RESEARCH WEEKLY: COVID-19 Mortality and Severe Mental Illness
By Elizabeth Sinclair Hancq
It is a new year but COVID-19 is very much still a part of our lives.
As emerging variants of SARS-CoV-2, the virus that causes COVID-19, continue to spread throughout the world, it remains of critical importance to advance our knowledge on the effects of the virus on those most vulnerable.
The evidence continues to mount showing that individuals with severe mental illness are more at risk for COVID-19 infection, severe illness and death compared to the general population. A recent study, published in JAMA Network Open by researchers from the University of Texas Health Science Center, confirms previous findings adding to the knowledge base about COVID-19 and mental illness.
Utilizing electronic health records from more than 2.5 million individuals in the United States, the study authors found that people with schizophrenia had increased odds of dying from COVID-19 compared to the general population. After controlling for demographic variables and comorbid conditions that might impact risk of death, such as lung disease or obesity, the study found that people with schizophrenia were four times more likely to die from COVID-19 compared to the reference group of general population individuals.
COVID-19 risks among psychiatric populations
The study authors included other populations with psychiatric conditions in the analysis as well, including mood and anxiety disorders. Of the 2.5 million individuals in the study, 1.2% of participants had schizophrenia, 9.7% had a mood disorder, including bipolar disorder and major depression, and 6.1% had an anxiety disorder.
The researchers were able to examine the COVID-19 positivity rate, or the percentage of individuals who tested positive for COVID-19 by a polymerase chain reaction (PCR) test, among the different psychiatric populations. The positivity rate for the schizophrenia and mood disorders population were both lower than the reference group at just under 10%, whereas the anxiety disorder population had a similar positivity rate to that of the general population at 11%. While only 10-15% of individuals received their positive test at an inpatient facility in the other groups, almost 40% of individuals with schizophrenia were tested at an inpatient facility. This result indicates that individuals with schizophrenia may have had lower testing rates than other populations, as they were only tested if admitted to an inpatient hospital. Therefore, the lower positivity rate of COVID-19 among people with schizophrenia could be a result of lower testing rates among people with schizophrenia rather than true lower infection rates.
More than 8% of individuals with schizophrenia who tested positive died from COVID-19, compared to only 2% of the reference group, meaning individuals with schizophrenia were four times more likely to die from COVID-19. People with mood disorders had 2.8 times greater odds and people with anxiety disorder had 2.4 times greater odds of mortality compared to the reference group.
People with schizophrenia were more likely to die from COVID-19 even after controlling for chronic medical comorbidities and smoking, suggesting people with psychiatric disorders have a higher risk of mortality from COVID-19 that is independent of their medical comorbidities. “Although the explanations for this finding remain elusive, it is tempting to speculate that an increased inflammatory response, a biological factor common to both severe COVID-19 pathophysiology (cytokine storm) and schizophrenia (chronic low grade inflammation), could be one of the mechanisms underlying this increased mortality,” the authors write.
Additionally, 2.5% of individuals with schizophrenia who tested negative for COVID-19 died during the pandemic year compared to just 1.4% of the reference group. These results are not surprising considering people with severe mental illness have a 25-year lower life expectancy than individuals in the general population.
The authors suggest that alternative approaches to COVID-19 testing and interventions to improve clinical outcomes in individuals with psychiatric conditions are needed. The Centers for Disease Control and Prevention’s (CDC) addition of mental illness to their list of medical conditions that put individuals at an increased risk of COVID-19 was an important first step, but more dedicated resources and attention to improving COVID-19 outcomes for individuals with severe mental illness are needed as we continue to live with COVID-19.
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