RESEARCH WEEKLY: Schizophrenia is Second Largest Risk Factor in COVID-19 Mortality
By Kelli South
People with schizophrenia are at a substantially elevated risk of dying from COVID-19, according to new research. Published last month in JAMA Psychiatry, the study found that a schizophrenia diagnosis is the second largest predictor of mortality from COVID-19, second only to age. This groundbreaking finding has major implications for the treatment and prevention efforts surrounding COVID-19 and suggests that it is more important than ever to prioritize people with schizophrenia for COVID-19 vaccination.
This study examined 7,348 patients in the NYU Langone Health System, which covers hospitals and care centers in Manhattan, Brooklyn and Long Island, N.Y. The study cohort included adults who tested positive for COVID-19 between March 3 and May 31, 2020. Researchers classified the cohort into three subgroups by psychiatric diagnosis: schizophrenia spectrum disorders, mood disorders and anxiety disorders, as well as a reference group with no mental illness. Researchers followed patient outcomes for 45 days after their positive COVID-19 diagnosis, and is the first study of its kind to examine COVID-19 mortality risk by psychiatric diagnosis.
Patients in the schizophrenia diagnosis group had 2.7 times greater odds of dying from COVID-19, according to the results. This risk was prevalent even after controlling for other factors that put people at increased risk of death, like age, race and other medical factors.
The odds of dying from COVID-19 were higher in all age groups from age 45 (3.9 times greater odds) to those over 75 (35.7 times greater odds), in the sample of individuals with psychiatric disorders. When comparing all risk factors for COVID-19 mortality in the study, a schizophrenia diagnosis ranked second following age in its strength of association with mortality.
Patients in the mood disorder and anxiety disorder groups did not have a statistically significant increased risk of death after controlling for the same factors.
The researchers note that they expected to see an increased mortality risk for people with schizophrenia but were surprised by the magnitude of the risk – they did not expect it to be so pronounced.
While the authors do not claim their findings are universal and call for more research to examine this question further, their findings have major implications for the treatment, prevention and vaccination efforts surrounding COVID-19. Results indicate that people with schizophrenia are the second highest risk group for dying from COVID-19, below the elderly, a fact that should be considered when prioritizing populations for vaccine distribution.
Interestingly, the authors discuss possible reasons why people with schizophrenia may be at a higher risk of death from COVID-19 infection. Aside from the significant barriers to medical treatment this population faces, one hypothesis is that the biological factors related to schizophrenia could increase mortality risk. In other words, it is possible that the relationship between schizophrenia and immune system and inflammatory problems could also be playing a role in how these patients react to COVID-19, putting them at a higher risk of infection or severe infection. If true, this could have profound impacts on the treatment of COVID-19 in those with schizophrenia. Further research in this area is essential to expand upon these results.