Schizophrenia is the second biggest risk factor for dying of Covid-19 after old age, new research shows.
The mental health condition almost triples the risk of dying from Covid-19 when compared to a healthy person aged between 18 and 44.
The only group of people at higher risk of death than those with schizophrenia are older people who, irrespective of comorbidities, are far more likely to die.
Scientists do not yet fully understand why people with schizophrenia are at increased risk, but believe it may be due to a genetic flaw inhibiting their immune response.
People with schizophrenia tend to live, on average, up to two decades less than people with no mental health issues and also suffer from increased disease as a result of a lack of exercise, obesity, smoking and side effects from some schizophrenia medication.
Other conditions which increased the risk of death include heart failure (60 per cent increased risk), high blood pressure (38 per cent) and diabetes (27 per cent).
Men were found to be 69 per cent more at risk of death than women and non-white people (black, asian, mixed race) were 47 per cent more at-risk compared to whites.
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The mental health condition almost triples the risk of dying from Covid-19 when compared to a healthy person aged between 18 and 44. Other conditions which increased the risk of death include heart failure (60 per cent increased risk), high blood pressure (38 per cent) and diabetes (27 per cent)
Researchers from New York University studied anonymous health records of more than 7,000 hospitalised Covid-19 patients between March and May 2020, 75 of which had medically diagnosed schizophrenia.
Mortality was defined as death or discharge to hospice within 45 days following a positive test result for the coronavirus.
‘Our findings illustrate that people with schizophrenia are extremely vulnerable to the effects of COVID-19,’ says study lead author Dr Katlyn Nemani.
‘With this newfound understanding, health care providers can better prioritise vaccine distribution, testing, and medical care for this group.’
Professor Shon Lewis of the University of Manchester, who was not involved in the study, said: ‘It is a good, robust study with important findings.
‘We have known for some time that people with schizophrenia in the UK have a life expectancy reduced by 18-20 years compared to the general population.
‘This awful statistic is due largely to increased rates of cardiovascular, respiratory and metabolic disease resulting from lack of exercise, obesity, smoking and side effects of some medications in people with schizophrenia.
‘This latest finding spotlights how good preventive care must now be urgently focused on this incredibly vulnerable and disadvantaged population. They should be immediately prioritised for vaccination.’
Currently, the UK Joint Committee on Vaccination and Immunisation has prioritised all people over 50 for the jab, as well as healthcare workers and the clinically extremely vulnerable, which are in the fourth priority slot ahead of over-65s.
This group includes people with ‘severe mental illness’, which is not currently listed as clinically extremely vulnerable, with people suffering from this condition give no priority when it comes to receiving the vaccine.
The clinically extremely vulnerable group includes chronic kidney disease and diabetes, which confer a 1.23 and 1.27 times increased risk of death from Covid, respectively. This is dwarfed by the 2.67 figure for schizophrenia.
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.’
The clinically extremely vulnerable vaccine priority group includes people with chronic kidney disease and diabetes, which were found to be at 1.23 and 1.27 more at risk of death from Covid than a healthy person. This is dwarfed by the 2.67 figure for schizophrenia (stock)
Dr Adrian James, president of the Royal College of Psychiatrists, said: ‘The deadly consequences of Covid-19 on people living with schizophrenia is deeply worrying and should serve as a catalyst to ensure this at-risk group of people are offered the vaccine at the earliest opportunity.
‘Those living in the community must be supported throughout the vaccination process, while those in mental health wards or residential settings must not be forgotten about or left behind.
‘People living with a severe mental illness already die on average 20 years earlier than the general population. The government must do all that they can to protect people living with severe mental illness, intellectual disability and dementia from Covid-19.’
While people with schizophrenia were found to be at much higher risk of death, people with anxiety and mood disorders were not.
This, the researchers say, indicates there may be an unknown underlying mechanism which puts people with schizophrenia at elevated risk.
Dr Nemani says this may be an immune system disturbance, possibly tied to the genetics of the disorder.
‘Now that we have a better understanding of the disease, we can more deeply examine what, if any, immune system problems might contribute to the high death rates seen in these patients with schizophrenia,’ says study senior author Dr Donald Goff at NYU Langone.
Stephen Buckley, Head of Information at Mind, said: ‘While we welcome research into the links between serious mental health problems and Covid19, much more robust research is needed worldwide, including in the UK.
‘Research that leads to improved health outcomes and quality of life for people with mental health problems is welcomed.
‘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 the UK research has shown links between covid19 and factors like poverty and ethnicity, so it’s really important that all these links are better understood.
“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, so it’s really important that we try to understand the reasons behind these poor health outcomes.’
The study was published today in JAMA Psychiatry.