COVID-19 and schizophrenia a deadly mix, study shows

David Heitz

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I have two of the biggest COVID-19 mortality factors working against me: Age and schizophrenia.

A new study shows that people with schizophrenia have the greatest known mortality rate for COVID-19 besides elderly people. The same study showed other mental illnesses do not affect COVID-19 death rates.

People with schizophrenia have three times the odds of COVID-19 death than those without schizophrenia, the study found.

The findings were published Wednesday in JAMA Psychiatry.

“In this cohort study of 7,348 adults with laboratory-confirmed COVID-19 in a New York health system, a schizophrenia spectrum diagnosis was associated with an increased risk of death after adjusting for demographic and medical risk factors,” the authors found. “Mood and anxiety disorders were not associated with increased risk of mortality.”

The patients included in the study all had their mental illness diagnoses prior to their COVID diagnosis.

Those who died did so within 45 days of their diagnosis.

“In comparison with other risk factors, a diagnosis of schizophrenia ranked behind only age in strength of an association with mortality,” the authors explained.

Why are so many mentally ill people dying of COVID-19?

The authors of the study hailed from NYU-Langone Medical Center. An accompanying interview with Dr. Donald Goff, lead author, detailed how the researchers arrived at their findings.

The sample all came from New York City but were representative in race and socioeconomic class, Goff said. The research began at the onset of COVID, and mentally ill people seemed to be dying faster than others.

He said clinicians began to see increased patient traffic and feared they would be overwhelmed. He said it signaled a “switch to telepsychiatry almost overnight.”

People with schizophrenia have a higher mortality rate than most people overall. They are at increased risk of cardiovascular death (many people with schizophrenia smoke), suicides and accidents.

But they also have a seven-fold increased risk of influenza and pneumonia, which hinted at COVID-19 susceptibility.

Diabetes, sex, age also COVID-19 risk factors

As I read the study, I learned I have risk factors beyond my age and my schizophrenia diagnosis. I’m not diabetic but I do take metformin, so I guess you could say I’m pre-diabetic. I’m also male.

“Risk factors identified to date include older age, male sex, cardiovascular disease, and diabetes,” the authors explained. “Differences in outcomes by socioeconomic status and race have also received attention, highlighting the potential for the pandemic to deepen existing health inequalities.”

I admit I have not been taking COVID-19 as seriously as I should. I frequently leave my apartment without putting on my mask, for example. But I’m getting better.

It is scary to think just how contagious COVID-19 really is if you are someone at increased risk of death from the disease. Most people recover.

I will make a point of getting the COVID-19 vaccination when it becomes available to me.

Correlation between schizophrenia, COVID-19 deaths strong

The authors were surprised by their findings. They hypothesized that death rates also would be higher with mood and anxiety disorders.

They also did not expect to see such a strong correlation between schizophrenia and COVID-19 deaths.

“A higher risk with schizophrenia spectrum diagnoses was expected based on previous studies of all-cause mortality, but the magnitude of the increase after adjusting for comorbid medical risk factors was unexpected,” the authors explained.

“It is possible that unmeasured medical comorbidities contributed to this finding, although the risk remained significantly increased after adjustment for multiple established risk factors. Delays in treatment seeking or reduced access to care may have contributed to worse outcomes.”

Research shows online counseling works

Meantime, there’s good news coming out of another study appearing this month in JAMA Psychiatry. The study shows personalized online therapy for depression works.

“Both psychotherapy and pharmacotherapy can treat depression effectively,” the authors explained. “Nevertheless, psychotherapy is unavailable to most of the world’s population owing to costs, availability of trained clinicians, and stigma.”

What’s more, COVID-19 has all but ended in-person visits. “The current coronavirus disease 2019 (COVID-19) pandemic has displaced and dislocated mental health services, while social and community containment measures, associated distress, loss, and potential financial difficulties are likely to be long lasting and impactful.

In other words, there are plenty of depressed people these days living under depressing conditions.

Guided online therapy works best

Counseling, also known as cognitive-behavioral therapy, can be guided or unguided. That means a counselor may coach you during therapy. You may mark things down in a workbook, even as you get counseling at home online.

“Over the past 20 years, the mental health care available for depression has undergone a major technological revolution,” the authors wrote. “Psychological interventions, such as cognitive behavioral therapy, are increasingly delivered over the internet.”

The study found that guided internet therapy resulted in greater improvements in depressive symptoms than unguided.

“Many people with depression may still benefit from the internet cognitive-behavioral therapy without therapeutic guidance and optimizing treatment assignment would considerably expand treatment coverage worldwide,” the authors concluded.

Internet brings depression treatment to millions

The authors argue the findings “open new avenues for treatment decision-making.”

“In this systematic review and meta-analysis of 39 studies comprising 9,751 participants, individuals with mild/subthreshold depression was associated with little or no benefit from therapeutic guidance, while guided internet cognitive-behavioral therapy was associated with more effectiveness in individuals with moderate and severe depression.”

Some patients, due to stigma or other reasons, do not want in-person therapy. “Individuals who seek self-treatment on the internet are making an implicit “no guidance” choice,” the authors wrote. “Our work indicates that this may not be the best choice for everyone, and that individuals signing up for fully automated programs should be advised that they might benefit from therapeutic support working through the program.”

The authors say future studies need to determine whether internet-based therapy is prohibitive in low-income communities where internet access is limited. They also say upcoming papers should examine how the therapy works in conjunction with medications and other interventions.

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I have been in the news business more than 30 years, spending much of my career at some of the best local newspapers in the country. Today, I report on Denver City Hall, homelessness and other topics for NewsBreak, much like I did in my twenties covering Newport Beach, Calif. for the Daily Pilot. I consider myself a lucky guy to still be doing what I love after so many years.

Denver, CO
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