Schizophrenia Patients at an Increased Risk of Severe COVID-19 Outcomes

Dana Tzur Bitan, PhD

Patients with schizophrenia are at an increased risk of severe COVID-19 outcomes and mortality and are less likely to be vaccinated compared to the general population.

A team, led by Dana Tzur Bitan, PhD, Department of Behavioral Sciences, Ariel University, assessed temporal trends in COVID-19 hospitalizations and mortality in patients with schizophrenia during the first year of the pandemic, the predictors for COVID-19 vaccination, post-vaccination infections, hospital admissions, and mortality in Israel.

The Study

In the longitudinal cohort, the investigators examined 25,539 patients with schizophrenia with a matching control group. Both groups were assessed for COVID-19 outcomes before and after vaccination up to April 30, 2021. The mean age of the patient population was 51.94 years old.

The investigators assessed longitudinal trends using Cox proportional hazard regression models and Kaplan-Meier analyses.

In the entire patient population, 0.7% (n = 356) of patients were hospitalized, 0.3% (n = 133) of patients died, and 53.6% (n = 27,400) of the participants had been vaccinated.

The Risks

However, there were higher risks for COVID-19 hospitalizations (HR, 4.81; 95% CI, 3.57-6.48; P <0.0001) and death (HR, 2.52; 95% CI, 1.64-3.85; P <0.0001) for patients with schizophrenia. This patient group also showed a sharper decline in survival as the pandemic progressed.

Looking at the control group, there was a sharper incline in the probability to vaccinate (log-rank = 309.88; P <0.0001).

The investigators also saw trends based on comorbidities.

Patients with diabetes, hypertension, obesity, or ischemic heart disease were predicative of vaccination rates in the schizophrenia arm (all P <0.0001), but not the control group.

Showing the success of the vaccines, hospitalization and mortality disparities remained higher in unvaccinated patients with schizophrenia compared to the control group (incidence rate difference of 6.2 and 3.2, respectively), but substantially declined in the fully vaccination groups (incidence rate difference of 1.1 and −0.9, respectively).

“People with schizophrenia have higher hospitalization and mortality risk yet have lower rates of vaccination than in the general population,” the authors wrote. “Disparities in COVID-19 severe outcomes can be substantially reduced by national vaccination plans aimed at actively reaching out to people with schizophrenia.”

Other Mental Health Disorders

There have been multiple studies showing a link between mental health disorders and COVID-19 mortality.

Overall, COVID-19 mortality was linked to an increased risk in patients with mental health disorders compared to the arm of patients without mental health disorders (pooled crude OR, 1.75; 95% CI, 1.40-2.20; P < .05; adjusted OR, 1.38; 95% CI, 1.15-1.65; P < .05).

In addition, patients with severe mental health disorders had the highest odds ratios for the risk of mortality (crude OR, 2.26; 95% CI, 1.18-4.31; adjusted OR, 1.67; 95% CI, 1.02-2.73).

The researchers suggest future studies should focus on patients with specific mental health disorders as the results show the highest risk might be found in patients with schizophrenia and/or bipolar disorders, which might be explained by the particular immunological profile of these patients.

The study, “COVID-19 hospitalization, mortality, vaccination, and postvaccination trends among people with schizophrenia in Israel: a longitudinal cohort study,” was published online in The Lancet Psychiatry.