Schizophrenia diagnosis among top risk factors for mortality in COVID-19 patients

Schizophrenia spectrum disorder diagnosis appeared to be a significant risk factor for mortality among individuals with COVID-19, according to results of a retrospective cohort study published in JAMA Psychiatry.

“The increased incidence of COVID-19 among individuals with mental disorders has been reported in at least [two] nationwide cohort studies in the US, with depression and schizophrenia associated with the highest infection risk in one sample,” Katlyn Nemani, MD, of the department of psychiatry at New York University Langone Medical Center, and colleagues wrote. “This association may be attributable to socioeconomic and environmental factors that contribute to exposure (eg, crowded housing, institutional settings and lack of personal protective equipment). Because outcomes may differ by diagnosis, it is important to determine which infected patients are at increased risk [for] adverse outcomes.”

The investigators sought to determine whether a diagnosis of a schizophrenia spectrum disorder, mood disorder or anxiety disorder was linked to mortality among individuals with COVID-19. They analyzed data of 7,348 adults for 45 days following laboratory-confirmed COVID-19 diagnosis between March 3, 2020, and May 31, 2020, in a single medical system in New York. July 15, 2020, was the final follow-up date. The researchers excluded individuals who did not have available medical records before testing. They categorized participants according to ICD-10 criteria prior to their testing date and compared those with one of the three assessed diagnoses to a reference group without psychiatric disorders. The main outcome was mortality, defined as death or discharge to hospice within 45 days of a positive severe acute respiratory syndrome coronavirus 2 test.

Results showed the following histories among participants with positive test results:

• 75 (1%), schizophrenia spectrum illness;

• 564 (7.7%), mood disorder; and

• 360 (4.9%), anxiety disorder.

However, adjustment for demographic and medical risk factors revealed premorbid diagnosis of a schizophrenia spectrum disorder was significantly linked to mortality (OR = 2.67; 95% CI, 1.48-4.8). They noted no association with mortality after adjustment for diagnoses of mood disorders (OR = 1.14; 95% CI, 0.87-1.49) and anxiety disorders (OR = 0.96; 95% CI, 0.65-1.41). Compared with other risk factors, schizophrenia diagnosis ranked behind only age in strength of association with mortality.

“Further research is needed to determine whether specific psychiatric disorders are associated with an increased risk [for] fatal illness among patients with COVID-19 in other settings,” Nemani and colleagues wrote. “Targeted interventions may be needed for patients with severe mental illness to prevent worsening health disparities.”