A retrospective cohort study published online in JAMA Psychiatry found that a schizophrenia spectrum diagnosis was associated with increased mortality risk in patients with COVID-19. Here, researcher Katlyn Nemani, MD, of the New York University School of Medicine, explains the study's key and surprising findings, its implications on vaccination strategy and clinical practice, and further research in this area.
What led you and your colleagues to look into the association between psychiatric disorders and mortality among patients with COVID-19?
Prior research has consistently reported elevated mortality rates in people with psychiatric disorders compared to the general population. Risk of premature mortality is especially high in patients with schizophrenia, who have a higher risk of death from respiratory infection. In a population that may be at higher risk of COVID-19 infection due socioeconomic and environmental factors (such as crowded housing), we thought it would be important to determine which infected patients may be at increased risk of adverse outcomes.
Please briefly describe your study method and key findings.
The aim of our study was to see if there was an association between schizophrenia spectrum, mood, or anxiety disorders and risk of mortality in patients with COVID-19. We performed a retrospective study of 7348 patients with laboratory-confirmed infection treated across the NYU Health system during the peak of the pandemic. Then we calculated mortality rates within 45 days of testing positive for the virus, comparing patients with each of the diagnoses above with a reference group of patients without psychiatric disorders.
The main finding was that patients with schizophrenia spectrum disorders were at significantly increased risk of death after controlling for demographic and medical risk factors, while this was not seen in patients with mood and anxiety disorders.
Were any of the outcomes unexpected or surprising?
We expected patients with psychiatric illness to be at higher risk for mortality in the setting of COVID-19 given their higher rates of medical conditions—particularly cardiovascular disease. What came as a surprise was the high risk of mortality associated with schizophrenia spectrum disorders, which ranked only second behind age among all the demographic and medical risk factors we examined. The magnitude of this finding after adjusting for other medical risk factors was unexpected.
What are the possible applications of these findings in clinical practice?
We believe that our results argue for prioritization for vaccination for people with schizophrenia. Clinicians can play a role in improving patient education and awareness, to encourage adherence to infection prevention measures and facilitate vaccine uptake. It is also important to keep in mind that while preventing infection is necessary, “physical distancing” should not be confused with “social distancing.” Maintaining connection is important.
Are you conducting any follow-up research in this area, and are there any other studies you feel are needed?
This study requires replication, although other studies have produced convergent evidence for increased mortality in people with serious mental illness. Further research is needed to understand why patients with schizophrenia are at increased risk of frequent and severe infections and what can be done to mitigate this risk. We are currently conducting follow-up studies to understand the immune mechanism that may underlie our findings and assess the potential effects of specific psychotropic medications.
Dr. Katlyn Nemani is a clinical research psychiatrist at the Nathan Kline Institute and Research Assistant Professor of Psychiatry at the New York University School of Medicine. After earning her medical degree at Tufts University, Medford, Massachusetts, she completed combined residency training in neurology and psychiatry at NYU. Her research is focused on understanding the bidirectional relationship between systemic disease and psychopathology, particularly the interaction between the nervous system and immune system in people with psychosis.