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Analysis of COVID-19 Infection and Mortality Among Patients With Psychiatric Disorders, 2020

Educational Objective
To identify the key insights or developments described in this article
1 Credit CME
Key Points

Question  Do people with major psychiatric disorders have greater odds of testing positive for COVID-19 and dying from it?

Findings  This cross-sectional study based on nationwide electronic health record data from 2 535 098 participants showed that the schizophrenia and mood disorder cohorts had significantly lower rates of positivity (9.86%) than the anxiety disorder cohort (11.17%) and the general population (11.91%). Conversely, patients with schizophrenia had a higher rate of death from COVID-19 than the reference group or those with mood disorders or anxiety disorders.

Meaning  This study suggests that patients with major psychiatric disorders may be more likely to have medical comorbidities associated with worse COVID-19 outcome and yet have a higher mortality rate independent of comorbidities.


Importance  People with major psychiatric disorders are more likely to have comorbidities associated with worse outcomes of COVID-19. This fact alone could determine greater vulnerability of people with major psychiatric disorders to COVID-19.

Objective  To assess the odds of testing positive for and mortality from COVID-19 among and between patients with schizophrenia, mood disorders, anxiety disorders and a reference group in a large national database.

Design, Setting, and Participants  This cross-sectional study used an electronic health record data set aggregated from many national sources in the United States and licensed from Optum with current and historical data on patients tested for COVID-19 in 2020. Three psychiatric cohorts (patients with schizophrenia, mood disorders, or anxiety disorders) were compared with a reference group with no major psychiatric conditions. Statistical analysis was performed from March to April 2021.

Exposure  The exposures observed include lab-confirmed positivity for COVID-19 and mortality.

Main Outcomes and Measures  The odds of testing positive for COVID-19 in 2020 and the odds of death from COVID-19 were measured.

Results  The population studied included 2 535 098 unique persons, 3350 with schizophrenia, 26 610 with mood disorders, and 18 550 with anxiety disorders. The mean (SD) age was 44 (23) years; 233 519 were non-Hispanic African American, 1 583 440 were non-Hispanic Caucasian; and 1 580 703 (62%) were female. The schizophrenia cohort (positivity rate: 9.86%; adjusted OR, 0.90 [95% CI, 0.84-0.97]) and the mood disorder cohort (positivity rate: 9.86%; adjusted OR, 0.93 [95% CI, 0.87-0.99]) had a significantly lower rate of positivity than the anxiety disorder cohort (positivity rate: 11.17%; adjusted OR, 1.05 [95% CI, 0.98-1.12) which was closer to the reference group (11.91%). After fully adjusting for demographic factors and comorbid conditions, patients with schizophrenia were nearly 4 times more likely to die from the disease than the reference group (OR, 3.74; 95% CI, 2.66-5.24). The mood disorders COVID-19 cohort had a 2.76 times greater odds of mortality than the reference group (OR, 2.76; 95% CI, 2.00-3.81), and the anxiety disorders cohort had a 2.39 times greater odds of mortality than the reference group (OR, 2.39; 95% CI, 1.68-3.27).

Conclusions and Relevance  By examining a large database while controlling for multiple confounding factors such as age, race and ethnicity, and comorbid medical conditions, the present study found that patients with schizophrenia had much increased odds of mortality by COVID-19.

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Article Information

Accepted for Publication: September 23, 2021.

Published: November 23, 2021. doi:10.1001/jamanetworkopen.2021.34969

Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2021 Teixeira AL et al. JAMA Network Open.

Corresponding Author: Antonio L. Teixeira, MD, PhD, Department of Psychiatry and Behavioral Sciences, UT Health, 1941 East Rd, Houston, TX 77051 (

Author Contributions: Dr Krause and Ms Ghosh had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Drs Teixeira and Krause contributed equally to this manuscript.

Concept and design: Teixeira, Krause, Ghosh, Shahani, Boerwinkle, Soares.

Acquisition, analysis, or interpretation of data: Teixeira, Krause, Ghosh, Machado-Vieira, Lane, Soares.

Drafting of the manuscript: Teixeira, Krause, Shahani.

Critical revision of the manuscript for important intellectual content: All authors.

Statistical analysis: Krause, Shahani.

Administrative, technical, or material support: Teixeira, Ghosh, Boerwinkle.

Supervision: Teixeira, Krause, Machado-Vieira, Soares.

Conflict of Interest Disclosures: Dr Soares reported receiving grants from Compass Pathways and Relmada; and personal fees from Boehringer Ingelheim, Merck, and Johnson & Johnson outside the submitted work. No other disclosures were reported.

Additional Information: Data used for this study was obtained by a licensed agreement from Optum. For information regarding licensing Optum data assets, researchers may contact Optum directly for information on data access.

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