More Data Link Psychiatric Disorders to Higher COVID Mortality

While people with certain psychiatric disorders were less likely to test positive for COVID-19, they still faced higher mortality than the general population, researchers reported.

Compared with the 11.91% COVID-19 positivity rate in the general population in 2020, individuals with schizophrenia or mood disorders saw lower positivity rates (9.86% each), according to Antonio L. Teixeira, MD, PhD, of UT Health in Houston, and colleagues.

Meanwhile, people with anxiety disorders tested positive at a rate similar to the general population free of major psychiatric conditions (11.17%), the group wrote in JAMA Network Open.

“Although previous studies reported that patients with premorbid psychiatric disorders are at increased risk of SARS-CoV-2 infection, our data did not confirm this, actually showing the opposite,” Teixeira’s group pointed out.

“It is possible that patients with major psychiatric disorders — schizophrenia and mood disorders — being more socially withdrawn are less exposed to the virus, explaining the lower positivity rate in the current study,” the researchers explained. “Alternatively, the lower positivity rate would reflect not a true reduced risk of infection, but lower testing numbers.”

Despite this, those with psychiatric disorders still saw a significantly higher rate of mortality. Specifically, people with schizophrenia who tested positive had a nearly fourfold higher chance of dying from COVID-19 than the general population in a model adjusted for demographics and comorbidities (8% vs 2%, respectively; adjusted odds ratio [aOR] 3.74, 95% CI 2.66-5.24).

Similarly, those with mood (aOR 2.76, 95% CI 2.00-3.81) or anxiety disorders (aOR 2.39, 95% CI 1.68-3.27) saw a higher likelihood of COVID-19 mortality versus the general population.

Looking beyond COVID-19, people with schizophrenia who tested negative still saw a higher mortality rate than the general population throughout 2020 (3.5% vs 1.4%, respectively), even after adjusting for chronic medical morbidities and smoking.

Using data from the Optum COVID-19 Electronic Health Record database, Teixeira’s group identified 2,535,098 adults (62.4% white, 9.2% Black) who were tested for COVID-19 from February to December 2020. Among these, 3,350 had schizophrenia, 26,610 had mood disorders, and 18,550 had anxiety disorders. Average age in the total population was 44 years old and 62% were female.

Overall, 12% of the reference group had a positive COVID-19 swab at an inpatient facility compared with 31% of patients with schizophrenia.

“These patients [with schizophrenia] would ostensibly be less likely to seek testing in outpatient clinics or dedicated sites, probably undergoing COVID-19 tests when presenting related symptoms,” the researchers highlighted.

Rates of chronic medical conditions also differed among individuals with psychiatric disorders versus the reference group. For those with schizophrenia, obesity was 8-15% lower than the comparison groups, while current smoking status was higher for all psychiatric cohorts than the reference group.

With the exception of obesity, nearly all chronic health conditions were tied to a higher chance of death among people with psychiatric disorders:

• Hypertension (aOR 1.79, 95% CI 1.53-2.09)
• Ischemic heart disease (aOR 1.53, 95% CI 1.36-1.73)
• Diabetes (aOR 1.43, 95% CI 1.23-1.66)
• Smoke (aOR 1.26, 95% CI 1.20-1.32)

In comparing their findings to previous studies that examined COVID-19’s impact on those with psychiatric disorders, Teixeira and co-authors asked readers to bear in mind the ways in which sampling during various stages of the pandemic can affect results.

One of the study’s major limitations, the group noted, was the voluntary nature of the database, which can result in missing data.