Patients with schizophrenia have increased risk of death from COVID-19, study suggests

Schizophrenia patients who contract COVID-19 have a significantly increased risk of dying compared with patients without psychiatric disorders, a new study suggests.

The study, published last week in JAMA Psychiatry, looked at the outcomes of 7,348 adult patients who tested positive for the coronavirus between March 3 and May 31 in a large academic medical system in New York to assess whether a prior diagnosis of a schizophrenia spectrum disorder, mood disorder, or anxiety disorder is associated with increased mortality in patients with COVID-19.

Researchers found that while patients with mood and anxiety disorders were not at significantly elevated risk of dying, patients on the schizophrenia spectrum were 2½ times more likely to die from COVID-19 than patients in the control group. While the study couldn’t identify exactly what caused this higher risk of death, researchers noted patients on the schizophrenia spectrum might delay seeking treatment, or might not have ready access to care.

The findings of the study were not a surprise to Robert Davis, a psychiatrist and co-medical director at Wesley Family Services, a behavioral health services group based in Pittsburgh.

“While people with schizophrenia are less likely to contract the virus at a holiday gathering or a superspreader event because they might not be as social, they have reduced access to treatment,” said Davis, who was not involved in the study. “Even if those patients may have had access to health care at some point, people with schizophrenia are less likely to have regular access. If you have schizophrenia, it’s very difficult to wait for testing, or in the lobby of a doctor’s office, while you’re dealing with internal stimuli.”

David Greenspan, the chair of the department of psychiatry at Einstein Medical Center, said that the findings confirmed what many mental health experts already know — people with schizophrenia are a “highly burdened group with a much shorter life expectancy.” He stressed the importance of treating schizophrenia patients with empathy.

“This is just one more piece of evidence that these health disparities that exist really accrue for people with this particular group of mental illnesses,” Greenspan said. “It’s just one more example of why we need more resources and more concern.”

The study’s researchers emphasized that their findings should not be taken as conclusive for a few reasons, including the limited sample size of individuals with a diagnosis of schizophrenia.

Another factor: People with psychotic disorders tend to be “physically sicker because they don’t take care of themselves as well,” said Greenspan, who was not involved in the study.

“The schizophrenia group in this sample had a higher propensity to be male, to be Black, to be in their 60s, and to have almost all the comorbid conditions that we associate with deaths from COVID, like hypertension, smoking, chronic obstructive pulmonary disease (COPD), everything but cancer,” he said.

Greenspan noted that even though the researchers tried to control for those factors, “the vulnerability to the virus may be additive.”

Davis also noted that poor adherence to medication for underlying conditions may have been a factor as well. He said that schizophrenia patients often have a harder time following a dietary regimen and have less social support from family and friends, and often suffer from more undiagnosed illnesses.

“We also know that Vitamin D levels, which play a role in helping the body fight infection, tend to be lower in people with schizophrenia,” Davis said. “Their diets may be less balanced because they have less ability to prepare healthy meals.”

Both Greenspan and Davis agreed that more research is needed to confirm the finding. Greenspan also noted research is needed to determine if patients’ medications might affect the outcome.

Davis said that public health experts need to consider the difficulties these patients face when trying to get vaccinated.

“Right now, getting a vaccination is very difficult,” he said. “You have to call a lot of pharmacies and read complex information about all of this. You have to get there at a certain time after using the internet to get an appointment. This is hard for people like you and me, so you can just imagine how difficult it is for someone with schizophrenia. It’s hard for them in every aspect of this illness to be protected.”