Medically reviewed by Susan Kerrigan, MD and Marianne Madsen

It’s been over one year since the COVID-19 pandemic began. Since then, scientists’ understanding of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that causes it has expanded greatly. While contact with contaminated surfaces was once seen as a primary driver of transmission, it’s now seen to be spread mainly through exhaling and inhaling tiny respiratory droplets that contain the virus. 

Similarly, the list of risk factors has changed. Some have been known since the beginning. The main risk factor is age. People who are older than 65 continue to be the ones most likely to die or be hospitalized. While some forms of asthma are no longer considered risk factors, obesity has been shown to increase the chance that someone with the virus will die. Now a new study is examining how some mental illnesses may also lead to fatal outcomes.

Mental Illness and COVID

Mental illness and its connection to physical wellbeing has long been understood. A recent study concluded that people with symptoms of depression or anxiety had a greater incidence of nearly all medical illnesses –– matching or even exceeding the effects of being obese or smoking. In 2010, researchers examined previous studies and noted that PTSD was connected to hypertension, obesity, and cardiovascular disease among others. They suggested that trauma exposure could affect how an individual’s body and mind interact. This can leave them vulnerable. Vulnerability to severe, even fatal outcomes from COVID-19 for people with mental illness was at the heart of a 2020 study at New York University (NYU)’s Langone Health System. 

As the pandemic peaked in the urban area, the study took a look at some 26,000 patients over the course of 45 days between March 3 and May 31, 2020. Of those patients, 7,348 tested positive for COVID-19. Of the group, some 53% were women with a median age of 54. Using psychiatric diagnostic codes from a variety of sources including electronic health and inpatient hospital records, researchers categorized them into three mutually exclusive psychiatric diagnostic categories: schizophrenia spectrum disorders, mood disorders, and anxiety disorders. Seventy-five of the patients had a history of a schizophrenia spectrum illness. Over 500 had a history of mood disorders while 360 had anxiety disorder histories.

Doctors have long known that people with schizophrenia spectrum disorders have a shorter than average life expectancy –– by some 15 years. Poverty, stress, stigma, and side effects of medications contribute to shortened life spans. So do high-calorie diets, lack of exercise, and abuse of alcohol and marijuana (which can negatively impact eating habits). For those with the condition, a strong support system from family and friends can help. 

Initially, researchers participating in the NYU study suspected that those with schizophrenia spectrum disorders who are institutionalized would be particularly vulnerable to COVID-19 –– just like people in prisons and nursing homes. Cramped, crowded facilities with uneven hygiene  practices are a breeding ground for the virus –- along with numerous other diseases. Yet even when adjusting for institutions, the study found that those who weren’t in crowded-care facilities were also vulnerable. Adjusting for age, sex, race, and known medical risk factors, the study found that “a schizophrenia spectrum diagnosis was associated with increased odds for 45-day mortality.” A similar study in France that looked at over 50,000 patients (including 823 with schizophrenia), came to a similar conclusion. Evidence from the study may lead to progress in the treatment of people with schizophrenia beyond the pandemic. That’s because it may indicate a genetic anomaly rather than lifestyle or behavior that increases vulnerability for infection. However, it also indicates poor outcomes when people with schizophrenia interact with the healthcare system versus those without the condition. For now, doctors who treat people with schizophrenia are advised to exercise particular caution –– especially toward younger patients with this condition who also smoke or are obese.

References

• Centers for Disease Control and Prevention: How COVID-19 Spreads
• Centers for Disease Control and Prevention: People With Medical Conditions 
• Comparing Anxiety and Depression to Obesity and Smoking as Predictors of Major Medical Illnesses and Somatic Symptoms
• The long-term costs of traumatic stress: intertwined physical and psychological consequences
• Association of Psychiatric Disorders With Mortality Among Patients With COVID-19