Abstract
Background: Increasing clinical evidence suggests that people with severe mental illness (SMI), including schizophrenia spectrum disorders, bipolar disorder (BD), and major depressive disorder (MDD), are at higher risk of dying from COVID-19. Several systematic reviews examining the association between psychiatric disorders and COVID-19-related mortality have recently been published. Although these reviews have been conducted thoroughly, certain methodological limitations may hinder the accuracy of their research findings.Methods: A systematic literature search, using the PubMed, Embase, Web of Science, and Scopus databases (from inception to July 23, 2021), was conducted for observational studies assessing the risk of death associated with COVID-19 infection in adult patients with pre-existing schizophrenia spectrum disorders, BD, or MDD. Methodological quality of the included studies was assessed using the Newcastle-Ottawa Scale (NOS).Results: Of 1,446 records screened, 13 articles investigating the rates of death in patients with pre-existing SMI were included in this systematic review. Quality assessment scores of the included studies ranged from moderate to high. Most results seem to indicate that patients with SMI, particularly patients with schizophrenia spectrum disorders, are at significantly higher risk of COVID-19-related mortality, as compared to patients without SMI. However, the extent of the variation in COVID-19-related mortality rates between studies including people with schizophrenia spectrum disorders was large because of a low level of precision of the estimated mortality outcome(s) in certain studies. Most studies on MDD and BD did not include specific information on the mood state or disease severity of patients. Due to a lack of data, it remains unknown to what extent patients with BD are at increased risk of COVID-19-related mortality. A variety of factors are likely to contribute to the increased mortality risk of COVID-19 in these patients. These include male sex, older age, somatic comorbidities (particularly cardiovascular diseases), as well as disease-specific characteristics.Conclusion: Methodological limitations hamper the accuracy of COVID-19-related mortality estimates for the main categories of SMIs. Nevertheless, evidence suggests that SMI is associated with excess COVID-19 mortality. Policy makers therefore must consider these vulnerable individuals as a high-risk group that should be given particular attention. This means that targeted interventions to maximize vaccination uptake among these patients are required to address the higher burden of COVID-19 infection in this already disadvantaged group.
Highlights
Increasing clinical evidence suggests that people with severe mental illness (SMI), including schizophrenia spectrum disorders, bipolar disorder (BD), and major depressive disorder (MDD), are at higher risk of dying from COVID-19
Results of this study suggest that central nervous system (CNS) changes are due to a maladaptive immune response, rather than the consequence of a direct virus-induced effect, given that viral presence was low at late stages of COVID-19 [29]
A comprehensive literature search, using the PubMed, Embase, Web of Science, and Scopus databases, was conducted without language restriction for studies reporting data on the risk of death associated with COVID-19 infection in adult patients with schizophrenia spectrum disorders, BD, or MDD, compared with controls
Summary
Increasing clinical evidence suggests that people with severe mental illness (SMI), including schizophrenia spectrum disorders, bipolar disorder (BD), and major depressive disorder (MDD), are at higher risk of dying from COVID-19. People with severe mental illness (SMI), including schizophrenia (SZ) (lifetime prevalence: 0.7%), bipolar disorder (BD) (lifetime prevalence: 0.4–1.1%), and major depressive disorder (MDD) (lifetime prevalence: 15–18%) [1–3], have a two to three times higher mortality rate than the general population [4–7] This mortality gap translates into a 10–20 years shortened life expectancy [6, 8] and appears to be widening [9]. The first longitudinal imaging study (which had not been peer reviewed as of Oct 13, 2021), comparing structural and functional brain scans acquired from individuals before and after SARS-CoV-2 infection (n = 401) with scans from a well-matched control group (n = 384), demonstrated brain atrophy, mainly in the limbic regions with direct neuronal connectivity to the primary olfactory and gustatory system, in addition to a more diffuse loss of gray matter These authors suggested that the observed brain changes may be due to a direct virus effect, or to neuroinflammation, following viral infection and initiating chronic neuronal dysfunctions [30]
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