Schizophrenia and the enhanced risk of COVID-19 mortality

Schizophrenia and the elevated risk of COVID-19 mortality

Research indicates that individuals with schizophrenia have an elevated risk of contracting and succumbing to SARS-CoV-2, the virus responsible for COVID-19.

The interplay between COVID-19 and mental health is intricate. The pandemic has spawned unprecedented levels of anxiety and depression. Moreover, it's become evident that COVID-19 can impact, and be impacted by, mental health.

A study revealed that individuals with schizophrenia appear to be particularly susceptible. Those diagnosed within the past year were over seven times more likely to contract COVID-19 compared to individuals without any mental health disorder.

A recent study published in the Journal of the American Medical Association also highlighted schizophrenia as a significant risk factor for dying from COVID-19, second only to age.

To shed light on these findings, Medical News Today spoke with Katlyn Nemani, MD, a psychiatrist at New York University (NYU) Grossman School of Medicine and the lead author of the study.

The findings

The study analyzed medical records of over 7,300 adults who tested positive for SARS-CoV-2 and received treatment at the NYU Langone Health System, including:

75 individuals with a history of schizophrenia
564 individuals with a history of a mood disorder, including major depression and bipolar disorder
360 individuals with a history of an anxiety disorder

The researchers compared the number of deaths in each group within 45 days of a positive SARS-CoV-2 test. They discovered that individuals with schizophrenia were 2.7 times more likely to die from COVID-19 compared to individuals without a mental health disorder history.

Individuals with an anxiety or mood disorder were not at increased risk.

Additional research has identified an elevated risk of severe COVID-19 and death in individuals with schizophrenia, including studies conducted in the United States and the United Kingdom.

Deciphering the connection

Dr. Nemani explained that there are several factors that might increase the risk of COVID-19 and complications in individuals with schizophrenia, such as:

living in crowded settings, such as group homes
lack of protective equipment, including masks
poor access to healthcare
a higher prevalence of underlying medical conditions, such as heart disease and diabetes

“However, these factors were unlikely to account for the increased risk of death associated with schizophrenia in our study,” Dr. Nemani explained. After adjusting for these factors, individuals with schizophrenia were still 2.7 times more likely to die from COVID-19 compared to individuals without schizophrenia.

She suggested that individuals with schizophrenia may be more likely to experience severe COVID-19 due to underlying immune system dysfunction.

“ research from animal and human studies suggests a central role of inflammation in schizophrenia,” Dr. Nemani said. “Certain risk genes and environmental stressors may alter the immune response and contribute to a chronic pro-inflammatory state.”

A pro-inflammatory state occurs due to increased immune system activity. When the immune system remains overactive for too long, it can lead to widespread tissue damage, which can cause health problems.

Some experts have proposed that an overactivation of the immune system, known as a cytokine storm, is a possible cause of severe COVID-19.

Immune dysregulation in individuals with schizophrenia may increase the risk of a cytokine storm. This can lead to severe COVID-19 and ultimately, death.

Henry Nasrallah, MD, a professor of psychiatry at the University of Cincinnati College of Medicine in Ohio, agreed that immune dysregulation in individuals with schizophrenia might explain the higher risk of death associated with COVID-19.

Immune system dysfunction can cause complications that make it harder for the body to fight off an infection, such as oxidative stress and impaired energy production.

The study by Dr. Nemani and colleagues accounted for many factors that may increase the risk of developing severe COVID-19. However, Dr. Nasrallah emphasized that individuals with schizophrenia are likely to have other underlying health and behavioral concerns that may increase the risk of severe disease and death, including:

sleep apnea
poor nutrition
substance use
neurodegeneration

In addition to immune dysregulation, Dr. Nemani added that medications used to treat schizophrenia might increase the risk of more severe COVID-19 and death.

“We are currently conducting studies to examine both possibilities,” she said.

There is currently no evidence that antipsychotics have associations with a higher risk of death in individuals with COVID-19 and schizophrenia. Dr. Nemani emphasized that it is important for individuals to stay in contact with their healthcare team to receive the most up-to-date treatment guidance.

Implications for other psychiatric disorders

Immune dysregulation is not exclusive to schizophrenia.

“We know that the brain and immune system communicate with each other through a common language that includes neurotransmitters and hormones,” Dr. Nemani explained. “It seems plausible that alterations to these pathways in the setting of a variety of psychiatric disorders could alter the immune response to COVID-19.”

Their study found that individuals with a history of mood or anxiety disorders did not have an increased risk of death. However, Dr. Nemani noted that more complications might occur in real life.

Other mental health conditions tend to follow a pattern, where symptoms worsen and then improve. This could explain why individuals with other disorders did not seem to be at increased risk of COVID-19. “This may be different from the risk associated with schizophrenia, which is generally considered to be a chronic illness,” she said.

What individuals with schizophrenia can do

Dr. Nemani emphasized that individuals with schizophrenia and their loved ones should follow guidelines to reduce their risk of contracting COVID-19 by:

wearing a mask
avoiding crowded indoor settings
seeking vaccination when possible

People dealing with severe mental health issues like schizophrenia should prioritize staying in touch with their mental health care team and adhering to treatment advice during the pandemic, stated Dr. Nemani further.

Individuals with serious mental health conditions, such as schizophrenia, are at a higher risk of experiencing severe COVID-19 symptoms and even death.

Yet, as of the beginning of 2021, mental health issues are not listed among the high-risk underlying medical conditions in the latest vaccination guidelines.

The key points

Schizophrenia is a multifaceted disorder characterized by various behavioral and health factors that may elevate the risk of experiencing severe COVID-19 and even death.

Although researchers continue to examine the intricate mechanisms behind this association, persistent immune system activation in individuals with schizophrenia may potentially induce health issues that make it more challenging to combat the virus and intensify the disease's severity.

Those with schizophrenia should focus on reducing their COVID-19 risk as much as possible by donning masks, steering clear of large gatherings, and getting vaccinated when the opportunity arises.

Moreover, Dr. Nemani underscored the importance of safeguarding mental health alongside physical health. "Physical distancing is crucial to ward off infection, but fostering connections is equally vital," she noted.

The study also revealed that individuals with schizophrenia have a higher risk of dying from COVID-19, second only to age, according to a recent publication in the Journal of the American Medical Association. This increased risk of mortality in individuals with schizophrenia persisted even after adjusting for factors such as living in crowded settings, lack of protective equipment, and underlying medical conditions.