Schizophrenia Linked to Higher COVID-19-Related Risks

Shot of a young woman having a therapeutic session with a psychologist
Researchers assessed trends in COVID-19 vaccination, hospitalization, and mortality among individuals with schizophrenia.

Compared with the general population, people with schizophrenia have been vaccinated for COVID-19 at lower rates and are at increased risk for hospitalization and mortality due to this illness.  These findings are from a large longitudinal study evaluating trends in COVID-19-related hospitalization and mortality among people with schizophrenia during the first year of the pandemic, the results of which were published in the Lancet Psychiatry.

Data for the study were sourced from the largest healthcare organization in Israel, Clalit Health Services, in Tel Aviv. Trends in COVID-19 vaccination, hospitalization, and mortality through April 30, 2021, were assessed among the subset of individuals with schizophrenia (n=25,539) and matched controls from the Clalit Health Services registry (n=25,539).

The mean age of the participants was 51.94 years (standard deviation [SD], 15.62), and 61.0% were men. Overall, 53.6% of the total study population (27,400 of 51,078 individuals) had been vaccinated. Among all participants, 0.7% were hospitalized with COVID-19, and 0.3% had died.

Stratified by schizophrenia status, hospitalization for COVID-19 was more likely among the schizophrenia cohort (adjusted hazard ratio [aHR], 4.81; 95% CI, 3.57-6.48; P <.0001), as was COVID-19-related mortality (aHR, 2.52; 95% CI, 1.64-3.85; P <.0002).

Although patients with schizophrenia were more likely to be hospitalized for COVID-19 than the general population (P <.0001), there was a trend for decreased hospitalization over time; individuals were more likely to be hospitalized during the beginning of the pandemic (HR, 6.44) compared with later (HR, 3.40). A temporal trend for mortality was not found to be significant.

Fewer individuals with schizophrenia were fully vaccinated (50.6%) compared with those in the general population (52.8%). Significant predictors for vaccination were similar between the 2 groups, including age, sex, and socioeconomic status (all P <.0001). Individuals with schizophrenia and comorbid obesity, diabetes, and hypertension were more likely to be vaccinated (all P <.0001) but similar patients in the general population were not.

Among individuals who were fully vaccinated by February 2021, those with schizophrenia had an incidence rate for hospitalization 1.1 per 1000 person-years (py) higher and for mortality 0.9 per 1000 py lower than the general population. Among nonvaccinated individuals, those with schizophrenia had a 6.2 per 1000 py higher hospitalization rate and a 3.2 per 1000 py higher mortality rate.

These data may not be generalizable as Israel is considered an outlier worldwide on the basis of health system coverage and vaccine accessibility.

The study authors concluded that participants with schizophrenia were less likely to be vaccinated for COVID-19 than the general population and were at increased risk for hospitalization and mortality from the infection. National vaccination campaigns targeting people with schizophrenia, they said, are needed to reduce disparities in COVID-19 severe outcomes in this population.

Disclosure: Multiple authors declared affiliations with industry. Please refer to the original article for a full list of disclosures.


Bitan DT, Kridin K, Cohen AD, Weinstein O. COVID-19 hospitalisation, mortality, vaccination, and postvaccination trends among people with schizophrenia in Israel: a longitudinal cohort study. Lancet Psychiatry. Published online August 5, 2021. doi:10.1016/S2215-0366(21)00256-X