It remains unknown whether coronavirus disease 2019 (COVID-19) patients with bipolar disorders (BDs) are at an increased risk of mortality. We aimed to establish whether health outcomes and care differed between patients infected with COVID-19 with BD and patients without a diagnosis of severe mental illness.

We conducted a population-based cohort study of all patients with identified COVID-19 and respiratory symptoms who were hospitalized in France between February and June 2020. The outcomes were in-hospital mortality and intensive care unit (ICU) admission. We used propensity score matching to control for confounding factors.

In total, 50 407 patients were included, of whom 480 were patients with BD. Patients with BD were 2 years older, more frequently women and had more comorbidities than controls without a diagnosis of severe mental illness. Patients with BD had an increased in-hospital mortality rate (26.6% v. 21.9%; p = 0.034) and similar ICU admission rate (27.9% v. 28.4%, p = 0.799), as confirmed by propensity analysis [odds ratio, 95% confidence interval (OR, 95% CI) for mortality: 1.30 (1.16–1.45), p < 0.0001]. Significant interactions between BD and age and between BD and social deprivation were found, highlighting that the most important inequalities in mortality were observed in the youngest [OR, 95% CI 2.28 (1.18–4.41), p = 0.0015] and most deprived patients with BD [OR, 95% CI 1.60 (1.33–1.92), p < 0.001].

COVID-19 patients with BD were at an increased risk of mortality, which was exacerbated in the youngest and most deprived patients with BD. Patients with BD should thus be targeted as a high-risk population for severe forms of COVID-19, requiring enhanced preventive and disease management strategies.

To compare three different kinds of health-related quality of life (HRQL) questionnaires available for use in patients suffering from schizophrenia: the SF-36 (a generic instrument), the QoLI (an instrument designed to a broad range of mental illnesses), the S-QoL (a questionnaire specific to schizophrenic patients), in terms of external validity and sensitivity to change.

Two hundred and five patients were included at D0 and one-third retested at D30. Socio-demographic data and clinical history were recorded, clinical evaluation comprised psychotic symptoms (PANSS), depression (Calgary depression scale for schizophrenia), global functioning (GAF), clinical severity (CGI), and extrapyramidal symptoms (ESRS). HRQL was assessed using the SF-36, the QoLI and the S-QoL.

A better agreement is observed between the SF-36 and the S-QoL than between the QoLI and the two other instruments. S-QoL and SF-36 are more strongly correlated with clinical status than QoLI. Compared to the SF-36 and the QoLI, the S-QoL better discriminates patients with comorbidity from others. The S-QoL shows better responsiveness than the QoLI and the SF-36.

For descriptive purpose, either generic tools like SF-36 or specific ones should be used, whereas when aiming at evaluating health treatment and care for schizophrenic patients, specific instruments like the S-QoL should be favoured.

Quality of life (QoL) measurements are increasingly considered to be an important evaluation of the treatment and care provided to patients with schizophrenia. However, there is little evidence that assessing QoL improves patient outcomes in clinical practice.

To investigate the impact of a QoL assessment with feedback for clinicians regarding satisfaction and other health outcomes in patients with schizophrenia.

We conducted a 6-month, prospective, randomised and controlled open-label study. Patients withschizophrenia were assigned to one of three groups: standard psychiatric assessment; QoL assessment with standard psychiatric assessment; and QoL feedback with standard psychiatric assessment. The primary outcome was patient satisfaction at 6 months. The local ethics committee (Comité de Protection des Personnes Sud-Métediterranéee V, France, trial number 07 067) and the French drug and device regulation agency (Agence Française de Sécurité Sanitaire des Produits de Santé, France, trial number A01033-50) approved this study.

We randomly assigned 124 patients into groups. Quality of life feedback significantly affectedpatient satisfaction. Global satisfaction was significantly higher in the QoL feedback group (72.5% of patients had a high level of satisfaction) compared with the standard psychiatric assessment (67.5%) and QoL assessment groups (45.2%). Despite trends towards decreased severity for all clinical outcomes and increased changes to medication in the QoL feedback group at 6-month follow-up, these effects were not significant.

Quality of life feedback positively influences patient satisfaction, which confirms the relevance of measuring QoL in clinical practice. The absence of a significant effect of QoL feedbackon clinical outcomes also suggests that clinicians did not use these data optimally. Our findings suggest a nocebo effect of QoL assessment without feedback that should be considered by researchers and clinicians.