According to a new study, schizophrenia may be one of the biggest risk factors for dying from COVID-19.
Previous studies have found that especially people with mental illnesses depression and schizophrenia – a condition that causes thinking and observation – has a higher risk of becoming infected with SARS-CoV-2, the virus that causes COVID-19. But it was not known whether mental disorders were also associated with the risk of dying from COVID-19.
In the new study, researchers looked at health records of 260 outpatients and four hospitals across New York, based on data published by the University of New York’s electronic health record; Of 26,540 patients tested (approximately 4,500 patients were excluded for various reasons), 7,348 adults tested positive COVID-19 between March 3 and May 31.
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They then divided the patients with a reported psychiatric disorder into one of three categories – schizophrenia spectrum, mood disorder or anxiety disorder – and compared them with COVID-19 patients who had no psychiatric disorder. They adjusted their findings for gender, age, race, and known risk factors for COVID-19: high blood pressure, diabetes, heart disease, chronic obstructive pulmonary disease, chronic kidney disease, smoking and cancer.
Of the more than 7,000 adults who tested positive for the coronavirus during that time, 75 patients had a history of schizophrenia; 564 had a history of mood disorder; and 360 had a history of anxiety disorder. Overall, 864 of the COVID-19 patients died or were discharged within 45 days of their diagnosis.
The researchers found no link between anxiety or mood disorders and death from COVID-19. But they found that people with schizophrenia were about 2.7 times more likely to die from COVID-19 than people without that mental disorder – the second highest risk factor after age.
In comparison, patients between 45 and 54 years of age were 3.9 times more likely to die from COVID-19 than younger patients (and the risk doubled to 54 every ten years), regardless of whether they had a mental disorder. Patients with heart failure or diabetes have a 1.65 times and 1.28 times greater risk of dying from COVID-19.
Expected but surprising
But why would a mental illness be associated with the risk of dying from COVID-19?
“It is expected, but also surprising,” said senior author, dr. Donald Goff, a professor of psychiatry at the NYU School of Medicine said. Research has shown that people with schizophrenia have reduced life expectancy by an average of up to 20 years; and many die earlier from pneumonia and viral diseases, he said.
It is suspected that the decline in life expectancy is mostly a reflection of other medical risk factors and behaviors commonly associated with schizophrenia, obesity, heart disease and cigarette smoking. In this study, people with schizophrenia still had a higher risk of mortality, despite the authors adapting to the conditions.
“There seemed to be something to the disease of schizophrenia or possibly medication that caused them to really be at high risk for deaths,” Goff told WordsSideKick. For example, the disease or medication can disrupt the disease Immune system, he said. Previous research has found that people with schizophrenia can alter immune responses and variations in the genes that regulate the body’s immune response to infections.
“This is a very interesting study, especially with regard to the role of the immune system,” says Dr. Norbert Müller, a professor of psychiatry at the Ludwig Maximilian University of Munich, Germany, who was not involved in the study. Some psychiatrists speculate that schizophrenia is related to the activation of the immune system and pro-inflammatory signaling molecules, known as cytokines, he said. A common cause of death from COVID-19 is an overreaction of the cytokines, also known as a cytokine storm.
“Such a mechanism could also play a role in schizophrenia and be a common path of schizophrenia and fatal course in COVID-19,” Müller told WordsSideKick. But the genes that direct and regulate the immune response may also play a role, he added. The study was still limited by the low number of schizophrenia patients, and also by the lack of data on psychosis medication (which the authors also mention).
The data also included patients who had access to treatment in the NYU health care system, and these were collected during the New York City outbreak when mostly people at high risk and symptomatic were tested.
“There were such high rates, and the whole system was almost overwhelmed and the treatments were not as effective as now,” Goff said. Since then, ‘absolute mortality rates have dropped across the board, but we think it’s likely to remain true that people with schizophrenia are at higher risk.’
Goff and his team are now doing more research to determine if there is a biological reason why patients with schizophrenia may be at higher risk. But for now, “we thought it was important to bring it to people’s attention,” Goff said. People with schizophrenia should be among those who ‘prefer vaccines’, he added.
The findings were published in the journal on January 27. JAMA Psychiatry.
Originally published on Live Science.