Schizophrenia Linked To Increased Risk Of Death From COVID-19

Among adults testing positive for SARS-CoV-2, those with a schizophrenia spectrum disorder may be at greater risk of death, a retrospective study in New York City suggests.

"People with schizophrenia had almost a three-fold increase in mortality from COVID compared to people without a psychiatric diagnosis, after statistically adjusting for age and comorbid medical risk factors," Dr. Donald Goff of New York University Langone Medical Center in New York City told Reuters Health by email. "This finding needs to be replicated, but it suggests that people with schizophrenia are at significantly elevated risk and so should be considered to be a priority group for vaccination and should be encouraged to practice mask wearing and social distancing— particularly when living in congregate situations like hospitals and group homes."

"We are now studying the possible roles of immune dysfunction and of medications that might account for this elevation of mortality," he said.

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As reported in JAMA Psychiatry, 7,348 patients (mean age, 54; 53% women) tested positive for SARS-CoV-2 in the NYU Langone Health System from March 3, 2020 to May 31, 2020, and were followed for 45 days.

Seventy-five patients (1%) had a history of a schizophrenia spectrum illness; 564 (7.7%) had a history of a mood disorder; and 360 (4.9%) had a history of an anxiety disorder.

After adjustment for demographics (sex, age, race) and medical conditions (hypertension, diabetes, myocardial infarction, heart failure, chronic obstructive pulmonary disease, chronic kidney disease, smoking status, and cancer), a premorbid diagnosis of a schizophrenia spectrum disorder was significantly associated with mortality (odds ratio, 2.67).

By contrast, diagnoses of mood disorders (OR, 1.14) and anxiety disorders (OR, 0.96) were not associated with mortality after adjustment.

Compared with other risk factors, a diagnosis of schizophrenia ranked behind only age in strength of an association with mortality.

Dr. Jo Ellen Wilson, Assistant Professor of Psychiatry and Behavioral Sciences at Vanderbilt University Medical Center in Memphis commented in an email to Reuters Health, "Because of how the psychiatric disorders were ascertained (i.e., through EHR codes rather than a review of diagnostic criteria or in-person evaluation), you cannot infer from this study that patients with schizophrenia are at increased odds of death. You can only infer that having a prior diagnostic code for a schizophrenia spectrum disorder is associated with an increased odds of death or discharge to hospice following a positive COVID-19 test result."

The study also has a risk of misclassification bias, she said, which can occur "because of the inherent errors potentially present in administrative datasets."

"The authors did try to mitigate some of this risk through chart reviews of patients with a schizophrenia spectrum disorder code," she acknowledged. "However, this type of review was not performed for the other diagnostic categories - mood disorders, anxiety disorders and reference group."

Further, she said, the authors did not adjust for obesity, a possible result of taking antipsychotic medications and lifestyle changes among individuals with mental illnesses.

Like Dr. Goff, she noted, "We should encourage our patients with schizophrenia spectrum illnesses to do the things we know help prevent against infection with COVID-19 such as frequent hand washing, wearing masks and social distancing."

Family members and group home managers should be told to seek medical help for patients with signs of COVID-19, such as low oxygen saturation or altered mental status, she added.

—Marilynn Larkin

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