Schizophrenia associated with mortality among adults with COVID-19

1. Schizophrenia spectrum disorders were significantly associated with mortality among adults with COVID-19.

2. Participants with Schizophrenia had 2.7 times the odds of death due to COVID-19 than those without Schizophrenia.

3. Mood and anxiety disorders were not associated with COVID-19-related mortality.

Evidence Rating Level: 2 (Good)

Study Rundown: Coronavirus disease 2019 (COVID-19) has placed substantial burden on people across the globe, with psychological well-being being one component of particular concern. COVID-19 incidence has been previously associated with psychiatric diagnoses, though little is known regarding the association between psychiatric disorders and mortality among adults with COVID-19. This study aimed to explicate this relationship and determine whether or not a range of psychiatric conditions were associated with mortality in these patients.

This retrospective cohort study of 7,348 adult patients utilized assessment data from 45 days post-laboratory-confirmed COVID-19 between Match 3 and May 31, 2020 in a New York academic medical center. Psychiatric classifications of interest included schizophrenia spectrum disorders, mood disorders, and anxiety disorders. These groups were compared to a reference group without psychiatric diagnoses. Participants with schizophrenia spectrum disorders were associated with an increased risk for COVID-19-related mortality, while this association was not found among those with mood and anxiety disorders.

Overall, this study demonstrated that COVID-19-positive adults with schizophrenia spectrum disorders are at an increased risk of mortality compared to those without these disorders. Adults with comorbid mood and anxiety disorders do not appear to share this risk of mortality. Limitations of this study included the inability to confirm the accuracy of some psychiatric diagnoses, as well as a lack of information related to social determinants of health (e.g., socioeconomic status, housing, education, ability/willingness to seek medical care). However, each participant was receiving care at the study’s academic medical center. This study provides important information regarding psychiatric risk factors among those testing positive for COVID-19, further highlighting the importance of treating psychiatric conditions during this period of time.

Click to read the study in JAMA Psychiatry

Relevant Reading: Risk Factors Associated With Mortality Among Patients With COVID-19 In Intensive Care Units in Lombardy, Italy

In-Depth [ retrospective cohort]:

The COVID-19 pandemic has resulted in the dramatic increase of several risk factors for psychiatric conditions, including extensive isolation and distancing, fears related to illness, further racial/ethnic health disparities, and political unrest. These factors have prompted studies on psychiatric disorders in the context of COVID-19. This retrospective cohort study of adults with laboratory-confirmed COVID-19 sought to investigate the association between psychiatric diagnoses and COVID-19-related mortality in adults, compared to a reference group without these psychiatric conditions. The relevant classifications were (1) schizophrenia spectrum disorders, (2) mood disorders, and (3) anxiety disorders. Of the 26,540 patients testing positive for COVID-19 between March 3 and May 31, 2020, a total of 7,348 tested positive and were included in subsequent analyses (M [SD] age = 54 [18.6] years, 53.0% female).

This group of 7,348 adults had data from the day of confirmed COVID-19 to 45 days later. Among this group, 1.0% had a history of schizophrenia spectrum disorders, 7.7% with mood disorders, and 4.9% with anxiety disorders. Odds ratios (ORs) were calculated after adjusting for demographic and medical risk factors, finding that adults with histories of schizophrenia spectrum disorders were significantly associated with mortality (OR = 2.67, 95% CI 1.48 to 4.80). Neither mood disorders (OR = 1.14, 95% CI 0.87 to 1.49) nor anxiety disorders (OR = 0.96, 95% CI 0.65 to 1.41) were associated with mortality following adjustments for demographic and medical risk factors. Age was the strongest risk factor associated with mortality in this sample, followed by a diagnosis of schizophrenia, which had 2.7 times the odds of death after adjusting for risk factors. Mortality risk also demonstrated a recency-dependent association with mood disorders, such that more recent documentation of mood disorders was associated with greater risk of mortality than older and more stable mood diagnoses.

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