People with schizophrenia are almost three times more likely to die from Covid than those without the psychiatric illness in America, a study has found.
The higher risk cannot be explained by factors that often accompany serious mental health disorders, such as higher rates of heart disease, diabetes and smoking, according to researchers at New York University’s (NYU) Grossman School of Medicine.
This particular investigation found schizophrenia is the “biggest risk factor for death from Covid-19 after age”. Being male, heart disease, and race ranked next after schizophrenia in order. This finding has not been replicated in the UK.
In the UK, adults with pre-existing mental health conditions are at greater risk of death and hospitalisation from Covid-19, according to a government analysis, but are considered at lower risk than other high-risk groups.
In light of the new findings from America, mental health charities have urged the government to do more to protect people with schizophrenia in the UK.
“We call on the government to urgently review these findings, and include people with schizophrenia in those vulnerable groups for early vaccination,” said Marjorie Wallace, chief executive of the mental health charity SANE.
What did the US study find?
For the study, published in the journal JAMA Psychiatry, the research team analysed 7,348 patient records of men and women treated for Covid-19 at the height of the pandemic in NYU Langone hospitals in New York City and Long Island between March 3 and May 31, 2020.
Of these cases, they identified 14% who were diagnosed with schizophrenia, mood disorders, or anxiety. The researchers then calculated patient death rates within 45 days of testing positive for the virus.
Being 75 or older increased the odds of dying by 35.7 times, the researchers found. Those aged 65-74 were 16.6 times more likely to be killed by Covid, while those aged 55-64 were almost eight times more likely to die, and those aged 45-54 were 3.9 times more likely to die.
Schizophrenia was the second biggest risk factor after age – the odds of dying were increased 2.7 times – and this was after adjustment for age, sex, race and other medical issues.
Initially, researchers believed issues such as heart disease, depression and barriers in care were behind the low life expectancy seen in schizophrenia patients. However the results suggest the biology of schizophrenia itself could be making people more vulnerable to Covid-19. One explanation is an immune system disturbance, possibly tied to the genetics of the disorder, said study lead author Katlyn Nemani, a research assistant professor in the Department of Psychiatry at NYU Langone Health.
The researchers noted that this large sample of patients who all were infected with the same virus provided a “unique opportunity” to study the underlying effects of schizophrenia on the body. They plan to explore whether medications used to treat schizophrenia may play a role as well.
However, study senior author Donald Goff cautioned that they could only determine the risk for patients with schizophrenia who had access to testing and medical care. Further research is needed, he said, to clarify how dangerous the virus may be for those who lack these resources.
What does this mean for the UK?
Wallace, of mental health charity SANE, said the study reveals the need for more research into the “still unexplained biochemistry of schizophrenia and the wider risks for patients” in the UK.
Lucy Schonegevel, deputy campaigns and policy associate director at Rethink Mental Illness, called the findings “very concerning” and said the study needs to be fully evaluated. “We need to develop a better understanding of why people diagnosed with a severe mental illness like schizophrenia are potentially at greater risk of dying from Covid-19,” she told HuffPost UK.
“It reinforces the importance of people living with severe mental illness being included as a priority group to receive the vaccine. To support this, we’re undertaking research to understand any potential barriers to vaccination so that they can be urgently addressed.”
While many people severely affected by mental illness will live long and happy lives with the right care and support, there are concerns that Covid-19 stands to exacerbate pre-existing health inequalities.
“Prior to the pandemic, we knew that people living with severe mental illness are more likely to experience poor physical health and are 4.5 times more likely to die before the age of 75 than the general population,” said Schonegevel.
“Physical health checks are routine health appointments for people severely affected by mental illness which can save lives and efforts to increase the number of people receiving these checks need to be redoubled. It’s essential to look beyond a diagnosis of mental illness and treat and care for people’s physical health to give them the best possible quality of life.”
“Never has it been more important for people with mental health problems to get the support they need and deserve”
Stephen Buckley, head of information at mental health charity Mind, added: “Never has it been more important for people with mental health problems to get the support they need and deserve.” Anyone with a diagnosis of schizophrenia who is worried about what impact coronavirus might have on their health should talk to their doctor to review their situation.
“In England, people living with severe mental illnesses are 4.5 times more likely than average to die before they reach the age of 75 in England, if they don’t get the right support,” he said, “so it’s really important that we try to understand the reasons behind these poor health outcomes.”
In response to the study, a Department for Health and Social Care spokesperson said: “The list of conditions used to identify individuals who may be clinically extremely vulnerable is agreed by the four UK Chief Medical Officers and reflects the latest available evidence.
“Clinicians in the NHS are able to add any patient to the shielded patient list, based on their own clinical judgement and an impartial assessment of their needs.”