Individuals who suffer from severe psychiatric disorders were at least twice as likely to die from COVID-19 than others who caught the virus, at least in the first year of the pandemic when the most deadly SARS-COV2 variants, including Delta, were predominant.

That is the key finding in a new study published in Molecular Psychiatry, which is also the largest on COVID and psychiatry to date.

The research team, led by Prof. Mark Weiser, director of the Psychiatric rehabilitation centre at Israel’s Sheba Hospital, examined anonymized medical records of all 125,273 Israelis over the age of 18 who had been hospitalized for psychiatric illness at any time in their lives. This included people diagnosed with schizophrenia, bipolar, post-traumatic stress or obsessive-compulsive disorder, among others.

The study reported on rates of testing, infection, hospitalization, mortality and vaccination between March 1, 2020 and March 31, 2021 – the first year of the pandemic.

Patients who tested positive for COVID were twice as likely to be hospitalized and twice as likely to die from the virus. They were also 20% less likely than the general population to have been tested for COVID-19 and 25% less likely to have been vaccinated.

The length of time for which people had been hospitalised for past psychiatric episodes, prior to becoming ill with COVID, had no impact on the outcome.

“People get better or worse over time,” Weiser told Health Policy Watch. “Most people have a chronic illness and ongoing disability.”

Additionally, he said that many severe psychiatric patients neglect their health, are more likely to smoke, be overweight or have diabetes, which would make them more prone to developing severe COVID.

“People with severe mental illness are less likely to work, be active socially, less likely to be up and about and hence less likely to come in and get tested,” Weiser continued. Regarding vaccination, he said that “people have less initiative … and some might have cognitive impairment and therefore a lesser understanding of the importance of vaccination. Others might have vaccine hesitancy and be more likely to believe in conspiracy theories.”

International challenge

Although the study was conducted in Israel, Weiser stressed that tacking diseases among people with chronic and severe psychiatric disorders is an international challenge. Worldwide, around 2% to 3% of the population suffers from schizophrenia or bipolar disorder – which translates into over 150 million people worldwide.

“The numbers are huge, and we are not only talking about schizophrenia and bipolar,” Weiser added. “When you add in severe PTSD, OCD and other personality disorders, you come to a prevalence of about 4% to 5% of the population if not higher. This is not something rare and unimportant.”

This latest study is the only one that looks at people treated within an entire national health system.  But it is also not the only study looking at the correlation between COVID and psychiatry to date. A series of studies done by New York University, for example, looked specifically at schizophrenia patients within the New York University health system and came up with similar results – that these patients were more likely to be hospitalized and die from COVID.

One of the studies led by Prof. Donald Goff of the NYU School of Medicine retrospectively looked at 464 adult patients within the New York University Langone Health electronic health record system, who had a pre-existing diagnosis of schizophrenia, schizo-affective or bipolar disorder to see if antipsychotic treatment was associated with COVID mortality. The 60-day case fatality rate among patients with a schizophrenia spectrum disorder was 13.7% and the case fatality rate among patients with bipolar disorder was 5.7%, meaning a diagnosis of a schizophrenia spectrum disorder was associated with a nearly three-fold increased risk of mortality, as compared with bipolar disorder. And both mortality rates were far higher than in the general population. \

Moreover, being under medication did not seem to help.  Of the 196 patients who were under treatment with antipsychotic medication and caught the virus, 41 patients (8.8%) died, not a significantly higher number than among those who were not treated with the medication.

“A growing body of evidence has suggested that people with schizophrenia spectrum disorders may have an increased risk of fatal illness after COVID-19 infection, but the mechanism is
not clear,” the authors wrote. That study was published by JAMA Psychiatry.

Weiser stressed that his study is focused on people with severe psychiatric illnesses and not individuals with milder forms of mental disabilities, such as depression or anxiety, which are even more common among the population – but also may be less closely associated with COVID mortality.

Time to act

Weiser said that communities need to see how to better reach out to people with mental health challenges, and encourage them to get vaccinated, since they may not choose to come on their own. He also noted that people with schizophrenia who get COVID should be closely watched for medical complications.

“The bottom line is that all over the world doctors are talking about people who have diabetes or cancer being at higher risk [for COVID death],” Weiser said. “These data call for public health measures.”

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