Schizophrenia may be an under-reported risk factor for death among coronavirus patients, research suggests.
Surviving a severe case of the infection has been linked to the onset of psychiatric disorders.
Feeling there was little research into how these conditions affect a patient’s risk of becoming seriously ill with the coronavirus, medics from New York University analysed more than 7,300 people with the infection.
Results suggest being diagnosed with a schizophrenia spectrum disorder more than doubled a patient’s risk of dying with the coronavirus within 45 days.
This makes the psychiatric condition second only to age in terms of death risk, according to the medics.
Other experts have had a mixed response to the research, with one calling it “a good, robust study” while another said “it is very difficult to draw firm conclusions” from the results.
Two previous US studies have suggested COVID-19, the disease caused by the coronavirus, is more common among people with depression and schizophrenia.
This may come down to “socioeconomic and environmental factors”, like living in a crowded home or a lack of personal protective equipment.
Scientists from University College London also reported that up two in five psychiatric ward patients in the UK had the coronavirus at the height of the first wave, while a University of Oxford team found coronavirus survivors may be twice as likely to develop a psychiatric disorder as those who overcome flu.
To learn more, the New York medics analysed more than 7,300 people with an average age 54 who tested positive for the coronavirus.
These were taken from the university’s electronic health record system, which was made up of patients from “outpatient office sites” and hospitals.
Of the more than 7,300 coronavirus patients, 75 had a history of “schizophrenia spectrum illness”.
This can include schizophrenia, which can cause hallucinations and delusions; schizoaffective disorder, where schizophrenia symptoms are combined with depression or mania; and delusional disorder, when a patient cannot distinguish between what is real and imagined.
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The results, published in the journal JAMA Psychiatry, reveal that of the 75 patients with “schizophrenia spectrum”, 20 (26%) died or were discharged to a hospice.
“A premorbid diagnosis of a schizophrenia spectrum disorder” was therefore linked to more than double the risk of death with the coronavirus.
This remained true after the medics accounted for age, sex, race and any other medical condition.
They concluded: “A diagnosis of schizophrenia ranked behind only age in strength of an association with mortality.”
Mood or anxiety disorders were not linked to a heightened coronavirus death risk.
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Although unclear, schizophrenia patients may be more susceptible to “COVID-19 mortality” due to “biological factors related to their psychiatric illness or treatment”.
“Immune dysregluation in the setting of genetic or acquired risk factors is a possibility,” wrote the medics.
They stressed that further research is required, but added: “Targeted interventions may be needed for patients with severe mental illness to prevent worsening health disparities.”
‘They should be prioritised for vaccination’
Speaking of the 20 schizophrenia spectrum patients who died or were discharged to a hospice, Professor David Curtis from University College London said: “This seems like a very high rate.”
He added, however, that the study’s overall mortality rate was around 11%, “which is much, much higher than we would expect for cases in general”.
“The study was carried out in New York between March and May 2020, and it is obvious the cases included must have been already exceptionally severe for the mortality to be so high,” said Professor Curtis.
“So the study does not really reflect people who have COVID-19 in general, but people who managed to get tested by the New York University Health System in the early period of the pandemic.”
Based on these limitations, Professor Curtis said: “Although it is well recognised people with severe mental illness are at significantly higher risk of physical ill health, it is very difficult to draw firm conclusions from this study.”
Another expert added that the medics did not account for “the wide range of social, cognitive and behavioural disadvantages” a schizophrenia spectrum diagnosis “usually infers”.
“While it is important to consider biological predispositions inherent to the condition, it is surprising the authors glance over the fact their work may, again, be illustrating the health and social inequalities to which patients with long-term psychiatric disorders such as schizophrenia remain prone,” said Professor David Owens from the University of Edinburgh.
Not everyone agreed, however.
Professor Shon Lewis from the University of Manchester called the research “a good, robust study with important findings”.
“We have known for some time people with schizophrenia in the UK have a life expectancy reduced by 18 to 20 years compared to the general population,” he said.
“This awful statistic is due largely to increased rates of cardiovascular, respiratory and metabolic disease resulting from lack of exercise, obesity, smoking and side effects of some medications in people with schizophrenia.
“This latest finding spotlights how good preventive care must now be urgently focused on this incredibly vulnerable and disadvantaged population.
“They should be immediately prioritised for vaccination.”
Others pointed out, however, that the same risk factors that raise a schizophrenia patient’s risk of an early death may also make the coronavirus more severe – like obesity, smoking or a distrust around asking for help.
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