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Background Pulmonary embolism (PE) is a life-threatening condition with significant morbidity and mortality. The relationship between psychiatric disorders and PE outcomes is complex and not well understood. This study aimed to determine the impact of psychiatric disorders on PE outcomes by comparing patients with and without these conditions.Methods Using the National Inpatient Sample database, we analysed 725 725 adult patients hospitalised with PE between 2016 and 2019. Patients were stratified based on the presence or absence of psychiatric disorders. Multivariable logistic regression models were used to examine associations between psychiatric disorders and in-hospital outcomes, adjusting for baseline differences.Results Of the patients studied, 26.6% had psychiatric disorders. These patients were younger (59.80 vs 63.91 years, p<0.001), more likely to be female (60.7% vs 48.8%, p<0.001), and had higher rates of smoking and obesity but lower rates of diabetes and atrial fibrillation. After adjustment, patients with psychiatric disorders were less likely to undergo systemic thrombolysis (adjusted OR (aOR) 0.83, 95% CI: 0.80 to 0.85, p<0.001), catheter-directed interventions and placement of inferior vena cava filters (aOR 0.90, 95% CI: 0.88 to 0.92, p<0.001). These patients had lower odds of all-cause mortality (aOR 0.81, 95% CI: 0.78 to 0.84, p<0.001) and major adverse cardiovascular and cerebrovascular events (aOR 0.87, 95% CI: 0.85 to 0.89, p<0.001), with no significant difference in major bleeding risk (aOR 1.01, 95% CI: 0.98 to 1.05, p=0.553).Conclusions Psychiatric disorders are associated with distinct management and outcomes in PE. Recognising these unique characteristics may help optimise care for this population; further research is needed to clarify the best management strategies.