Patients with schizophrenia are significantly more likely to die from COVID-19 than those without the disorder, even though they appear to have lower rates of infection, according to a study in JAMA Network Open. Further, while patients with mood disorders and anxiety were found less likely to die from COVID-19 than those with schizophrenia, they still died at higher rates from the virus than those without mental disorders.
“This study’s findings suggest the need to foster recognition of pandemic risks on specific groups of patients with psychiatric conditions and may drive alternative approaches to COVID-19 disease testing and interventions to improve clinical outcomes,” wrote Antonio L. Teixeira, M.D., Ph.D., of the University of Texas Health Science Center at Houston and colleagues.
Teixeira and colleagues analyzed data from the electronic health records (EHRs) of more than 2.5 million patients in the Optum COVID-19 Electronic Health Record database, derived from a network of health care provider organizations across the United States. Of these, 317,849 patients tested positive for COVID-19; more than 2.4 million patients tested negative.
Patients with psychiatric disorders were categorized into three mutually exclusive psychiatric diagnostic categories based on diagnostic codes in the EHR documented before March 1, 2020: schizophrenia spectrum disorders (n=3,350), mood disorders (n=26,610), and anxiety disorders (n=18,550). The authors compared the risk of testing positive for COVID-19 and COVID-19–related death for these three groups with a reference group of patients who had received laboratory tests for COVID-19 but had no documented psychiatric disorder.
They found that the COVID-19 positivity rate in patients with schizophrenia matched that of patients with mood disorders at 9.86%—a lower positivity rate than the reference group’s positivity rate (11.91%). The anxiety disorders cohort had a positivity rate of 11.17%.
After adjusting for demographic factors and comorbid conditions, patients with schizophrenia were found to be 3.74 times more likely to die from COVID-19 than patients in the reference group. Patients with mood disorders and those with anxiety disorders were 2.76 times and 2.39 times, respectively, more likely to die from COVID-19 compared with those in the reference group.
“It is possible that patients with major psychiatric disorders—schizophrenia and mood disorders—being more socially withdrawn are less exposed to the virus, explaining the lower positivity rate in the current study,” the authors wrote. “Alternatively, the lower positivity rate would reflect not a true reduced risk of infection, but lower testing numbers.”
For related information, see the Psychiatric News article “COVID-19 Greatly Increases Mortality Risk for Schizophrenia Patients, Research Shows.”
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