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COVID-19-Related Outcomes Among Group Home Residents with Serious Mental Illness in Massachusetts in the First Year of the Pandemic

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Abstract

This study examined COVID-19 infection and hospitalizations among people with serious mental illness who resided in residential care group homes in Massachusetts during the first year of the COVID-19 pandemic. The authors analyzed data on 2261 group home residents and COVID-19 data from the Massachusetts Department of Public Health. Outcomes included positive COVID-19 tests and COVID-19 hospitalizations March 1, 2020–June 30, 2020 (wave 1) and July 1, 2020–March 31, 2021 (wave 2). Associations between hazard of outcomes and resident and group home characteristics were estimated using multi-level Cox frailty models including home- and city-level frailties. Between March 2020 and March 2021, 182 (8%) residents tested positive for COVID-19, and 51 (2%) had a COVID-19 hospitalization. Compared with the Massachusetts population, group home residents had age-adjusted rate ratios of 3.0 (4.86 vs. 1.60 per 100) for COVID infection and 13.5 (1.99 vs. 0.15 per 100) for COVID hospitalizations during wave 1; during wave 2, the rate ratios were 0.5 (4.55 vs. 8.48 per 100) and 1.7 (0.69 vs. 0.40 per 100). In Cox models, residents in homes with more beds, higher staff-to-resident ratios, recent infections among staff and other residents, and in cities with high community transmission risk had greater hazard of COVID-19 infection. Policies and interventions that target group home-specific risks are needed to mitigate adverse communicable disease outcomes in this population.

Clinical Trial Registration Number This study provides baseline (i.e., pre-randomization) data from a clinical trial study NCT04726371.

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Funding

This study was funded by the Patient Centered Outcomes Research Institute (PCORI) COVID-2020C2-10803 (Co-PIs S Bartels and B Skotko) “Best Practices to Prevent COVID-19 in Staff and People with Serious Mental Illness and Developmental Disabilities in Congregate Living Settings.”

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Author notes

  1. Brian G. Skotko and Stephen Bartels are co-senior authors.

Authors and Affiliations

  1. Mongan Institute, Massachusetts General Hospital, Harvard Medical School, 100 Cambridge Street, Suite 1600, Boston, MA, 02114, USA

    Vicki Fung, Julie H. Levison, Anna Wilson, Cindy Chau, David Krane, Hao D. Trieu, Kelly Irwin, Karen Donelan, Ronita Samuels, Kenneth A. Freedberg, Alexander C. Tsai, John Hsu & Stephen Bartels

  2. Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA

    Vicki Fung, Julie H. Levison, David Cheng, Karen Donelan, Kenneth A. Freedberg, John Hsu & Stephen Bartels

  3. Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA

    Julie H. Levison & Kenneth A. Freedberg

  4. Biostatistics Center, Massachusetts General Hospital, Boston, MA, USA

    David Cheng

  5. Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA

    Kelly Irwin, Jessica E. Becker & Alexander C. Tsai

  6. Vinfen Corporation, Cambridge, MA, USA

    Elizabeth Cella, Bruce Bird, Kim Shellenberger, Paula Silverman, Joey Batson, Ahmed Fathi, Stefanie Gamse, Jessica Wolfe & Sibyl Holland

  7. North Suffolk Mental Health Association, Chelsea, MA, USA

    Jean-Louise Reichman

  8. Bay Cove Human Services, Boston, MA, USA

    Terina Keller

  9. Department of Health Care Policy, Harvard Medical School, Boston, MA, USA

    John Hsu

  10. Down Syndrome Program, Division of Medical Genetics and Metabolism, Department of Pediatrics, Massachusetts General Hospital, Boston, MA, USA

    Brian G. Skotko

  11. Department of Pediatrics, Harvard Medical School, Boston, MA, USA

    Brian G. Skotko

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  1. Vicki Fung
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Contributions

All authors contributed to the study conception and design and interpretation of the results. Analysis was performed by VF, JL, AW, DC, CC, DK, HT, AT, JH, BS, and SB. VF drafted the manuscript. All authors provided critical revision of the manuscript for important intellectual content and approved the final manuscript. BS and SB obtained funding for the project and provided supervision.

Corresponding author

Correspondence to Vicki Fung.

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Conflict of interest

Dr. Fung reports receiving research grants from AHRQ and NIH, consulting fees from Headspace, Inc., and financial interest in Vertex Pharmaceuticals outside the submitted work. Dr. Levison reports receiving research grants from NIH and receives fees as a medical advisor to eMED, LLC. Dr. Becker was supported by AHRQ grant number T32HS000063 as part of the Harvard‐wide Pediatric Health Services Research Fellowship Program. Dr. Freedberg reports receiving research grant funding from NIH. Dr. Tsai reports receiving a financial honorarium from Elsevier, Inc. for his role as Co-Editor in Chief of the Elsevier-owned journal SSM-Mental Health. Dr Bartels reports receiving research grant funding from PCORI and NIH, and receives consulting fees as scientific co-director for a SAMHSA funded Center of Excellence for Behavioral Health Disparities in Aging at Rush University. Dr. Irwin reports receiving research grants from NIH and PCORI. Dr. Hsu reports receiving research grants from NIH, AHRQ, PCORI, and CHCF, and has received consulting fees from Cambridge Health Alliance, Community Servings, AltaMed, Columbia University, and the University of Southern California. Dr. Skotko has received research funding from the NIH, PCORI, F. Hoffmann-La Roche, Inc., AC Immune, and LuMind Research Down Syndrome Foundation to conduct clinical trials for people with Down syndrome within the past 2 years. All other authors have no relevant financial or non-financial interests to disclose.

Ethical Approval for Human Participants

This study was approved by the Mass General Brigham Institutional Review Board, the Massachusetts Department of Mental Health Institutional Review Board, and the Massachusetts Department of Developmental Services Research Review Committee. These entities have also granted a waiver of consent from residents and staff for data routinely collected by the participating provider organizations. Provider organization Chief Executive Officers provided written consent for their sites to be included in the study.

Standards of Reporting

This study follows the Strengthening the Reporting of Observation Studies in Epidemiology (STROBE) guidelines.

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Fung, V., Levison, J.H., Wilson, A. et al. COVID-19-Related Outcomes Among Group Home Residents with Serious Mental Illness in Massachusetts in the First Year of the Pandemic. Adm Policy Ment Health 51, 60–68 (2024). https://doi.org/10.1007/s10488-023-01311-9

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