People With Schizophrenia at High Risk of Dying From COVID-19

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With people who have major psychiatric disorders being more likely to have comorbidities which could lead to worse results concerning COVID-19, researchers using a US database assessed the odds of testing positive for COVID-19, as well as mortality from COVID-19.

A large database study examining more than 2.5 million patients found people with schizophrenia were nearly 4 times more likely to die from COVID-19 than the general population. People with mood disorders were more than twice as likely to die from the disease than the reference group studied.

Previous studies have shown people with existing psychiatric disorders are at a higher risk of SARS-CoV-2 infection, as well as experiencing severe COVID-19 outcomes, the study authors state. Because 1 of the more pivotal studies were taken from a single health system, among other limitations, the authors of the current study wanted to gain more specific information.

The researchers used the Optum COVID-19 Electronic Health Record database, which includes data on more than 3.6 million patients across the United States. After eliminating records of patients under 18, those with missing data or nondefinitive test results, and those taking psychotropic medication without a psychiatric diagnosis, the researchers had data from about 2.54 million patients. Of those, 294,417 had tested positive for COVID-19. The researchers further divided the sample into patients diagnosed with schizophrenia spectrum disorder, mood disorder, and/or anxiety disorder before March 2020.

The positivity rate for the schizophrenia population (9.86%; adjusted OR, 0.90 [95% CI, 0.84-0.97]) was comparable to that of the mood disorders group (9.86%; adjusted OR, 0.93 [95% CI, 0.87-0.99]). The anxiety disorders cohort had a 11.17% (OR, 1.05 [95% CI, 0.98-1.12]) positivity rate. Overall, patients with psychiatric disorders had a lower positivity rate in 2020 than the general population (11.91%), possibly due to social isolation, the researchers state.

More than 8% of the patients with schizophrenia in the sample group who tested positive for COVID-19 (n = 287) died compared with 2% of the reference group (n = 5899). COVID-19 positive patients with mood disorders were 2.76 times more likely to die of COVID-19 complications than the reference group (OR, 2.76; 95% CI, 2.00-3.81), while COVID-19-positive patients with anxiety disorders had 2.39 times greater odds of mortality than the reference group (OR, 2.39; 95% CI, 1.68-3.27).

Most chronic health conditions increased the odds of mortality, especially heart disease, which increased the odds by 80%.

Although this study examines a large number of COVID-19 patients, it is limited to those who tested positive in 2020, and it only examines data from patients whose records appear in the Optum EHR. Also, the results reflect trends in the US and may not reflect trends worldwide.

The researchers conclude, “this study’s findings suggest the need to foster recognition of pandemic risks on specific groups of patients with psychiatric conditions, and may drive alternative approaches to COVID-19 disease testing and interventions to improve clinical outcomes.”

Disclosure: One study author declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.


Teixeira AL, Krause TM, Ghosh L, et al. Analysis of COVID-19 infection and mortality among patients with psychiatric disorders, 2020. JAMA Netw Open. Published online November 1, 2021. doi:10.1001/jamanetworkopen.2021.34969