Schizophrenia Linked to Higher COVID-19 Mortality

Katlyn Nemani, MD

As the coronavirus disease 2019 (COVID-19) pandemic took over the lives of many, the psychiatric impact could be felt for years to come.

A team, led by Katlyn Nemani, MD, Department of Psychiatry, New York University Langone Medical Center, assessed whether a diagnosis of a schizophrenia spectrum disorder, mood disorder, or anxiety disorder is linked to mortality for patients with COVID-19 infections.

In the retrospective cohort study, the investigators assessed 7348 consecutive adult patients for 45 days following laboratory-confirmed COVID-19 between March and May 31 in a large academic medical system in New York.

The researchers categorized patients based on International Statistical Classification of Diseases, Tenth Revision, Clinical Modification diagnoses before their testing date for schizophrenia spectrum disorders, mood disorders, and anxiety disorders.

The team also compared these patients with a reference group without psychiatric disorders.

The investigators sought main outcomes of mortality, defined as death or discharge to hospice within 45 days following a positive severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) test result.

Patient Population

Overall, the researchers tested 26,540 patients, 7348 of which tested positive for the virus. The mean age was 54 years old. Of the remaining patients with positive test results, 75 (1.0%) had a history of schizophrenia spectrum illnesses, 564 (7.7%) had a history of mood disorders, and 360 (4.9%) individuals had a history of an anxiety disorder.

The researchers adjusted for demographic and medical risk factors and found a premorbid diagnosis of a schizophrenia spectrum disorder was significantly associated with mortality (OR, 2.67; 95% CI, 1.48-4.80).

In addition, a diagnosis of mood disorders (OR, 1.14; 95% CI, 0.87-1.49) and anxiety disorders (OR, 0.96; 95% CI, 0.65-1.41) were not linked to mortality after adjustment.

A diagnosis of schizophrenia ranked only behind age in strength of an association with mortality in comparison with other risk factors.

“In this cohort study of adults with SARS-CoV-2–positive test results in a large New York medical system, adults with a schizophrenia spectrum disorder diagnosis were associated with an increased risk for mortality, but those with mood and anxiety disorders were not associated with a risk of mortality,” the authors wrote. “These results suggest that schizophrenia spectrum disorders may be a risk factor for mortality in patients with COVID-19.”

How COVID-19 Changed Health Care

The ongoing pandemic has created several global challenges to the health care system, particularly in psychiatry. There has been at least 2 nationwide cohort studies focusing on the incidence of COVID-19 on individuals with psychiatric disorders, particularly for patients with depression and schizophrenia has the highest infection risk factors.

It was also essential since the beginning of the pandemic to identify the risk factors linked to severe COVID-19 outcomes to guide clinical decision-making, target enhanced protective measures, and allocate limited resources.

The identified risk factors include older age, male sex, cardiovascular disease and diabetes.

Differences in outcomes has also been stratified by socioeconomic status and race, which could mean the pandemic has deepened existing health inequalities.

The study, “Association of Psychiatric Disorders With Mortality Among Patients With COVID-19,” was published online in JAMA Psychiatry.