High COVID-19 Mortality Rates Recorded in Patients with Psychiatric Disorders

Lokesh Shahani, MD

New data suggested that patients with major psychiatric disorders such as schizophrenia had increased odds of mortality by the COVID-19 virus.

Additionally, patients with major psychiatric disorders were also more likely to have medical comorbidities associated with worse outcomes with the virus, though the higher mortality rate was deemed independent from these comorbidities.

According to Lokesh Shahani, MD, The University of Texas Health Science Center at UTHealth, and fellow investigators, much had been written and reported about the associations between acute and chronic psychiatric symptoms and the COVID-19 virus.

However, limitations such as sample size were noted.

For their study, Shahani and colleagues utilized the Optum COVID-19 Electronic Health Record (EHR) database to evaluate the effect of COVID-19 on patients with psychiatric disorders at a nationally representative level.

The Methods

The information surrounding COVID-19 that was utilized from the HER incorporated clinical and medical administrative data from both inpatient and ambulatory electronic health records, practice management, and other internal systems.

The data set for the present study consisted of a cohort of individuals who receiced a laboratory test for COVID-19 between February and December 2020. The identification of medical and psychiatric comorbidities were culled from available EHRs from contributing sources dating as far back as 2010.

A total of 3,614,884 participants were included in the cohort, with the total test count at 7,318,988. However, nearly 24% of the cohort did not meet the criteria for eligibility.

In the end, the population studied including 2,535,098 participants.

Variables such as age, gender, race and ethnicity, geographic region, body mass index, smoking status, and a myriad of medical comorbidities such as diabetes were collected.

From there, participants were divided into 3 unique psychiatric cohorts: patients with schizophrenia (3350), mood disorders (26,610), and anxiety disorders (18,550).

The 3 psychiatric cohorts would then be compared with a reference group with no major psychiatric conditions, followed by a statistical analysis which would be performed from March to April 2021.

The Findings

Investigators reported that the overall positivity rate for a SARS-CoV-2 infections was 11.91%. Female participants were less likely to test positive, as were smokers and most comorbid conditions other than diabetes.

The positivity rate for the schizophrenia population in the study matched the mood disorders cohort (9.86%), with the highest being anxiety disorders (11.17%).

Despite a lower positivity rate, the schizophrenia cohort had the highest rate of mortality, with more than 8% of all patients in that group who tested positive for the virus dying.

The mortality rate for the schizophrenia group was 4 times that of the reference groups (2%), while 3.5% of the patients with schizophrenia who tested negative for COVID-19 (n = 1075) also died during the pandemic year compared with 1.4% of the reference group (n = 2431).

Ethnicity, chronic obstructive pulmonary disease, and metabolic syndrome were not statistically associated with mortality, however.

Despite the large sample size of the study, investigators noted that the infection rate was comparatively low. As such, they believed the result might not have reflected the susceptibility of the participants featured in the study to the “dynamic landscape” of the infection.

“Although the explanations for this finding remain elusive, it is tempting to speculate that an increased inflammatory response, a biological factor common to both severe COVID-19 pathophysiology (cytokine storm) and schizophrenia (chronic low grade inflammation),could be one of the mechanisms underlying this increased mortality,”the team wrote.

The study, “Analysis of COVID-19 Infection and Mortality Among Patients With Psychiatric Disorders, 2020,” was published online in JAMA Open Network.