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Schizophrenia Among Highest Risk Factors for COVID-19 Death

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Key Takeaways

  • A new study found that COVID-19 patients with a history of schizophrenia are at higher risk of dying compared to patients with two other psychiatric conditions.
  • Schizophrenia has been linked to viruses before, but the relationship still isn't clear.
  • People who have schizophrenia spectrum disorder and their loved ones should keep following pandemic protocols and get vaccinated against COVID-19 when it becomes available.

In a new study, researchers at New York University (NYU) Langone Health System found that people with schizophrenia are three times more likely to die from COVID-19 compared to those without the illness.

The study, which was published in JAMA Psychiatry in January, found that schizophrenia spectrum disorders significantly increased COVID-19 mortality. Schizophrenia ranks as the second-highest predictor of death from COVID-19 after age. These rates were determined after controlling for demographic and medical risk factors.

Between March 3 and May 31, 2020, the researchers followed 7,348 people who had tested positive for COVID-19 during the 45 days prior. The goal was to find out whether a patient's risk of dying from COVID-19 could be predicted by any or all of three psychiatric conditions: mood disorders, anxiety disorders, or schizophrenia spectrum disorders.

Almost 12% of the patients—864—died within 45 days of getting a positive COVID-19 test result. Of all the patients in the study, 75 had a history of schizophrenia, and 20 of those patients died (26.7%). The patients with histories of mood and anxiety disorders died at lower rates than the patients with schizophrenia—18.4% and 10.8%, respectively.

In the study, the authors wrote that "a higher risk with schizophrenia spectrum diagnoses was expected based on previous studies of all-cause mortality, but the magnitude of the increase after adjusting for comorbid medical risk factors was unexpected."

The study concluded that mood and anxiety disorders did not have a significant effect on COVID-19 morality. However, the authors noted that the stage of illness—for example, whether the patient was currently experiencing a major depressive episode—"may contribute to differential risk in patients with episodic psychiatric disorders."

What This Means For You

Experts are still not sure why people with schizophrenia appear to be at an increased risk for dying from COVID-19, but they are working on figuring out the connection. People with schizophrenia spectrum disorders or any mental health condition should keep protecting themselves from COVID-19, remain in touch with their medical and mental health providers, and get a vaccine as soon as it becomes available.

Study Limitations

The study did have several limitations that could have exaggerated or skewed the data. For example, the researchers were collecting data during the first waves of the pandemic in New York City when testing was reserved mostly for symptomatic and high-risk people.

Additionally, only individuals who had access to the NYU health care system were included in the study. The researchers could only include a relatively small sample of individuals with a history of schizophrenia.

Even with the study's limitations, the authors maintain that the magnitude of COVID-19 mortality risk for schizophrenia spectrum disorders remains high.

Viruses and Schizophrenia

Older age is a well-documented COVID-19 risk factor, and scientists understand why: the older you are, the harder it is for your body to fight the virus. The link between schizophrenia and increased COVID-19 mortality is less clear.

What Is Schizophrenia?

Schizophrenia is a mental health condition where alterations in the structure and function of the brain cause cognitive, behavioral, and emotional dysfunction. People with the condition may experience delusions, hallucinations, disorganization, unusual behavior, and withdrawal. The condition typically appears during young adulthood and is related to several genetic, environmental, and other risk factors.

Katlyn Nemani, MD, a psychiatrist and one of the study's authors, tells Verywell that biological mechanisms might be at play. Schizophrenia spectrum disorders have been linked to viruses for years, though the connection is not totally clear.

What is certain, according to Nemani, is that researchers "are seeing a connection between schizophrenia and increased risk of death due to COVID-19."

"Future studies may find an association between COVID-19 infection and later development of schizophrenia," Nemani says. "We will need to address why. At this stage, we can only speculate. But it is possible that abnormalities of the immune system, from genetic or acquired risk factors, may put people at higher risk of both severe infection and psychosis."

Why Does Schizophrenia Increase Mortality Risk?

In analyzing why schizophrenia increases mortality risk, the researchers considered many factors, including logistics such as access to health care, as well as biological mechanisms.

People with schizophrenia might be less likely to seek health care and can encounter systemic barriers when they do. People with the disorder can be socially isolated, may lack the resources that they need, and face the social stigma attached to schizophrenia. These variables can also contribute to increased mortality.

Schizophrenia and psychosis have also long been associated with viruses. Previous research has demonstrated compromised immune system function in patients with schizophrenia. In the case of COVID-19, abnormal inflammation could contribute to the illness's severity and mortality.

Which Came First?

"For several decades research across various fields of study have pointed towards a connection between schizophrenia and infection," Nemani says. "The direction of association, however, has been less clear—do infections cause schizophrenia, or are people with schizophrenia more prone to severe infection?"

Nemani says that there is evidence for both sides. Childhood infection may increase the chances of developing schizophrenia later in life, and having schizophrenia may increase the chances of severe infection.

Katlyn Nemani, MD

Do infections cause schizophrenia, or are people with schizophrenia more prone to severe infection?

— Katlyn Nemani, MD

Further, Nemani references a 2015 study where a link between schizophrenia and respiratory illnesses had already been identified. "[A]dults with schizophrenia are more prone to developing severe infections later in life, with a seven-fold increase in risk of dying from influenza and pneumonia," she says.

The directionality of the virus-schizophrenia link still isn't clear, but the pandemic can help researchers become more certain. "The COVID-19 pandemic provided an opportunity to look at the relationship between schizophrenia and the effects of a single virus, controlling for all of the outside factors that may contribute to increased mortality in this population (such as heart disease, obesity, smoking, access to care)," Nemani says.

What You Can Do

Nemani recommends that people with a schizophrenia spectrum disorder, or any psychiatric condition for that matter, continue to take COVID-19 precautions.

"Patients with schizophrenia, as well as their loved ones, should adhere to precautionary measures such as mask-wearing and avoiding crowded indoor settings," Nemani says. She also recommends getting a vaccine when it becomes available.

Staying in touch with your healthcare provider, a mental health provider, and reaching out for support from people that you trust is also important.

"Clinicians can play a role in improving patient education and awareness, to encourage adherence to infection prevention measures and address any concerns their patients may have," Nemani says. "Physical distancing is important to prevent infection, but maintaining connection is important."

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