COVID-19 trajectories among 57 million adults in England: a cohort study using electronic health records

BACKGROUND: Updatable estimates of COVID-19 onset, progression, and trajectories underpin pandemic mitigation efforts. To identify and characterise disease trajectories, we aimed to define and validate ten COVID-19 phenotypes from nationwide linked electronic health records (EHR) using an extensible framework. METHODS: In this cohort study, we used eight linked National Health Service (NHS) datasets for people in England alive on Jan 23, 2020. Data on COVID-19 testing, vaccination, primary and secondary care records, and death registrations were collected until Nov 30, 2021. We defined ten COVID-19 phenotypes reflecting clinically relevant stages of disease severity and encompassing five categories: positive SARS-CoV-2 test, primary care diagnosis, hospital admission, ventilation modality (four phenotypes), and death (three phenotypes). We constructed patient trajectories illustrating transition frequency and duration between phenotypes. Analyses were stratified by pandemic waves and vaccination status. FINDINGS: Among 57 032 174 individuals included in the cohort, 13 990 423 COVID-19 events were identified in 7 244 925 individuals, equating to an infection rate of 12·7% during the study period. Of 7 244 925 individuals, 460 737 (6·4%) were admitted to hospital and 158 020 (2·2%) died. Of 460 737 individuals who were admitted to hospital, 48 847 (10·6%) were admitted to the intensive care unit (ICU), 69 090 (15·0%) received non-invasive ventilation, and 25 928 (5·6%) received invasive ventilation. Among 384 135 patients who were admitted to hospital but did not require ventilation, mortality was higher in wave 1 (23 485 [30·4%] of 77 202 patients) than wave 2 (44 220 [23·1%] of 191 528 patients), but remained unchanged for patients admitted to the ICU. Mortality was highest among patients who received ventilatory support outside of the ICU in wave 1 (2569 [50·7%] of 5063 patients). 15 486 (9·8%) of 158 020 COVID-19-related deaths occurred within 28 days of the first COVID-19 event without a COVID-19 diagnoses on the death certificate. 10 884 (6·9%) of 158 020 deaths were identified exclusively from mortality data with no previous COVID-19 phenotype recorded. We observed longer patient trajectories in wave 2 than wave 1. INTERPRETATION: Our analyses illustrate the wide spectrum of disease trajectories as shown by differences in incidence, survival, and clinical pathways. We have provided a modular analytical framework that can be used to monitor the impact of the pandemic and generate evidence of clinical and policy relevance using multiple EHR sources. FUNDING: British Heart Foundation Data Science Centre, led by Health Data Research UK

The Assessment and Detection Feigned Symptoms that may persist after a Mild Traumatic Brain Injury: An Analogue Investigation

Psychologists have available to them different instruments to assess the non-credible over-reporting of symptoms that can persist after a mild traumatic brain injury (mTBI), including symptom validity tests (SVTs) and performance validity tests (PVTs). The comparative predictive capacity of SVTs “embedded” in the Minnesota Multiphasic Personality Inventory 2 Restructured Form (MMPI-2-RF) and the Personality Assessment Inventory (PAI) versus three “stand alone” PVTs were examined in a simulation study. Participants were administered the MMPI-2-RF, PAI and PVTs and instructed to either feign symptoms that can persist after an mTBI or “respond honestly.” Using a series of hierarchical logistic regression analyses, the performance of SVTs and PVTs to differentiate feigners from honest responders was examined. The Response Bias Scale (RBS) of the MMPI-2-RF was the best predictor relative to all other SVTs and the PVTs. Although the results need to be replicated in other experimental studies and in clinical contexts, those assessing the possible feigning of mTBI would be well served by including the MMPI-2-RF in their psychological test battery.M.A

Perceived and Objective Cognitive Impairment in Depression: The Identification, Investigation, and Measurement of Cognitive Impairment Bias

A recently introduced construct – Cognitive Impairment Bias (CIB) – suggests that the common, but heterogeneous cognitive impairments reported in patients with depression and/or depressive symptoms may be related to biased perceptions related to one’s cognitive abilities. The current program of research examines CIB in a young adult sample with a range of depressive symptom severity. In the first study, CIB uniquely accounts for variation in depressive symptoms and functioning above and beyond objective measures of cognitive functioning. In the next study, CIB was shown to vary based on depressive symptom severity, distinguishing groups belonging to different depressive symptom severity groups, demonstrating large effects as a standalone distinguishing construct, but also when compared to objective measures of cognitive functioning. Finally, after highlighting that CIB is an important construct associated with depressive symptoms, warranting further exploration, the Cognitive Impairment Bias Scale (CIBS) was developed. Psychometric properties of the initial development of the CIBS are discussed. Collectively, results show that CIB is an important construct to consider for both clinicians and researchers. Future studies should seek additional evidence to support the validity of the CIBS in diverse clinical samples and research settings.Ph.D

The Effect of Response Bias on the Personality Inventory for DSM?5 (PID?5)

Valid self-report assessment of psychopathology relies on accurate and credible responses to test questions. There are some individuals who, in certain assessment contexts, cannot or choose not to answer in a manner typically representative of their traits or symptoms. This is referred to, most broadly, as test response bias. In this investigation, we explore the effect of response bias on the Personality Inventory for DSM–5 (PID–5; Krueger, Derringer, Markon, Watson, & Skodol, 2013), a self-report instrument designed to assess the pathological personality traits used to inform diagnosis of the personality disorders in Section III of DSM–5. A set of Minnesota Multiphasic Personality Inventory Restructured Form (MMPI–2–RF; Ben-Porath & Tellegen, 2008/2011) validity scales, which are used to assess and identify response bias, were employed to identify individuals who engaged in either noncredible overreporting (OR) or underreporting (UR), or who were deemed to be reporting or responding to the items in a “credible” manner—credible responding (CR). A total of 2,022 research participants (1,587 students, 435 psychiatric patients) completed the MMPI–2–RF and PID–5; following protocol screening, these participants were classified into OR, UR, or CR response groups based on MMPI–2–RF validity scale scores. Groups of students and patients in the OR group scored significantly higher on the PID–5 than those students and patients in the CR group, whereas those in the UR group scored significantly lower than those in the CR group. Although future research is needed to explore the effects of response bias on the PID–5, results from this investigation provide initial evidence suggesting that response bias influences scale elevations on this instrument