393
cord_uid: 6l0clu28

nan

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. 1 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. 2 A rapid local outbreak in the region resulted in a severe shortage of more than 2000 hospital beds at the peak of the pandemic. 3 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.

A d d i t i o n a l l y, c l u s t e r s o f 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. 2 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. 4 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 study

Updates on COVID-10 in Republic of Korea

A brief telephone severity scoring system and therapeutic living centers solved acute hospital-bed shortage during the COVID-19 outbreak in Daegu

How a South Korean psychiatric ward became a 'medical disaster' when coronavirus hit. The Washington Post