A recent study published in the Journal of the American Medical Association, found that people diagnosed with schizophrenia disorder, and those on the spectrum are at a greater risk of dying from Covid-19.
New York-based researchers collected data from electronic medical records on chronic conditions for a period of three months between March and May 2020. Throughout this period, they followed upwards of 7000 adult patients with a positive Covid-19 diagnosis, for a period of 45 days.
Post this time frame, they noted the outcome of the disease which allowed them to then assess mortality rates. From this population, 75 patients (1.0%) had a prior diagnosis of schizophrenia spectrum disorder, while 564 (7.7%) and 360 (4.9%) patients had a history of mood and anxiety disorders, respectively.
Of the 7,348 846 (11.8%) were diagnosed with Covid-19 and died or, on the other hand, discharged to hospice within 45 days since their original positive test result. Interestingly, of those 846 patients, 75 (1.0%) had a history of schizophrenia. While seemingly insignificant, upon adjustment of data, it shows that people with schizophrenia spectrum disorder, a psychotic disorder with heterogeneous symptoms, were 2.7 times more likely to die of Covid-19, compared to people with no prior psychiatric diagnoses. In turn, people with mood and anxiety disorders showed no significant difference in mortality rates than those without psychiatric history. These results suggested that people with schizophrenia are more vulnerable to the effects of Covid-19. In fact, the only risk factor that has a stronger association with mortality is old age. Having schizophrenia even increased the risk associated with having heart or kidney failure, diabetes or cancer.
Why are people with schizophrenia more vulnerable to the effects of Covid-19?
It’s a multifactorial issue.
While it was expected that people with schizophrenia will suffer from slightly higher rates of mortality based on previous observational studies, the magnitude of Covid-related death rates found in this study is surprising. Research has shown that people with schizophrenia, on average, have a significantly shortened life expectancy than people with no psychiatric illnesses. It is possible that people with schizophrenia suffer from unmeasured or untreated medical comorbidities that contribute to this high mortality rate.
Another factor contributing to their increased susceptibility to Covid-19 are typical accompanying behaviours seen among people with schizophrenia, such as smoking, increased social isolation, obesity and heart disease. Alternatively, it is also possible that schizophrenia, and its associated medications, weaken the immune system, making people more vulnerable. Additionally, previous genetic research has shown that people with schizophrenia can have altered genetic variability which causes immune system deficits.
Nonetheless, these findings are limited as they only included symptomatic patients with previous medical records. The study was also conducted at the peak of the pandemic when our collective knowledge about the disease was limited, which could perhaps account for the high rates of Covid-positive patients and the high overall mortality.
So, what does this mean?
While this association between Schizophrenia and higher mortality rates from Covid-19 requires further testing and confirmation, it does however, raise a few questions.
Should people with schizophrenia spectrum disorder be prioritised in the vaccination programmes? Should organisations such as the WHO and NHS amend their risk groups classification to include people with schizophrenia?
Based on this alarming newfound understanding, Dr. Adrian James, the president of the Royal College of Psychiatrists, says that “the deadly consequences of Covid-19 on people living with schizophrenia are deeply worrying and should serve as a catalyst to ensure this at-risk group of people are offered the vaccine at the earliest opportunity”.
This study provides an insight into which patients are at the highest risk, and should be used to alter our clinical decision-making.
Nemani K, Li C, Olfson M, et al. Association of Psychiatric Disorders With Mortality Among Patients With COVID-19. JAMA Psychiatry. Published online January 27, 2021. doi:10.1001/jamapsychiatry.2020.4442
Edited by Malavika Ramanand